This weighted sample of trauma occurrences can then be used to obtain estimates both of the distribution of trauma exposure in the population and the conditional probability of PTSD after exposure to traumas of different types. The weight would be 1 for respondents who reported lifetime exposure to only one occurrence of one trauma type.
By weighting the random trauma reports by the inverse of their probabilities of selection at the individual level and combining these weighted reports with reports about the worst lifetime trauma, a representative sample can be generated of all lifetime traumas experienced by all survey respondents.
one randomly-selected occurrence of one randomly-selected trauma type). One approach to deal with this problem is to assess PTSD twice for epidemiological survey respondents who report experiencing multiple lifetime traumas: once for the trauma nominated by the respondent as their worst lifetime trauma and a second time for a random trauma (i.e. This approach makes it impossible to estimate conditional risk of PTSD after trauma exposure without upward bias because the traumas for which PTSD is assessed are atypically severe. The issue of biasedness comes up because of a common data collection convention in general population epidemiological studies of PTSD whereby respondents are asked about lifetime exposure to each of a wide range of traumas but then assessed for PTSD only for the one trauma nominated by the respondent as their worst or most upsetting lifetime trauma. Few studies estimating these differences across trauma types did so using unbiased methods, raising questions about the validity of results regarding these differences. A related line of research suggests that trauma history is a risk factor for subsequent PTSD, with prior traumas involving violence again possibly of special importance (Lowe, Walsh, Uddin, Galea, & Koenen, 2014 Smith, Summers, Dillon, & Cougle, 2016). Such differences have been documented, with highest PTSD risk thought to occur after traumas involving interpersonal violence (Caramanica, Brackbill, Stellman, & Farfel, 2015 Fossion et al., 2015). One prior consideration is the possibility that PTSD risk varies significantly by trauma type. These questions are the subject of considerable research (Liberzon & Abelson, 2016 Sayed, Iacoviello, & Charney, 2015 Smoller, 2016). The fact that only a small minority of people in the population develops post-traumatic stress disorder (PTSD) (Atwoli, Stein, Koenen, & McLaughlin, 2015) even though the vast majority are exposed to traumas at some time in their life (Benjet et al., 2016) has raised questions about individual differences in psychological vulnerability to PTSD. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized. Prior trauma history predicted both future trauma exposure and future PTSD risk.Ĭonclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. 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 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%). Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. Traumas involving interpersonal violence had highest risk. Substantial between-trauma differences were found in PTSD onset but less in persistence. Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview. 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.
#Trauma center second opinion episodes series#
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. 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.’