C Benjet1, E Bromet2, E G Karam3, R C Kessler4, K A McLaughlin5, A M Ruscio6, V Shahly4, D J Stein7, M Petukhova4, E Hill4, J Alonso8, L Atwoli9, B Bunting10, R Bruffaerts11, J M Caldas-de-Almeida12, G de Girolamo13, S Florescu14, O Gureje15, Y Huang16, J P Lepine17, N Kawakami18, Viviane Kovess-Masfety19, M E Medina-Mora1, F Navarro-Mateu20, M Piazza21, J Posada-Villa22, K M Scott23, A Shalev24, T Slade25, M ten Have26, Y Torres27, M C Viana28, Z Zarkov29, K C Koenen30. 1. Department of Epidemiology and Psychosocial Research,Instituto Nacional de Psiquiatría Ramón de la Fuente,Mexico City,Mexico. 2. Department of Psychiatry,Stony Brook University School of Medicine,New York,NY,USA. 3. Department of Psychiatry and Clinical Psychology,Balamand University,Beirut,Lebanon. 4. Department of Health Care Policy,Harvard University Medical School,Boston,MA,USA. 5. Department of Psychology,University of Washington,Seattle,WA,USA. 6. Department of Psychology,University of Pennsylvania,Philadelphia,PA,USA. 7. Department of Psychiatry and Mental Health,University of Cape Town,Cape Town,Republic of South Africa. 8. IMIM-Hospital del Mar Research Institute,Parc de Salut Mar;Pompeu Fabra University (UPF);and CIBER en Epidemiología y Salud Pública (CIBERESP),Spain. 9. Moi University School of Medicine,Eldoret,Uasin Gishu,Kenya. 10. School of Psychology,University of Ulster,Northern Ireland,UK. 11. Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL),Campus Gasthuisberg,Leuven,Belgium. 12. Chronic Diseases Research Center (CEDOC) and Department of Mental Health,Faculdade de Ciências Médicas,Universidade Nova de Lisboa,Lisbon,Portugal. 13. IRCCS St John of God Clinical Research Centre,Brescia,Italy. 14. National School of Public Health,Management and Professional Development,Bucharest,Romania. 15. Department of Psychiatry,University College Hospital,Ibadan,Nigeria. 16. Institute of Mental Health,Peking University,Beijing,People's Republic of China. 17. Hôpital Lariboisière Fernand Widal,Assistance Publique Hôpitaux de Paris,University Paris Diderot and Paris Descartes,Paris,France. 18. Department of Mental Health,School of Public Health,The University of Tokyo,Tokyo,Japan. 19. Paris Descartes University,Paris,France. 20. IMIB-Arrixaca,CIBERESP-Murcia,Subdirección General de Salud Mental y Asistencia Psiquiátrica,Servicio Murciano de Salud,El Palmar (Murcia),Spain. 21. National Institute of Health,Lima,Peru. 22. Colegio Mayor de Cundinamarca University,Bogota,Colombia. 23. Department of Psychological Medicine,University of Otago,Dunedin,New Zealand. 24. NYU School of Medicine,New York,NY,USA. 25. National Drug and Alcohol Research Centre,University of New South Wales,Sydney,Australia. 26. Netherlands Institute of Mental Health and Addiction,Utrecht,the Netherlands. 27. Center for Excellence on Research in Mental Health,CES University,Medellin,Colombia. 28. Department of Social Medicine,Federal University of Espírito Santo,Vitoria,Brazil. 29. Directorate Mental Health,National Center of Public Health and Analyses,Sofia,Bulgaria. 30. Department of Epidemiology,Harvard TH Chan School of Public Health,Boston,MA,USA.
Abstract
BACKGROUND: Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. METHOD: General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. RESULTS: Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. CONCLUSIONS: Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
BACKGROUND: Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs. METHOD: General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure. RESULTS: Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events. CONCLUSIONS: Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
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