Trauma and PTSD in the WHO World Mental Health Surveys

Abstract

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.

Posttraumatic stress and depressive symptoms in children after the Wenchuan earthquake

“…combat or physical violence), natural disasters (i.e. earthquakes or floods) lead to fewer PTSD symptoms among survivors (Bromet et al, 2017; Kessler et al, 2017). In addition, there are psychological differences between children and adults.…”

Child maltreatment across the lifespan

“…As Schnyder et al (2017) note, the collaboration can be seen as encouraging steps towards a more global structure in the field of traumatic stress. As trauma is a global issue (Hall & Olff, 2016; Kessler et al, 2017; Magruder, McLaughlin, & Borbon, 2017), global collaboration on important topics seems an efficient way to move the field forward.…”

The association between different traumatic life events and suicidality

“…A majority (60–90%) of individuals will experience a traumatic event in their lifetime (Kessler et al, 2017; Kilpatrick et al, 2013; Thordardottir et al, 2015). While most individuals adjust to the trauma and recover from the emotional strain that follows, it remains unexplained why some suffer more than others and experience mental health decline, even to the point of suicidal risk .…”

“…A minority may experience post-traumatic stress disorder (PTSD) following trauma, which has been linked to suicidality (Ford & Gomez, 2015; Krysinska & Lester, 2010; Panagioti, Gooding, Triantafyllou, & Tarrier, 2015). The risk of PTSD may, however, vary according to trauma event type (Kessler et al, 2017; Ozer, Best, Lipsey, & Weiss, 2003). The risk of suicidality may also vary according to type of traumatic event.…”