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Posttraumatic stress disorder in the World Mental Health Surveys

  • K. C. Koenen (a1), A. Ratanatharathorn (a2), L. Ng (a3), K. A. McLaughlin (a4), E. J. Bromet (a5), D. J. Stein (a6), E. G. Karam (a7) (a8), A. Meron Ruscio (a9), C. Benjet (a10), K. Scott (a11), L. Atwoli (a12), M. Petukhova (a13), C. C.W. Lim (a11) (a14) (a15), S. Aguilar-Gaxiola (a16), A. Al-Hamzawi (a17), J. Alonso (a18), B. Bunting (a19), M. Ciutan (a20), G. de Girolamo (a21), L. Degenhardt (a22), O. Gureje (a23), J. M. Haro (a24), Y. Huang (a25), N. Kawakami (a26), S. Lee (a27), F. Navarro-Mateu (a28), B.-E. Pennell (a29), M. Piazza (a30) (a31), N. Sampson (a13), M. ten Have (a32), Y. Torres (a33), M. C. Viana (a34), D. Williams (a35), M. Xavier (a36) and R. C. Kessler (a13)...
Abstract
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.

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Corresponding author
*Address for correspondence: K. C. Koenen, Ph.D., Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA. (Email: kkoenen@hsph.harvard.edu)
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