Disability and treatment of specific mental and physical
                        disorders across the world

Ormel, Johan; Petukhova, Maria; Chatterji, Somnath; Aguilar‐Gaxiola, Sergio; Alonso, Jordi; Angermeyer, Matthias C.; Bromet, Evelyn J.; Burger, Huibert; Demyttenaere, Koen; Girolamo, Giovanni de; Haro, Josep María; Hwang, Irving; Karam, Elie G.; Kawakami, Norito; Lépine, Jean Pierre; Medina‐Mora, María Elena; Posada‐Villa, José; Sampson, Nancy A.; Scott, Kate M.; Üstün, T. Bedirhan; Korff, Michael Von; Williams, David R.; Zhang, Mingyuan; Kessler, Ronald C.

doi:10.1192/bjp.bp.107.039107

Cited by 333 publications

(253 citation statements)

References 33 publications

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“…Although we did not present any results about severity of illness, other WMH results document clearly that PTSD is a seriously impairing disorder (Kessler et al, 2009). PTSD causes substantial loss of human capital from a societal perspective both in the form of days out of role (Alonso et al, 2011) and in the form of decreased productivity on days in role (Ormel et al, 2008). Roughly half of people with PTSD in high income countries and about half that number in low or middle income countries seek some type of treatment (Koenen et al, 2017), but the type and duration of treatment seldom meet even minimal standards for treatment adequacy (Wang et al, 2007).…”

Section: Discussionmentioning

confidence: 99%

Trauma and PTSD in the WHO World Mental Health Surveys

Kessler

Aguilar‐Gaxiola

Alonso

et al. 2017

European Journal of Psychotraumatology

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984

720

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Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’ Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD. Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk. Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

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Section: Discussionmentioning

confidence: 99%

Trauma and PTSD in the WHO World Mental Health Surveys

Kessler

Aguilar‐Gaxiola

Alonso

et al. 2017

European Journal of Psychotraumatology

Self Cite

984

720

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“…Also, functional impairment may be the result of the environment interacting with depressive symptoms (Üstün and Kennedy, 2009). Nevertheless, the association between functional impairment and depression is strong even below clinical threshold, as found by multiple studies (Wells et al, 1989;Sadek and Bona, 2000;Cuijpers et al, 2004;Ormel et al, 2008). A second limitation may be that, although a considerable group of healthy controls was randomly included, a large part of the sample was selected for (the risk of) anxiety or depression.…”

Section: Discussionmentioning

confidence: 99%

“…To illustrate, major depressive disorder (MDD) is among the most impairing disorders in the world (Lépine, 2001), but impairment is not limited to full blown MDD alone. The presence of less than the five symptoms required for MDD has consistently been found to be associated with significant levels of impairment as well, indicating its clinical relevance (Wells et al, 1989;Sadek and Bona, 2000;Cuijpers et al, 2004;Ormel et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Subthreshold depression based on functional impairment better defined by symptom severity than by number of DSM-IV symptoms

Karsten

Hartman

Ormel

et al. 2010

Journal of Affective Disorders

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“…Individuals who develop PTSD following trauma experience impaired role functioning and reduced life course opportunities (Kessler, 2000). PTSD was associated with high levels of disability, and in developing countries disability associated with PTSD was higher than most common medical conditions except for headaches and chronic pain (Ormel et al, 2008). The economic costs of PTSD are staggering, with work impairment associated with the disorder estimated at 3.6 days per month per person with PTSD.…”

Section: Public Health Impact Of Traumamentioning

confidence: 99%

Trauma is a public health issue

Magruder

McLaughlin

Borbon

2017

European Journal of Psychotraumatology

186

134

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Exposure to trauma is pervasive in societies worldwide and is associated with substantial costs to the individual and society, making it a significant global public health concern. We present evidence for trauma as a public health issue by highlighting the role of characteristics operating at multiple levels of influence – individual, relationship, community, and society – as explanatory factors in both the occurrence of trauma and its sequelae. Within the context of this multi-level framework, we highlight targets for prevention of trauma and its downstream consequences and provide examples of where public health approaches to prevention have met with success. Finally, we describe the essential role of public health policies in addressing trauma as a global public health issue, including key challenges for global mental health and next steps for developing and implementing a trauma-informed public health policy agenda. A public health framework is critical for understanding risk and protective factors for trauma and its aftermath operating at multiple levels of influence and generating opportunities for prevention.

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Disability and treatment of specific mental and physical disorders across the world

Abstract: Despite often higher disability, mental disorders are under-treated compared with physical disorders in both high-income and in low- and middle-income countries.

Cited by 333 publications

References 33 publications

Trauma and PTSD in the WHO World Mental Health Surveys

Trauma and PTSD in the WHO World Mental Health Surveys

Subthreshold depression based on functional impairment better defined by symptom severity than by number of DSM-IV symptoms

Trauma is a public health issue

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