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Symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study

  • Saskia S. L. Mol (a1), Arnoud Arntz (a2), Job F. M. Metsemakers (a3), Geert-Jan Dinant (a3), Pauline A. P. Vilters-van Montfort (a3) and J. André Knottnerus (a3)...
Abstract
Background

Post-traumatic stress disorder (PTSD) is the only psychiatric condition that requires a specific event to have occurred for its diagnosis.

Aims

To gather evidence from the adult general population on whether life events (e. g. divorce, unemployment) generate as many symptoms of post-traumatic stress as traumatic events (e. g. accidents, abuse).

Method

Data on demographic characteristics and history of stressful events were collected through a written questionnaire sent to a random sample of 2997 adults. Respondents also filled out a PTSD symptom checklist, keeping in mind their worst event. Mean PTSD scores were compared, controlling for differences between the two groups. Differences in item scores and in the distribution of the total PTSD scores were analysed.

Results

Of the 1498 respondents, 832 were eligible for inclusion in our analysis. For events from the past 30 years the PTSD scores were higher after life events than after traumatic events; for earlier events the scores were the same for both types of events. These findings could not be explained by differences in demographics, history of stressful events, individual item scores, or the distribution of the total PTSD scores.

Conclusions

Life events can generate at least as many PTSD symptoms as traumatic events. Our findings call for further studies on the specificity of traumatic events as a cause of PTSD.

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Copyright
Corresponding author
Dr Saskia S. L. Mol, Department of General Practice, Julius Centre, Stratenum 6. 108, UMC Utrecht, Postbox 85060, 3508 AB Utrecht, The Netherlands. Tel: +31 30 253 8149; e-mail: s.s.l.mol@umcutrecht.nl
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Declaration of interest

None.

Footnotes
References
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Symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study

  • Saskia S. L. Mol (a1), Arnoud Arntz (a2), Job F. M. Metsemakers (a3), Geert-Jan Dinant (a3), Pauline A. P. Vilters-van Montfort (a3) and J. André Knottnerus (a3)...
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eLetters

PTSD after non-traumatic events-how 'traumatic' should the trauma be?

K.A.L.A Kuruppuarachchi MD,MRCPsych(UK), Professor of Psychiatry
31 August 2005

Sir: We read with interest the article 'symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study' (1). Though PTSD is a term very widely used in western societies it is yet to gain a firm foothold in developing countries. It isa vague concept if used loosely and many of its symptoms can be categorized under other disease entities such as anxiety disorders. The diagnostic label of PTSD is used to describe suffering due to many distressing events and has moved from its initial rigorous formulation in the military context into civil life, and thus in the process, has become inflated (2). However, we should not trivialize the suffering that many endure due to PTSD.

South Asians faced trauma of exceptional magnitude due to the tsunamiof Boxing Day, 2004. The survivors had to cope with the double tragedy of grief and bereavement over loss of family members and property and the traumatic experience of the tsunami itself. There were a number of people who were diagnosed as suffering from PTSD but many more would have not been identified due to the manifestations of distress differing due to thesocio-cultural influences. Responses to traumatic events may share some common features but ethno cultural factors may play a substantial role in the individual’s vulnerability to PTSD and the expression and treatment response to PTSD (3).

In addition, PTSD is a well-recognized entity in children. In Sri Lanka, there are many children who have lost either one or both parents not only due to the tsunami but also due to the 20 year long civil war that has ravaged the country, especially in the North and the East. Exposure to high rates of traumatic events and evidence of PTSD among children imply that mental health personnel worldwide should recognize post- traumatic reactions in children that require intervention and offer timely and effective therapies (4).

There is no doubt that in the months to come, a large amount of research articles and data will be published in many journals worldwide ofthe repercussions of the tsunami on mental health of the effected people. We hope that it would help us in understanding the socio-cultural aspects of trauma and bring us closer to refining the diagnostic category of PTSD.In addition, we also propose that a cross-culturally validated instrument should be developed which could be used in the detection and management ofPTSD.

References1.Mol, S.S.L., Arntz , A., Metsemakers, J.F.M et al.(2005) Symptoms of post-traumatic stress disorder after non-traumatic events: evidence from an open population study. British Journal of Psychiatry 186:494-499.2. Wessely, S. (2005) Risk, psychiatry and the military. British Journal of Psychiatry 186:459-466.3.Marsella, A.J., Friedman, M.J., Spain, E.H. (1992) A selective review ofthe literature on ethnocultural aspects of PTSD. PTSD Research Quarterly 3; 2:1-2.4. Kaminer, D, .Seedat, S., Stein, D.J. (2005) Post-traumatic stress disorder in children. World Psychiatry 4; 2:121-125.
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