Posttraumatic stress disorder in the World Mental Health Surveys

Abstract

Background Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Methods Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. Results The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. Conclusions PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.

Trauma and PTSD in the WHO World Mental Health Surveys

“…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). These results suggest that outreach efforts are needed to increase the proportion of people with PTSD who obtain treatment and that treatment quality improvement efforts are needed for patients in treatment.…”

DSM-5 posttraumatic stress symptom dimensions and health-related quality of life among Chinese earthquake survivors

“…According to a recent WHO survey, the lifetime prevalence of PTSD was 3.9% in the general population and 5.6% among individuals who reported trauma history (Koenen et al, 2017). PTSD is associated with significant psychological distress, functional disability, and decreased quality of life (Schnurr, Lunney, Bovin, & Marx, 2009).…”

Prevalence and predictors of posttraumatic stress disorder and depressive symptoms among burn survivors two years after the 2015 Formosa Fun Coast Water Park explosion in Taiwan

“…Based on the latest Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5; American Psychiatric Association, 2013), PTSD now consists of four symptom clusters: intrusion, active avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. Although most individuals experience psychological distress subsequent to trauma, only a substantial minority go on to develop PTSD, with the cross-national lifetime prevalence being 3.9% in the total sample and 5.6% among the trauma-exposed (Koenen et al, 2017). PTSD and MDD are highly comorbid, as shown by a recent meta-analysis that 52% of individuals with current PTSD had co-occurring MDD (Rytwinski, Scur, Feeny, & Youngstrom, 2013).…”