Frequency of trauma exposure and Post-Traumatic Stress Disorder in Italy: analysis from the World Mental Health Survey Initiative

Abstract

Epidemiological studies have examined the relative importance of Traumatic Events (TEs) in accounting for the societal burden of post-traumatic stress disorder (PTSD). However, most studies used the worst trauma experienced, which can lead to an overestimation of the conditional risk of PTSD. Although a number of epidemiological surveys on PTSD have been carried out in the United States, only a few studies in limited sample have been conducted in Italy. This study, carried out in the framework of the World Mental Health Survey Initiative, is a cross-sectional household survey of a representative sample of the Italian adult population. Lifetime prevalence of traumatic events (TEs) and 12-month prevalence of PTSD were evaluated using the Composite International Diagnostic Interview (CIDI). Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. Network events was the most commonly reported TE (29.4%). War events had the highest conditional risk of PTSD (12.2%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (24.1%) and having seen atrocities (18.2%). Being female was related to high risk of PTSD after experiencing a TE. Exposure to network events is commonly reported among Italian adults, but two TE are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.

Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys

“…We found this to average 5.2%, which is somewhat higher than the 4.0% mean prevalence for any randomly selected TE across the WMH surveys (Kessler et al, 2014), although the prevalence of UD-related PTSD varied widely across surveys. It is unclear why this variation exists, but the higher mean prevalence than for other TEs emphasizes the public health importance of UD-related PTSD (Atwoli et al, 2013; Breslau et al, 1998; Carmassi et al, 2014; Ferry et al, 2014; Kawakami, Tsuchiya, Umeda, Koenen, & Kessler, 2014; Keyes et al, 2014; Olaya et al, 2014). …”

Epidemiology of posttraumatic stress disorder

“…The South African Stress and Health Survey, for example, reported a lifetime traumatic event prevalence rate of 73.8%, which was higher than in other surveys in Europe and Japan where the rate was in the range of 54–64% [6 ▪▪ ,8,10 ▪▪ ,12 ▪▪ ]. At 54%, Spain has the lowest reported prevalence of trauma exposures [12 ▪▪ ], followed by Italy’s 56.1% [6 ▪▪ ], and Japan’s 60% [10 ▪▪ ]. Northern Ireland’s rate of 60.6% was the highest among surveys in Europe [8].…”

“…For example, South Africa’s history of state-sanctioned discrimination and political violence, coupled with rising rates of criminal assault in public spaces may contribute to the higher rates of trauma exposure compared to Europe and Japan [15]. Consistent with this idea, physical violence and witnessing trauma occurring to another person contributed the largest proportion of all lifetime traumatic events in South Africa [5 ▪▪ ], whereas in Europe accidents and unexpected death of a loved one were the biggest contributors to the burden of trauma [6 ▪▪ ,7,12 ▪▪ ]. Similarly, Northern Ireland’s long history of civil conflict is likely to have contributed to its high prevalence of traumatic event exposure [8].…”

“…For example, employment status is the only sociodemographic factor associated with risk of traumatic event exposure in South Africa, with homemakers being at significantly lower risk of traumatic event exposure compared with those who were employed [5 ▪▪ ]. In other WMH surveys, female sex was associated with reduced risk of traumatic event exposure [6 ▪▪ ,8,12 ▪▪ ], a pattern that is similar to previous work in the United States and other high-income countries [1,4]. Other sociodemographic factors are also associated with reduced risk of traumatic event exposure in some European countries, including low education in Spain and Italy [6 ▪▪ ,12 ▪▪ ], and low income in Northern Ireland [8].…”

“…Recent epidemiological studies from around the world have included low and middle-income countries [5 ▪▪ ,6 ▪▪ ,7,8,9 ▪ ,10 ▪▪ ,11, 12 ▪▪ ,13], providing novel evidence on the distribution of trauma and PTSD cross-nationally. In this review, we focus on recent findings from the World Mental Health (WMH) surveys in particular [5 ▪▪ ,6 ▪▪ ,8,10 ▪▪ ,12 ▪▪ ], and compare these with previous work.…”