Criterion a issue: What other events lead to the onset of posttraumatic stress disorder symptoms? A meta-analysis.

Abstract

The ongoing debate about the stressor criterion issue concerning posttraumatic stress disorder (PTSD) diagnosis is far from the end. Prior research shows that PTSD symptoms can arise in the aftermath of events that do not fall within the current psychiatric nosology (e.g., Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision [DSM-5-TR]; American Psychiatric Association, 2022). This meta-analysis includes 124 studies (N = 23,356) that assess PTSD symptoms following non-Criterion A events, commonly referred to as stressors. A significant pooled mean was obtained, and several moderators were tested. Based on the index event, subgroup analyses estimated the pooled mean for studies examining cancer’s impact. The results show that PTSD symptoms can also develop from stressful life events such as discrimination, relationship dissolution, home eviction, workplace bullying, nontraumatic childbirth, chronic illnesses (e.g., cancer), expected loss, racism, or revealing sexual orientation. Moreover, the employed questionnaire for the assessment of PTSD symptoms yielded a significant moderating effect, emphasizing the necessity of using standardized measurement tools. These findings also underline several important methodological limitations that derive from the specific variability of this field.