Posttraumatic Stress Disorder in a Nationally Representative Mexican Community Sample

This study describes the public health burden of trauma exposure and posttraumatic stress disorder (PTSD) in relation to the full range of traumatic events to identify the conditional risk of PTSD from each traumatic event experienced in the Mexican population and other risk factors. The representative sample comprised a subsample (N = 2,362) of the urban participants of the Mexican National Comorbidity Survey (2001?2002). We used the World Health Organization's Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and the presence of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM‐IV; American Psychiatric Association, 1994 ) in each respondents’ self‐reported worst traumatic event, as well as a randomly selected lifetime trauma. The results showed that traumatic events were extremely common in Mexico (68.8%). The estimate of lifetime PTSD in the whole population was 1.5%; among only those with a traumatic event it was 2.1%. The 12‐month prevalence of PTSD in the whole population was 0.6%; among only those with a traumatic event it was 0.8%. Violence‐related events were responsible for a large share of PTSD. Sexual violence, in particular, was one of the greatest risks for developing PTSD. These findings support the idea that trauma in Mexico should be considered a public health concern.     

The Criterion A problem revisited: controversies and challenges in defining and measuring psychological trauma

The Criterion A problem in the field of traumatic stress refers to the stressor criterion for posttraumatic stress disorder (PTSD) and involves a number of fundamental issues regarding the definition and measurement of psychological trauma. These issues first emerged with the introduction of PTSD as a diagnostic category in the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III; American Psychiatric Association, 1980) and continue to generate considerable controversy. In this article, the authors provide an update on the Criterion A problem, with particular emphasis on the evolution of the DSM definition of the stressor criterion and the ongoing debate regarding broad versus narrow conceptualizations of traumatic events.     

Post-traumatic stress disorder and postpartum depression and their reported association with recent labor and delivery: a questionnaire survey cohort

BackgroundWe aimed to investigate the index traumatic event associated with post-traumatic stress disorder (PTSD) and evaluate the timing of the onset of symptoms in relation to the recent delivery.MethodsQuestionnaire study regarding prior exposure to traumatic events, PTSD, postpartum depression (PPD) and fear of childbirth among women two to 12 months postpartum, recruited via targeted internet sites.ResultsQuestionnaires were completed by 143 women, with PPD reported by 22 (15.4%), probable PTSD by 11 (7.7%), and fear of childbirth by 14 (9.8%). Overall, 97 (67.8%) women reported a prior traumatic event: 16 (16.5%) reported the recent delivery to be the worst traumatic event and that symptoms began subsequent to this delivery; 17 (17.5%) reported the worst traumatic event was not the recent delivery but symptoms had started postpartum. Significantly higher symptom levels suggestive of PTSD and PPD were found in women whose trauma event was not delivery, yet symptoms started postpartum. Women whose traumatic event pre-dated the delivery also showed significantly higher symptom levels of PTSD. More than half of those describing PTSD related to the recent delivery presented with clinically relevant levels of fear of childbirth, compared with less than a third of women whose PTSD was related to a different event.ConclusionPTSD identified postpartum may not be linked to the recent delivery and often pre-dates it. Future studies should identify the trigger traumatic event responsible for PTSD symptoms, to enable a more accurate picture of the reasons for PTSD and fear of childbirth.     

Trauma-Related Symptomatology Among American Indian Adolescents

The Diagnostic Interview Schedule for Children (DISC-2.1C), including the posttraumatic stress disorder (PTSD) module, was administered to 109 American Indian adolescents from a Northern Plains reservation. In response to the DISC's open-ended probes, 61% of respondents reported at least one traumatic event. Despite high rates of trauma and substantial numbers of subsyndromal PTSD symptoms, the prevalence rate of diagnosable PTSD was found to be only 3%. The reporting of traumatic events was associated with increased prevalence of behavioral disorders and substance abuse or dependence diagnoses. There was, however, no significant difference in academic performance (grade point average or scholastic aptitude test scores) between those who reported traumatic events, or PTSD symptoms, and those who did not.     

Contribution of Criterion A2 to PTSD Screening in the Presence of Traumatic Events

Criterion A2 according to the Diagnostic and Statistical Manual of Mental Disorders (4^th ed.; DSM‐IV; American Psychiatric Association [APA], 1994) for posttraumatic stress disorder (PTSD) aims to assess the individual's subjective appraisal of an event, but it has been claimed that it might not be sufficiently specific for diagnostic purposes. We analyse the contribution of Criterion A2 and DSM‐IV criteria to detect PTSD for the most distressing life events experienced by our subjects. Young adults (N = 1,033) reported their most distressing life events, together with PTSD criteria (Criteria A2, B, C, D, E, and F). PTSD prevalence and criterion specificity and agreement with probable diagnoses were estimated. Our results indicate 80.30% of the individuals experienced traumatic events and met one or more PTSD criteria; 13.22% cases received a positive diagnosis of PTSD. Criterion A2 showed poor agreement with the final probable PTSD diagnosis (correlation with PTSD .13, specificity = .10); excluding it from PTSD diagnosis did not the change the estimated disorder prevalence significantly. Based on these findings it appears that Criterion A2 is scarcely specific and provides little information to confirm a probable PTSD case.     

National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM‐IV and DSM‐5 Criteria

Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM‐5; 2013) and fourth edition (DSM‐IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self‐administered survey. Traumatic event exposure using DSM‐5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past‐12‐month, and past 6‐month PTSD prevalence using the Same Event definition for DSM‐5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM‐5 prevalence estimates were slightly lower than their DSM‐IV counterparts, although only 2 of these differences were statistically significant. DSM‐5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM‐IV criteria, but not DSM‐5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.     

When disaster strikes,acute stress disorder may follow

During and immediately following a traumatic event, people may manifest a pattern of dissociative and anxiety symptoms and other reactions, referred to as Acute Stress Disorder. A review of the empirical literature on psychological reactions to trauma suggest that this pattern of symptoms has often been identified across different kinds of traumatic events. It is likely to constitute a psychological adaptation to a stressful event, limiting painful thoughts and feelings associated with the event and allowing the person to function at least minimally. Continuation of these symptoms, however, may impair the person's quality of life and disrupt social and other functioning. If symptoms last beyond a month following the traumatic event, Post Traumatic Stress Disorder (PTSD) may ensue, continuing for months or even years after the precipitating event. Hence, it is important to be able to identify this pattern of reactions that may be manifested in reaction to trauma, so that appropriate intervention can be provided. Although it was not officially recognized in the 3rd edition Diagnostic and Statistical Manual (DSM-III-R), Acute Stress Disorder is included as a separate diagnosis in the DSM-IV.     

Post‐traumatic stress and psychological health following infidelity in unmarried young adults

Infidelity is often conceptualized as a traumatic event; however, little research has explored this topic empirically, particularly in unmarried adults. We determined the prevalence of infidelity‐related post‐traumatic stress disorder (PTSD) symptoms among unmarried adults who experienced a partner's infidelity and whether probable infidelity‐related PTSD was associated with additional psychological health outcomes (i.e., depressive symptoms, perceived stress, and anxiety symptoms). We also investigated whether negative post‐traumatic cognitions mediated the associations between infidelity‐related PTSD symptoms and psychological health. This study included 73 adults (M age = 19.42, SE = 0.19 years) who experienced infidelity within a committed nonmarital relationship within the last 5 years. Controlling for gender, race, and exposure to Diagnostic and Statistical Manual of Psychiatric Disorders Criterion A traumas, 45.2% of our sample reported symptoms suggesting probable infidelity‐related PTSD. Whether used as continuous or categorical predictor, infidelity‐related PTSD symptoms were significantly associated with depressive symptoms, although results for perceived stress and anxiety symptoms were mixed. Post‐traumatic cognitions acted as a partial mediator for depressive symptoms and full mediator for perceived stress and anxiety symptoms. This empirical evidence suggests that infidelity may produce PTSD symptoms at a relatively high rate, even in unmarried young adults, and may put individuals at risk for poorer psychological health, partially through post‐traumatic cognitions.     

Event Centrality: Factor Structure and Links to Posttraumatic Stress Disorder Symptom Clusters

Event centrality is defined as the extent to which traumatic events are perceived to be integral to one's life. However, there are discrepancies regarding the factor structure of event centrality, as the factor structure may differ depending on the nature of the trauma. Event centrality has predicted posttraumatic stress disorder (PTSD); yet, few studies have taken into account other key cognitive predictors of PTSD, such as posttraumatic cognitions. The PTSD symptom clusters also remain largely unexamined, despite potential specificity in their ties to event centrality. The aims of the current study were to: (a) examine the factor structure of event centrality and whether the structure differs following interpersonal versus noninterpersonal trauma; (b) investigate whether event centrality predicts PTSD symptom clusters beyond posttraumatic cognitions; and (c) determine if the associations between event centrality, posttraumatic cognitions, and PTSD are equivalent between trauma types. The study aims were examined utilizing 263 college students (M_age = 24.54, SD = 6.29; 79.8% female; 58% White). Event centrality was best represented by one factor, which was consistent between groups. Structural equation models indicated that event centrality and posttraumatic cognitions regarding the self predicted each of the PTSD symptom clusters across groups, βs = .27–.58. However, event centrality was more strongly related to avoidance symptoms among individuals who experienced a noninterpersonal trauma. For both the interpersonal and noninterpersonal groups, event centrality had equivalent ties to each cluster. Even after accounting for negative trauma‐related beliefs, event centrality appears to be relevant in understanding posttrauma functioning.     

Lifetime Prevalence of Posttraumatic Stress Disorder in Two American Indian Reservation Populations

Posttraumatic stress disorder (PTSD) has been found to be more common among American Indian populations than among other Americans. A complex diagnosis, the assessment methods for PTSD have varied across epidemiological studies, especially in terms of the trauma criteria. Here, we examined data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI‐SUPERPFP) to estimate the lifetime prevalence of PTSD in two culturally distinct American Indian reservation communities, using two formulas for calculating PTSD prevalence. The AI‐SUPERPFP was a cross‐sectional probability sample survey conducted between 1997 and 2000. Southwest (n = 1,446) and Northern Plains (n = 1,638) tribal members living on or near their reservations, aged 15–57 years at time of interview, were randomly sampled from tribal rolls. PTSD estimates were derived based on both the single worst and 3 worst traumas. Prevalence estimates varied by ascertainment method: single worst trauma (lifetime: 5.9% to 14.8%) versus 3 worst traumas (lifetime, 8.9% to 19.5%). Use of the 3‐worst‐event approach increased prevalence by 28.3% over the single‐event method. PTSD was prevalent in these tribal communities. These results also serve to underscore the need to better understand the implications for PTSD prevalence with the current focus on a single worst event.     

Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey

A potentially traumatic event (PTE) contributes to trauma through its frequency, conditional probability of posttraumatic stress disorder (PTSD), and experience of other PTEs. A cross-sectional survey was conducted, enrolling 21,425 adults nationally representative of six European countries. Using the WHO-Composite International Diagnostic Interview, 8,797 were interviewed on 28 PTEs and PTSD. Prevalence of 12-month PTSD was 1.1%. When PTSD was present, the mean number of PTEs experienced was 3.2. In a multivariate analysis on PTEs and gender, six PTEs were found to be more traumatic, and to explain a large percentage of PTSD, as estimated by their attributable risk of PTSD: rape, undisclosed private event, having a child with serious illness, beaten by partner, stalked, beaten by caregiver.     

Worst Life Events and Media Exposure to Terrorism in a Nationally Representative U.S. Sample

Indirectly experienced negative life events are not considered Criterion A traumatic events per DSM-5 posttraumatic stress disorder diagnostic criteria, yet individuals indirectly exposed to trauma via the media may report these events as peak traumatic experiences. We studied which events people considered to be the “worst” in their lifetimes to gain a better understanding of the types of events individuals consider to be distressing. This longitudinal study included a nationally representative sample of U.S. residents living outside New York (N = 1,606) who were exposed to the September 11th, 2001 (9/11) terror attacks exclusively via the media. Bereavement was the most frequently cited “worst” life event (42.0%); violent events were cited by 11.4% of the sample. However, 22.0% of respondents reported 9/11 as their worst life event even though they did not directly experience the attacks. More lifetime exposure to violent events and bereavement, odds ratios (ORs) = 0.79 and 0.72, respectively, and a college education, OR = 0.61, were associated with decreased odds of naming 9/11 as one's worst life event. Watching 4 or more hours of 9/11-related television coverage in the week after the attacks, OR = 1.67, and identifying as African American, OR = 2.01, were associated with increased odds of naming 9/11 as one's worst life event 1 year after the attacks. Events experienced indirectly through the media may be considered the worst of people's lives, with important implications for assessing stressful life event history and understanding indirect exposure to negative life events.     

Prevalence of traumatic events and post-traumatic psychological symptoms in a nonclinical sample of college students

The lifetime prevalence of traumatic events and their psychological impact were assessed in 440 undergraduate students. Eighty-four percent of the subjects reported experiencing at least one event of sufficient intensity potentially to elicit Post-Traumatic Stress Disorder (PTSD). One-third of the sample had experienced four or more traumatic events. Subjects who had experienced trauma reported higher levels of depression, anxiety, and PTSD symptomatology than nontraumatized subjects, and these symptoms were more intense in subjects who experienced multiple traumas. Events that were particularly negative in their impact included unwanted sexual experiences and events that subjects reported were too traumatic to discuss openly. Males and females differed in their probability of experiencing some types of events and in the psychological response to certain events.     

Trauma-related guilt and posttraumatic stress among journalists

This study explored the psychological impact of exposure to work-related trauma among journalists. It was hypothesised that positive associations would exist between (a) exposure and PTSD symptoms, (b) exposure and guilt cognitions, and (c) guilt cognitions and PTSD symptoms, and that the relationship between exposure and PTSD symptoms would be mediated by guilt cognitions. The sample consisted of 50 journalists (response rate = 15%), who had recently been exposed to work-related trauma. They were predominantly male, aged 40 years or older, well-educated, and most had worked in journalism for at least 15 years. Participants completed an online questionnaire that explored their work-related experiences of trauma, PTSD symptoms, and trauma-related guilt cognitions. The findings showed that higher levels of exposure to work-related trauma were significantly associated with higher levels of PTSD symptoms (r = .36) and trauma-related guilt cognitions (r = .29). Guilt cognitions were significantly and positively independently associated with PTSD symptoms (r = .12) and were consistent with partial mediation of relationship between exposure to work-related trauma and PTSD symptoms. This study provides greater insight into the psychological processing of work-related traumatic events among journalists and emphasizes the importance of posttrauma appraisals of guilt regarding their experiences.     

Is DSM‐IV criterion A2 associated with PTSD diagnosis and symptom severity?

The diagnostic criteria for posttraumatic stress disorder (PTSD) have received significant scrutiny. Several studies have investigated the utility of Criterion A2, the subjective emotional response to a traumatic event. The American Psychiatric Association (APA) has proposed elimination of A2 from the PTSD diagnostic criteria for DSM-5; however, there is mixed support for this recommendation and few studies have examined A2 in samples at high risk for PTSD such as veterans. In the current study of 908 veterans who screened positive for a traumatic event, A2 was not significantly associated with having been told by a doctor that the veteran had PTSD. Those who endorsed A2, however, reported greater PTSD symptom severity in the 3 DSM-IV symptom clusters of reexperiencing (d = 0.45), avoidance (d = 0.61), and hyperarousal (d = 0.44), and A2 was significantly associated with PTSD symptom severity for all 3 clusters (R(2) = .25, .25, and .27, respectively) even with trauma exposure in the model. Thus, although A2 may not be a necessary criterion for PTSD diagnosis, its association with PTSD symptom severity warrants further exploration of its utility.     

Quality of Life in Ethiopia's Street Youth at a Rehabilitation Center and the Association With Trauma

Quality of life (QOL) tends to be lower among the homeless than the general population, and traumatic events experienced on the streets have a negative impact on QOL. Low‐income countries face a high number of street youth, yet little research has been performed so far on QOL, trauma, and posttraumatic stress disorder (PTSD) among this group. This study aimed at examining the QOL of a sample of Ethiopian street youth within a rehabilitation program and at exploring whether the street youth have experienced traumatic events and show posttraumatic stress symptoms. We interviewed 84 street youths with the World Health Organization Quality of Life Questionnaire (WHOQOL‐BREF) and the Diagnostic Interview for Children and Adolescents (DICA). Mean QOL scores differed significantly between the groups assessed at the beginning and at the end of the program (Cohen's d = 0.48). Eighty‐three percent of the Ethiopian street youths had experienced traumatic events, and 25.0% met criteria for PTSD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. QOL did not differ between those with and without PTSD symptoms. These findings show the high rate of traumatic events among Ethiopian street youth and the importance for rehabilitation programs that focus on improving QOL. The results of the study may have cultural limitations.     

Prevalence of Traumatic Events and Peritraumatic Predictors of Posttraumatic Stress Symptoms in a Nonclinical Sample of College Students

This study investigated lifetime prevalence of traumatic events and posttraumatic stress disorder (PTSD) symptoms among 937 college students. Participants rated their lifetime experiences of traumatic events and, in response to their most stressful event, completed measures of objective stressor dimensions, PTSD, and peritraumatic reactions. Approximately 67% of respondents reported at least one traumatic event. An estimated 4% of the full sample (12% of traumatized individuals) met PTSD criteria within the past week. After controlling for vulnerability factors and objective characteristics, peritraumatic reactions remained strongly predictive of PTSD symptoms. Results are discussed with respect to immediate reactions to traumatic events as potential precursors of PTSD symptomatology.     

Mild Traumatic Brain Injury Does not Produce Post-Traumatic Stress Disorder

It has been widely assumed that patients who sustain mild traumatic brain injury (MTBI) or post-concussive syndrome develop post-traumatic stress disorder (PTSD) in response to their cognitive difficulties, diminished coping skills, or other losses. This study examined 70 patients who had previously been diagnosed as having either PTSD or MTBI. Each patient was asked to provide a highly detailed chronological history of the events which preceded, followed, and occurred during the traumatic event, to indicate whether they were rendered unconscious or had amnesia for the event, and to describe the various symptoms they developed. All (100.0%) of the PTSD patients were able to provide a highly detailed and emotionally charged recollection of the events which occurred within 15 minutes of the traumatic event in comparison to none (0.0%) of the MTBI patients. None of the MTBI patients reported symptoms such as intrusive recollections of the traumatic event, nightmares, hypervigilance, phobic or startle reactions, or became upset when they were asked to describe the traumatic event or were exposed to stimuli associated with it. These data suggest that PTSD and MTBI are two mutually exclusive disorders, and that it is highly unlikely that MTBI patients develop PTSD symptoms. Furthermore, these findings suggest that clinicians should exercise considerable caution in ruling out PTSD prior to making the diagnosis of MTBI.     

The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands

Little information exists on the lifetime prevalence of traumatic events and posttraumatic stress disorder (PTSD) in the general population of the Netherlands. A national representative sample of 1087 adults aged 18 to 80 years was selected using random digit dialing and then surveyed by telephone using the Composite International Diagnostic Interview (CIDI) to determine the prevalence of trauma and DSM‐IV PTSD. The lifetime prevalence of any potential trauma was 80.7%, and the lifetime prevalence of PTSD was 7.4%. Women and younger persons showed higher risk of PTSD. It was concluded that PTSD is a fairly common disorder and exposure to trauma is high throughout the population. Unexpectedly, prevalence rates resemble those found in the United States and are higher than in several other European countries.