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Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys

  • A. J. Rosellini (a1), H. Liu (a2) (a3), M. V. Petukhova (a3), N. A. Sampson (a3), S. Aguilar-Gaxiola (a4), J. Alonso (a5), G. Borges (a6), R. Bruffaerts (a7), E. J. Bromet (a8), G. de Girolamo (a9), P. de Jonge (a10) (a11), J. Fayyad (a12), S. Florescu (a13), O. Gureje (a14), J. M. Haro (a15), H. Hinkov (a16), E. G. Karam (a12) (a17), N. Kawakami (a18), K. C. Koenen (a2), S. Lee (a19), J. P. Lépine (a20), D. Levinson (a21), F. Navarro-Mateu (a22), B. D. Oladeji (a14), S. O'Neill (a23), B.-E. Pennell (a24), M. Piazza (a25), J. Posada-Villa (a26), K. M. Scott (a27), D. J. Stein (a28), Y. Torres (a29), M. C. Viana (a30), A. M. Zaslavsky (a3) and R. C. Kessler (a3)...
Abstract
Background

Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.

Methods

The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.

Results

20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).

Conclusions

We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.

Copyright
Corresponding author
*Author for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: Kessler@hcp.med.harvard.edu)
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