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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.
Pubmed ID: 29075426 RIS Download
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The WMH Survey Initiative is a project of the Assessment, Classification, and Epidemiology (ACE) Group at the World Health Organization coordinating the implementation and analysis of general population epidemiologic surveys of mental, substance use, and behavioral disorders in countries in all WHO Regions. Reported are the first results of the WHO World Mental Health (WMH) Survey Initiative, a highly ambitious series of cross-national psychiatric epidemiological surveys. The general population surveys in the WMH series span 17 countries in all parts of the world. In many of these countries the WMH surveys provide the first community epidemiological data ever available on mental disorders in the population. The detailed information on lifetime prevalence, age of onset, course, correlates, and treatment of mental disorders in this volume provides mental health professionals and healthcare policy planners with an unprecedented reference on the cross-national descriptive epidemiology of mental disorders. The WHO Global Burden of Disease Study estimates that mental and addictive disorders are among the most burdensome in the world and their burden will increase over next decades. However, these estimates and projections are based largely on literature reviews and limited and isolated studies rather than on cross-national epidemiologic surveys. In order to move forward with public health initiatives aimed at addressing the global burden of mental disorders the WMH Survey Initiative carried out rigorously implemented general population surveys that estimate the prevalences of mental disorders, evaluate risk factors for purposes of targeting interventions, study patterns of and barriers to service use, and validate estimates of disease burden world-wide. The WMH Survey Initiative aims to obtain accurate cross-national information about the prevalences and correlates of mental, substance, and behavioral disorders. Included in studies of correlates will be analyses of impairments, other adverse social consequences, and patterns of help-seeking. The WMH Survey Consortium includes nationally or regionally representative surveys in 28 countries, representing all regions of the world, and with a total eventual sample size in excess of 154,000. ISBN:9780521884198
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