Lukoye Atwoli1,2, Dan J Stein2, Andrew King3, Maria Petukhova3, Sergio Aguilar-Gaxiola4, Jordi Alonso5,6,7, Evelyn J Bromet8, Giovanni de Girolamo9, Koen Demyttenaere10, Silvia Florescu11, Josep Maria Haro12, Elie G Karam13,14,15, Norito Kawakami16, Sing Lee17, Jean-Pierre Lepine18, Fernando Navarro-Mateu19, Siobhan O'Neill20, Beth-Ellen Pennell21, Marina Piazza22,23, Jose Posada-Villa24, Nancy A Sampson3, Margreet Ten Have25, Alan M Zaslavsky3, Ronald C Kessler3. 1. Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya. 2. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa. 3. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. 4. Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA. 5. IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain. 6. Pompeu Fabra University (UPF), Barcelona, Spain. 7. CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. 8. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA. 9. IRCCS St. John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy. 10. Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. 11. National School of Public Health, Management and Professional Development, Bucharest, Romania. 12. Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain. 13. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon. 14. Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon. 15. Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon. 16. Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan. 17. Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong. 18. Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Descartes, Paris Diderot, France. 19. IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain. 20. School of Psychology, University of Ulster, Londonderry, UK. 21. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. 22. Universidad Peruana Cayetano Heredia, Lima, Peru. 23. National Institute of Health, Lima, Peru. 24. Colegio Mayor de Cundinamarca University, Bogota, Colombia. 25. Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Abstract
BACKGROUND: Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues. METHODS: Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk. RESULTS: PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%. CONCLUSIONS: The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.
BACKGROUND: Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues. METHODS: Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk. RESULTS:PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%. CONCLUSIONS: The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.
Authors: Isaac R Galatzer-Levy; Karen-Inge Karstoft; Alexander Statnikov; Arieh Y Shalev Journal: J Psychiatr Res Date: 2014-09-16 Impact factor: 4.791
Authors: C Benjet; E Bromet; E G Karam; R C Kessler; K A McLaughlin; A M Ruscio; V Shahly; D J Stein; M Petukhova; E Hill; J Alonso; L Atwoli; B Bunting; R Bruffaerts; J M Caldas-de-Almeida; G de Girolamo; S Florescu; O Gureje; Y Huang; J P Lepine; N Kawakami; Viviane Kovess-Masfety; M E Medina-Mora; F Navarro-Mateu; M Piazza; J Posada-Villa; K M Scott; A Shalev; T Slade; M ten Have; Y Torres; M C Viana; Z Zarkov; K C Koenen Journal: Psychol Med Date: 2015-10-29 Impact factor: 7.723
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Authors: Ronald C Kessler; Sergio Aguilar-Gaxiola; Jordi Alonso; Corina Benjet; Evelyn J Bromet; Graça Cardoso; Louisa Degenhardt; Giovanni de Girolamo; Rumyana V Dinolova; Finola Ferry; Silvia Florescu; Oye Gureje; Josep Maria Haro; Yueqin Huang; Elie G Karam; Norito Kawakami; Sing Lee; Jean-Pierre Lepine; Daphna Levinson; Fernando Navarro-Mateu; Beth-Ellen Pennell; Marina Piazza; José Posada-Villa; Kate M Scott; Dan J Stein; Margreet Ten Have; Yolanda Torres; Maria Carmen Viana; Maria V Petukhova; Nancy A Sampson; Alan M Zaslavsky; Karestan C Koenen Journal: Eur J Psychotraumatol Date: 2017-10-27
Authors: Lauren C Ng; Anne Stevenson; Sreeja S Kalapurakkel; Charlotte Hanlon; Soraya Seedat; Boniface Harerimana; Bonginkosi Chiliza; Karestan C Koenen Journal: PLoS Med Date: 2020-05-15 Impact factor: 11.069