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Connolly CE, Norris K. Understanding psychological outcomes following exposure to potentially morally injurious events in animal care: development of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals. N Z Vet J 2024; 72:201-211. [PMID: 38684229 DOI: 10.1080/00480169.2024.2342903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 04/04/2024] [Indexed: 05/02/2024]
Abstract
AIMS To generate a taxonomy of potentially morally injurious events (PMIE) encountered in veterinary care and develop an instrument to measure moral distress and posttraumatic growth following exposure to PMIE in the veterinary population. METHODS Development and preliminary evaluation of the Moral Distress-Posttraumatic Growth Scale for Veterinary Professionals (MD-PTG-VP) employed data from veterinary professionals (veterinarians, veterinary nurses, veterinary technicians) from Australia and New Zealand across three phases: (1) item generation, (2) content validation, and (3) construct validation. In Phase 1 respondents (n = 46) were asked whether they had experienced any of six PMIE and to identify any PMIE not listed that they had experienced. In Phase 2 a different group of respondents (n = 11) assessed a list of 10 PMIE for relevance, clarity and appropriateness. In Phase 3 the final instrument was tested with a third group of respondents (n = 104) who also completed the Short Post-Traumatic Stress Disorder Rating Interview (SPRINT), a measure of posttraumatic stress, and the Stress-Related Growth Scale-Short Form (SRGS-SF) a measure of perceived posttraumatic growth. Spearman's correlation coefficients were calculated between respondent scores on each of the MD-PTG-VP subscales, the SPRINT, and the SRGS-SF to assess construct validity. RESULTS A 10-item taxonomy of PMIE encountered in veterinary care was generated in Phase 1. Items were deemed relevant, clear and appropriate by veterinary professionals in Phase 2. These were included in the developed instrument which measures frequency and impact of exposure to 10 PMIE, yielding three subscale scores (exposure frequency, moral distress, and posttraumatic growth). Assessment of construct validity by measuring correlation with SPRINT and SRGS-SF indicated satisfactory validity. CONCLUSIONS The MD-PTG-VP provides an informative tool that can be employed to examine professionals' mental health and wellbeing following exposure to PMIE frequently encountered in animal care. Further evaluation is required to ascertain population norms and confirm score cut-offs that reflect clinical presentation. CLINICAL RELEVANCE Once fully validated this instrument may be useful to quantify the frequency and intensity of positive and negative aspects of PMIE exposure on veterinary professionals so that accurate population comparisons can be made and changes measured over time.
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Affiliation(s)
- C E Connolly
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - K Norris
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
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Trauma exposure and psychometric properties of the life events checklist among adults in South Africa. Eur J Psychotraumatol 2023; 14:2172257. [PMID: 37052114 PMCID: PMC9901439 DOI: 10.1080/20008066.2023.2172257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Trauma exposure is widespread and linked to chronic physical and mental health conditions including posttraumatic stress disorder. However, there are major gaps in our knowledge of trauma exposure in Africa and on the validity of instruments to assess potentially life-threatening trauma exposure.Objective: The Life Events Checklist for the DSM-5 (LEC-5) is a free, widely used questionnaire to assess traumatic events that can be associated with psychopathology. As part of a case-control study on risk factors for psychosis spectrum disorders, we used the LEC-5 to examine the frequency of traumatic events and to assess the questionnaire's factor structure in South Africa (N = 6,765).Method: The prevalence of traumatic events was measured by individual items on the LEC-5 across the study sample, by case-control status, and by sex. Cumulative trauma burden was calculated by grouping items into 0, 1, 2, 3, and ≥4 traumatic event types. Psychometric properties of the LEC-5 were assessed through exploratory and confirmatory factor analyses.Results: More than 92% of the study sample reported experiencing ≥1 traumatic event; 38.7% reported experiencing ≥4 traumatic event types. The most endorsed item was physical assault (65.0%), followed by assault with a weapon (50.2%). Almost 94% of cases reported ≥1 traumatic event compared to 90.5% of controls (p < .001) and 94% of male participants reported ≥1 traumatic event compared to 89.5% of female participants (p < .001). Exploratory factor analysis revealed a 6-factor model. Confirmatory factor analyses of three models found that a 7-factor model based on the South African Stress and Health survey was the best fit (standardized root mean square residual of 0.024, root mean square error of approximation of 0.029, comparative fit index of 0.910).Conclusion: Participants reported very high exposure to traumatic events. The LEC-5 has good psychometric priorities and is adequate for capturing trauma exposure in South Africa.
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Magalhães E, Ferreira C, Antunes C, Jongenelen I, Castro E. Stressful Events During Last Year, Violence and Anxiety and Depression: A Moderated Mediation Model by Sex. VIOLENCE AND VICTIMS 2022; 37:610-624. [PMID: 36192121 DOI: 10.1891/vv-2021-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The literature suggests that being subject to a stressful life and victimization may negatively affect mental health, and that women and men seem to differ in these variables. Nevertheless, neither the mediating role of victimization experiences in the relationship between stress and mental health, nor the moderated role of sex have been explored. A sample of 826 adults, aged from 18 to 77 years old, completed a set of self-reported questionnaires (69.4% women). Results revealed significant mediation effects of psychological violence on the relationship between stress, depression and anxiety. Participants who reported more stressful life events in the previous year, also reported higher psychological abuse, which in turn predicted higher depression and anxiety. Furthermore, the moderating effects of sex were found to be statistically significant. Results suggest that interventions should be tailored to individual needs in order to prevent secondary victimization derived from biased beliefs related to stress, violence and gender in professional practice.
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Affiliation(s)
- Eunice Magalhães
- Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Lisboa, Portugal
| | | | | | | | - Emma Castro
- Instituto Universitário de Lisboa (ISCTE-IUL), Cis-IUL, Lisboa, Portugal
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Ojeahere MI, Uwakwe R, Piwuna CG, Audu M, Goar SG, Armiyau A, Afolaranmi T. Assessment of full and subsyndromal PTSD and quality of life of internally displaced older adults in northern Nigeria. AGING AND HEALTH RESEARCH 2021. [DOI: 10.1016/j.ahr.2021.100040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Platt JM, Pozen J, Ntaganira J, Sezibera V, Neugebauer R. Gender Differences in Traumatic Experiences and Posttraumatic Stress Symptoms After the Rwandan Genocide Against the Tutsi. J Trauma Stress 2021; 34:799-807. [PMID: 34118164 PMCID: PMC9059246 DOI: 10.1002/jts.22693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
The effects of the 1994 Rwandan Genocide against the Tutsi are widespread and long-lasting, but little is known about how posttraumatic consequences differ regarding gender. In the present study, we estimated the associations between trauma exposure and posttraumatic stress symptoms (PTSS) in a Rwandan community sample and examined whether the associations differed by gender. The sample comprised 498 adults (75.2% women) living in Rwanda's Huye District in 2011. We used a validated self-report checklist to assess the eight most frequent traumatic experiences during the Genocide. The PTSD Checklist-Civilian version (PCL-C) was used to assess PTSS. Associations between trauma exposure and PTSS were estimated using structural equation modeling (SEM), with additional SEMs stratified by gender. The prevalence of exposure to each traumatic event ranged from 15.1% to 64.5%, with more severe PTSS among individuals who reported personal physical injury, β = .76, 95% CI [0.54, 0.98]; witnessing sexual/physical violence against a loved one, β = .51, 95% CI [0.20, 0.81]; a close relative/friend's death, β = .54, 95% CI [0.24, 0.83]; property destruction, β = .35, 95% CI [0.048, 0.51]; or a family member's death due to illness, β = .21, 95% CI [0.00, 0.41]. Men who saw people killed and women who witnessed sexual/physical violence against a close family member reported elevated PTSS. The psychiatric impact of the Rwandan Genocide continues into the 21st century. Increased attention should be paid to the long-term and demographic patterns of distress and disorder, especially in the absence of widespread clinical mental health services.
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Affiliation(s)
- Jonathan M. Platt
- Department of Epidemiology, Mailman School of Public Health at Columbia University, 722 W 168th st, New York, 10032, USA
| | - Joanna Pozen
- New York University College of Global Public Health, New York, New York, USA
| | - Joseph Ntaganira
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, University of Rwanda School of Public Health, Kigali, Rwanda
| | - Vincent Sezibera
- Department of Clinical Psychology, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Richard Neugebauer
- Department of Epidemiology, Mailman School of Public Health at Columbia University, 722 W 168th st, New York, 10032, USA,Division of Epidemiology, Department of Child & Adolescent Psychiatry, New York State Psychiatric Institute, New York, New York, USA,Departement of Psychiatry, Faculty of Medicine, Columbia University
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Payne CF, Mall S, Kobayashi L, Kahn K, Berkman L. Life-Course Trauma and Later Life Mental, Physical, and Cognitive Health in a Postapartheid South African Population: Findings From the HAALSI study. J Aging Health 2020; 32:1244-1257. [PMID: 32207348 DOI: 10.1177/0898264320913450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To investigate the relationships between exposure to life-course traumatic events (TEs) and later life mental, physical, and cognitive health outcomes in the older population of a rural South African community. Method: Data were from baseline interviews with 2,473 adults aged ≥40 years in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study, conducted in 2015. We assessed exposure to 16 TEs, and used logistic regression models to estimate associations with depression, post-traumatic stress disorder (PTSD), activities of daily living disability, and cognitive impairment. Results: Participants reported an average of 5 (SD = 2.4) TEs over their lifetimes. Exposure was ubiquitous across sociodemographic and socioeconomic groups. Trauma exposure was associated with higher odds of depression, PTSD, and disability, but not with cognitive health. Discussion: Results suggest that TEs experienced in earlier life continue to reverberate today in terms of mental health and physical disability outcomes in an older population in rural South Africa.
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Affiliation(s)
| | - Sumaya Mall
- University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kathy Kahn
- University of the Witwatersrand, Johannesburg, South Africa.,Umeå University, Sweden
| | - Lisa Berkman
- University of the Witwatersrand, Johannesburg, South Africa.,Harvard T.H. Chan School of Public Health, Cambridge, USA
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Beharie N, Scheidell JD, Quinn K, McGorray S, Vaddiparti K, Kumar PC, Frueh BC, Boone L, Khan MR. Associations of Adolescent Exposure to Severe Violence with Substance Use From Adolescence into Adulthood: Direct Versus Indirect Exposures. Subst Use Misuse 2019; 54:191-202. [PMID: 30541369 PMCID: PMC6482818 DOI: 10.1080/10826084.2018.1495737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND While previous research has documented the impact of violence on substance use, none has looked longitudinally across the lifespan to measure independent effects of direct and indirect violence exposure. OBJECTIVE To examine independent associations between adolescent experiences of violence and subsequent substance use in adolescence and adulthood in the United States. METHOD Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we examined being shot or stabbed ("experienced"), being threatened with a knife or gun ("threatened"), and seeing someone either shot or stabbed ("witnessed") during adolescence (Wave I) as correlates of substance use in adolescence and adulthood (Wave IV) via logistic regression. RESULTS Violence exposure was a significant correlate of drug use in adolescence and several associations remained significant in adulthood. Witnessing violence had the highest point estimates in the adjusted models in adolescence for each substance use outcome (e.g., Cocaine-Adjusted Odds Ratios [AOR] = 2.59, 95% confidence interval [CI] = 1.21, 5.54). However, the point estimates for threatened with violence or experienced violence were highest in three out of the four drug outcomes in adulthood (e.g., Threatened with violence: Binge drinking-AOR = 1.41, 95% CI = 1.08, 1.83). Conclusion/Importance: Adolescent exposure to witnessing violence had stronger effects on substance use in adolescence, while experiencing and being threatened with violence in adolescence had stronger effects on substance use in adulthood. Violence prevention efforts targeted toward adolescents may lead to a reduction in substance use throughout the life-course, and clinicians and policy makers should be aware of the downstream effects of violence experienced in adolescence.
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Affiliation(s)
- Nisha Beharie
- a Behavioral Science Training Program, NYU Rory Meyers College of Nursing , New York, New York , USA
| | - Joy D Scheidell
- b Department of Population Health, NYU School of Medicine , New York , New York , USA
| | - Kelly Quinn
- b Department of Population Health, NYU School of Medicine , New York , New York , USA
| | - Susan McGorray
- c College of Public Health & Health Professions College of Medicine , University of Florida , Gainesville , Florida , USA
| | - Krishna Vaddiparti
- c College of Public Health & Health Professions College of Medicine , University of Florida , Gainesville , Florida , USA
| | - Pritika C Kumar
- b Department of Population Health, NYU School of Medicine , New York , New York , USA
| | - B Christopher Frueh
- d Department of Psychology , University of Hawaii, Hilo , Hilo, Hawaii , USA
| | - Lauren Boone
- e Health Behavior Health Education, University of Michigan School of Public Health , Brooklyn , New York , USA
| | - Maria R Khan
- b Department of Population Health, NYU School of Medicine , New York , New York , USA
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The role of grief symptoms and a sense of injustice in the pathways to post-traumatic stress symptoms in post-conflict Timor-Leste. Epidemiol Psychiatr Sci 2017; 26:403-413. [PMID: 27573421 PMCID: PMC6998498 DOI: 10.1017/s2045796016000317] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AIMS Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste. METHODS The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms. RESULTS We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, s.e. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, s.e. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, s.e. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex inter-relationship of these factors in contributing to PTSD symptoms. CONCLUSIONS Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma-focused psychotherapies for PTSD amongst populations exposed to mass conflict and violence. Further research is needed to identify the precise mechanisms whereby grief symptoms and the sense of injustice impact on PTSD symptoms.
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Gvozdanovic GA, Stämpfli P, Seifritz E, Rasch B. Neural correlates of experimental trauma memory retrieval. Hum Brain Mapp 2017; 38:3592-3602. [PMID: 28419641 DOI: 10.1002/hbm.23613] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/16/2017] [Accepted: 04/04/2017] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Traumatic memories such as intrusions and flashbacks play a major role in the development and maintenance of post-traumatic stress disorder (PTSD). A thorough understanding of the neural mechanisms underlying traumatic memories is indispensable for precise diagnosis, for personalized treatment and prevention. In particular, the identification of early neural predictor variables for intrusion development shortly after trauma exposure requires detailed investigation. EXPERIMENTAL DESIGN Here, we examined the neural correlates of early experimental trauma memory retrieval in a traumatic film paradigm in 42 young healthy females, using both implicit and explicit retrieval tasks. PRINCIPAL OBSERVATIONS We show that implicit experimental trauma retrieval specifically involved the retrosplenial cortex and the anterior cingulate cortex (ACC), while both retrieval tasks resulted in trauma-related activity in the posterior cingulate cortex (PCC) and the precuneus. Importantly, neural activity early after experimental trauma exposure predicted later intrusion development, with independent contributions from activity in the retrosplenial cortex (implicit retrieval) and the PCC (explicit retrieval). Additional analyses revealed a stronger connectivity between the bilateral amygdala and the supplementary motor area, precentral and paracentral lobule for the control group compared to the experimental trauma group. CONCLUSIONS Our study gives new insights in the neural correlates of experimental trauma memory retrieval and their predictive value for subsequent symptom development. Our results could provide the basis for personalized early treatment and prevention of PTSD. Hum Brain Mapp, 2017. © 2017 Wiley Periodicals, Inc. Hum Brain Mapp 38:3592-3602, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Geraldine A Gvozdanovic
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland.,Division of Biopsychology, Institute of Psychology, University of Zürich, Zürich, Switzerland
| | - Philipp Stämpfli
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zürich, Zürich, Switzerland.,Division of Biopsychology, Zurich Center for Interdisciplinary Sleep Research (ZiS), University of Zürich, Switzerland
| | - Björn Rasch
- Division of Biopsychology, Zurich Center for Interdisciplinary Sleep Research (ZiS), University of Zürich, Switzerland.,Division of Cognitive Biopsychology and Methods, Department of Psychology, University of Fribourg, Fribourg, Switzerland
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Assessing the factorial structure and measurement invariance of PTSD by gender and ethnic groups in Sri Lanka: An analysis of the modified Harvard Trauma Questionnaire (HTQ). J Anxiety Disord 2017; 47:45-53. [PMID: 28254549 DOI: 10.1016/j.janxdis.2017.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 01/05/2017] [Accepted: 02/01/2017] [Indexed: 02/04/2023]
Abstract
The Harvard Trauma Questionnaire (HTQ) remains the most widely used screening measure for post-traumatic stress disorder (PTSD) in the refugee and post-conflict field. The present study is the first to test the factorial structure and measurement invariance of the HTQ according to DSM-5 criteria across gender and ethnic groups in the ethnically diverse society of post-conflict Sri Lanka. The survey sample included 5136 participants (86% response rate) followed up 12 months after a baseline nationally representative survey undertaken in Sri Lanka in 2014. Exposure to conflict-related traumatic experiences (TEs) generating a trauma count (TC), and symptoms of PTSD were assessed using a modified version of the HTQ adapted to the local context. The final analytic sample included 4260 participants after excluding records with missing data on key variables. We conducted Multigroup Confirmatory Factor Analysis (MG-CFA) to test the four-factor (DSM-5 consistent) and three-factor (DSM-IV-TR) models of PTSD, then assessing measurement invariance of the four factor model by gender and ethnic groups. The three-factor and four-factor DSM-5 model each produced a good fit across the sample as a whole. In addition, there was configural, metric, and scalar invariance for the four-factor model both by gender and ethnicity. The trauma count was directly associated with each of the symptom domains of the four factor model. Our findings provide support for the capacity of the modified HTQ to measure the DSM5 construct of PTSD across gender and key ethnic groupings in Sri Lanka. Confirmation of our findings in other cultures will be important.
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Liu H, Petukhova MV, Sampson NA, Aguilar-Gaxiola S, Alonso J, Andrade LH, Bromet EJ, de Girolamo G, Haro JM, Hinkov H, Kawakami N, Koenen KC, Kovess-Masfety V, Lee S, Medina-Mora ME, Navarro-Mateu F, O’Neill S, Piazza M, Posada-Villa J, Scott KM, Shahly V, Stein DJ, ten Have M, Torres Y, Gureje O, Zaslavsky AM, Kessler RC. Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys. JAMA Psychiatry 2017; 74:270-281. [PMID: 28055082 PMCID: PMC5441566 DOI: 10.1001/jamapsychiatry.2016.3783] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Previous research has documented significant variation in the prevalence of posttraumatic stress disorder (PTSD) depending on the type of traumatic experience (TE) and history of TE exposure, but the relatively small sample sizes in these studies resulted in a number of unresolved basic questions. OBJECTIVE To examine disaggregated associations of type of TE history with PTSD in a large cross-national community epidemiologic data set. DESIGN, SETTING, AND PARTICIPANTS The World Health Organization World Mental Health surveys assessed 29 TE types (lifetime exposure, age at first exposure) with DSM-IV PTSD that was associated with 1 randomly selected TE exposure (the random TE) for each respondent. Surveys were administered in 20 countries (n = 34 676 respondents) from 2001 to 2012. Data were analyzed from October 1, 2015, to September 1, 2016. MAIN OUTCOMES AND MEASURES Prevalence of PTSD assessed with the Composite International Diagnostic Interview. RESULTS Among the 34 676 respondents (55.4% [SE, 0.6%] men and 44.6% [SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3% of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95% CI, 2.0-3.8) and witnessing atrocities (4.2; 95% CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95% CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95% CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95% CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95% CI, 1.2-1.7), rape (OR, 2.5; 95% CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95% CI, 1.1-2.3). CONCLUSION AND RELEVANCE The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.
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Affiliation(s)
- Howard Liu
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Maria V. Petukhova
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Nancy A. Sampson
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Sergio Aguilar-Gaxiola
- Center for Reducing Health Disparities, University of California, Davis, Health System, Sacramento
| | - Jordi Alonso
- Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University, Barcelona, Spain5Group 9/Program 06–Evaluation of Health Services of Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Laura Helena Andrade
- Section of Psychiatric Epidemiology–Laboratórios de Investigação Médica No. 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil
| | - Evelyn J. Bromet
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York
| | - Giovanni de Girolamo
- Istituto di Ricovero e Cura a Carattere Scientifico, Fatebenefratelli, Brescia, Italy
| | - Josep Maria Haro
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain
| | - Hristo Hinkov
- National Center for Public Health and Analyses, Ministry of Health, Sofia, Bulgaria
| | - Norito Kawakami
- Department of Mental Health, School of Public Health, University of Tokyo, Tokyo, Japan
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Viviane Kovess-Masfety
- Ecole des Hautes Etudes en Santé Publique, EA 4057, Paris Descartes University, Paris, France
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong, China
| | - Maria Elena Medina-Mora
- Dirección de Investigaciones Epidemiológicas y Psicosociales, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
| | - Fernando Navarro-Mateu
- Servicio Murciano de Investigación y Formación en Salud Mental, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria–Arrixaca, CIBERESP, Murcia, Spain
| | - Siobhan O’Neill
- School of Psychology, Ulster University, Londonderry, Northern Ireland
| | - Marina Piazza
- Facultad de Salud Pública y Administración, Universidad Cayetano Heredia, Lima, Peru18National Institute of Health, Lima, Peru
| | - José Posada-Villa
- Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia
| | - Kate M. Scott
- Department of Psychological Medicine, University of Otago, Dunedin, New Zealand
| | - Victoria Shahly
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
| | - Margreet ten Have
- Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Alan M. Zaslavsky
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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