Posttraumatic stress disorder in the World Mental Health Surveys
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. Data were analyzed from 26 population surveys in the World Health Organization...
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| Published in: | Psychological medicine Vol. 47; no. 13; pp. 2260 - 2274 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Cambridge, UK
Cambridge University Press
01.10.2017
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| Subjects: | |
| ISSN: | 0033-2917, 1469-8978, 1469-8978 |
| Online Access: | Get full text |
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| Abstract | 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.
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.
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.
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. |
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| AbstractList | 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. 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. 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. 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. 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. 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.BACKGROUNDTraumatic 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.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.METHODSData 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.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.RESULTSThe 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.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.CONCLUSIONSPTSD 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. |
| Author | Kessler, R. C. Xavier, M. ten Have, M. Williams, D. Piazza, M. Lim, C. C.W. Meron Ruscio, A. Lee, S. Degenhardt, L. Ratanatharathorn, A. Petukhova, M. Benjet, C. Stein, D. J. Alonso, J. Viana, M. C. Navarro-Mateu, F. Bromet, E. J. Haro, J. M. de Girolamo, G. Karam, E. G. Torres, Y. Ciutan, M. Koenen, K. C. Gureje, O. Huang, Y. Sampson, N. Aguilar-Gaxiola, S. Pennell, B.-E. Atwoli, L. McLaughlin, K. A. Bunting, B. Ng, L. Scott, K. Kawakami, N. Al-Hamzawi, A. |
| AuthorAffiliation | 21 IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy 9 Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA 11 Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand 10 Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico 2 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA 14 Queensland Brain Institute, University of Queensland, St Lucia 31 National Institute of Health, Lima, Peru 17 College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq 25 Institute of Mental Health, Peking University, Beijing, China 5 Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA 3 Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA 8 Department of Psychia |
| AuthorAffiliation_xml | – name: 22 National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia – name: 31 National Institute of Health, Lima, Peru – name: 30 Universidad Cayetano Heredia, Lima, Peru – name: 20 National School of Public Health, Management and Professional Development, Bucharest, Romania – name: 2 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA – name: 18 Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Pompeu Fabra University (UPF); CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain – name: 35 Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massaschusetts, USA – name: 11 Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand – name: 4 Department of Psychology, University of Washington, Seattle, Washington, USA – name: 27 Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong – name: 28 UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud IMIB-Arrixaca; CIBERESP-Murcia, Murcia, Spain – name: 15 Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia – name: 32 Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands – name: 34 Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil – name: 36 Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal – name: 3 Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA – name: 10 Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico – name: 12 Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya – name: 6 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa – name: 17 College of Medicine, Al-Qadisiya University, Diwania governorate, Iraq – name: 29 Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA – name: 7 Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon – name: 13 Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA – name: 16 Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA – name: 33 Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia – name: 9 Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA – name: 8 Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon – name: 26 Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan – name: 23 Department of Psychiatry, University College Hospital, Ibadan, Nigeria – name: 5 Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA – name: 14 Queensland Brain Institute, University of Queensland, St Lucia – name: 25 Institute of Mental Health, Peking University, Beijing, China – name: 19 School of Psychology, Ulster University, Londonderry, UK – name: 1 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA – name: 21 IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy – name: 24 Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain |
| Author_xml | – sequence: 1 givenname: K. C. surname: Koenen fullname: Koenen, K. C. email: kkoenen@hsph.harvard.edu organization: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA – sequence: 2 givenname: A. surname: Ratanatharathorn fullname: Ratanatharathorn, A. organization: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA – sequence: 3 givenname: L. surname: Ng fullname: Ng, L. organization: Department of Psychiatry, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, USA – sequence: 4 givenname: K. A. surname: McLaughlin fullname: McLaughlin, K. A. organization: Department of Psychology, University of Washington, Seattle, Washington, USA – sequence: 5 givenname: E. J. surname: Bromet fullname: Bromet, E. J. organization: Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA – sequence: 6 givenname: D. 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C. surname: Viana fullname: Viana, M. C. organization: 4 Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil – sequence: 33 givenname: D. surname: Williams fullname: Williams, D. organization: 5 Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, Massaschusetts, USA – sequence: 34 givenname: M. surname: Xavier fullname: Xavier, M. organization: 6 Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal – sequence: 35 givenname: R. C. surname: Kessler fullname: Kessler, R. C. organization: 3 Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28385165$$D View this record in MEDLINE/PubMed |
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| Copyright | Copyright © Cambridge University Press 2017 |
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| Title | Posttraumatic stress disorder in the World Mental Health Surveys |
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