The Co‐Occurrence of Major Depressive Disorder Among Individuals With Posttraumatic Stress Disorder: A Meta‐Analysis

Abstract

Although co-occurring posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) is associated with greater distress, impairment, and health care utilization than PTSD alone, the magnitude of this problem is uncertain. This meta-analysis aimed to estimate the mean prevalence of current MDD co-occurrence among individuals with PTSD and examine potential moderating variables (U.S. nationality, gender, trauma type, military service, referral type) that may influence the rate of PTSD and MDD co-occurrence. Meta-analytic findings (k = 57 studies; N = 6,670 participants) revealed that 52%, 95% confidence interval [48, 56], of individuals with current PTSD had co-occurring MDD. When outliers were removed, military samples and interpersonal traumas demonstrated higher rates of MDD among individuals with PTSD than civilian samples and natural disasters, respectively. U.S. nationality, gender, and referral type did not significantly account for differences in co-occurrence rates. This high co-occurrence rate accentuates the importance of routinely assessing MDD among individuals with PTSD and continuing research into the association between these disorders.

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

“…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). …”

Impact of comorbid depression on quality of life in male combat Veterans with posttraumatic stress disorder

“…A recent large meta-analysis composed of 57 studies, across both military and civilian samples, reported a comorbidity rate of 52 percent [2]. The underlying reason for this high degree of comorbidity is unclear.…”

Socio-demographic patterns of posttraumatic stress disorder in Medellin, Colombia and the context of lifetime trauma exposure

“…The same authors 67,68 found that gender was not significantly connected to the co-occurrence of depression and PTSD. This may also have clinical significance because it is known that irritability and hostility are frequent depressive symptoms, particularly in men, constituting a clinical picture that could be confused with PTSD, 69 thus making it harder to arrive at a valid diagnosis of depression.…”

“…65,66 A meta-analysis conducted by Rytwinski et al 67 found that the average co-occurrence of depression in people with PTSD was 52%, and that depression is 4 times more frequent in individuals already diagnosed with PTSD, regardless of place of residence. In the Medellin analyses, major depression was the only variable that showed a significant predictive relationship to PTSD.…”

“…70 Ritwinsky and colleagues also found that in rural areas, the onset of depression coincides with, or occurs after, PTSD more often than in urban zones. 67 …”