CUMULATIVE TRAUMAS AND RISK THRESHOLDS: 12‐MONTH PTSD IN THE WORLD MENTAL HEALTH (WMH) SURVEYS. Issue 2 (27th August 2013)

• Record Type: Journal Article
• Authors: Karam, Elie G.; Friedman, Matthew J.; Hill, Eric D.; Kessler, Ronald C.; McLaughlin, Katie A.; Petukhova, Maria; Sampson, Laura; Shahly, Victoria; Angermeyer, Matthias C.; Bromet, Evelyn J.; de, Giovanni; de, Ron; Demyttenaere, Koen; Ferry, Finola; Florescu, Silvia E.; Haro, Josep Maria; He, Yanling; Karam, Aimee N.; Kawakami, Norito; Kovess‐Masfety, Viviane; Medina‐Mora, María Elena; Browne, Mark A. Oakley; Posada‐Villa, José A.; Shalev, Arieh Y.; Stein, Dan J.; Viana, Maria Carmen; Zarkov, Zahari; Koenen, Karestan C.
• Is Part Of: Depression and anxiety. Volume 31:Issue 2(2014:Feb.)
• Page Start: 130
• Page End: 142
• Publication Date: 2013-08-27
• Subjects: Anxiety -- Periodicals; Depression, Mental -- Periodicals; Depression -- Periodicals; Anxiety -- Periodicals; Anxiety Disorders -- Periodicals; 616.8527005
• DOI: 10.1002/da.22169
• Languages: English
• ISSNs: 1091-4269

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="da22169-sec-0010" sec-type="section"> <title>Background</title> <p>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.</p> </sec> <sec id="da22169-sec-0020" sec-type="section"> <title>Methods</title> <p>Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (<italic>n</italic> = 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.</p> </sec> <sec id="da22169-sec-0030" sec-type="section"> <title>Results</title> <p>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.</p> </sec> <sec id="da22169-sec-0040" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>