Cumulative traumas and risk thresholds: 12-month ptsd in the world mental health (WMH) surveys

Elie G. Karam, Matthew J. Friedman, Eric D. Hill, Ronald C. Kessler, Katie A. McLaughlin, Maria Petukhova, Laura Sampson, Victoria Shahly, Matthias C. Angermeyer, Evelyn J. Bromet, Giovanni De Girolamo, Ron De Graaf, Koen Demyttenaere, Finola Ferry, Silvia E. Florescu, Josep Maria Haro, Yanling He, Aimee N. Karam, Norito Kawakami, Viviane Kovess-MasfetyMaría Elena Medina-Mora, Mark A Oakley Browne, José A. Posada-Villa, Arieh Y. Shalev, Dan J. Stein, Maria Carmen Viana, Zahari Zarkov, Karestan C. Koenen

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. Methods: Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n = 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. Results: 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyperarousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. Conclusions: A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more "complex" clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies.

Original languageEnglish
Pages (from-to)130-142
Number of pages13
JournalDepression and Anxiety
Volume31
Issue number2
DOIs
Publication statusPublished - Feb 2014

Keywords

  • comorbidity
  • epidemiology
  • functional impairment
  • PTSD
  • World Mental Health Surveys

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

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