Diagnostic Accuracy of the Composite International Diagnostic Interview (CIDI 3.0) PTSD Module Among Female Vietnam‐Era Veterans

The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) posttraumatic stress disorder (PTSD) module is widely used in epidemiological studies of PTSD, yet relatively few data attest to the instrument's diagnostic utility. The current study evaluated the diagnostic utility of the CIDI 3.0 PTSD module with U. S. women Vietnam‐era veterans. The CIDI and the Clinician‐Administered PTSD Scale (CAPS) were independently administered to a stratified sample of 160 women, oversampled for current PTSD. Both lifetime PTSD and recent (past year) PTSD were assessed within a 3‐week interval. Forty‐five percent of the sample met criteria for a CAPS diagnosis of lifetime PTSD, and 21.9% of the sample met criteria for a CAPS diagnosis of past‐year PTSD. Using CAPS as the diagnostic criterion, the CIDI correctly classified 78.8% of cases for lifetime PTSD (κ = .56) and 82.0% of past year PTSD cases (κ = .51). Estimates of diagnostic performance for the CIDI were sensitivity of .61 and specificity of .91 for lifetime PTSD and sensitivity of .71 and specificity of .85 for past‐year PTSD. Results suggest that the CIDI has good utility for identifying PTSD, though it is a somewhat conservative indicator of lifetime PTSD as compared to the CAPS.     

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.     

ICD‐11 Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder in the United States: A Population‐Based Study

The primary aim of this study was to provide an assessment of the current prevalence rates of International Classification of Diseases (11th rev.) posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) among the adult population of the United States and to identify characteristics and correlates associated with each disorder. A total of 7.2% of the sample met criteria for either PTSD or CPTSD, and the prevalence rates were 3.4% for PTSD and 3.8% for CPTSD. Women were more likely than men to meet criteria for both PTSD and CPTSD. Cumulative adulthood trauma was associated with both PTSD and CPTSD; however, cumulative childhood trauma was more strongly associated with CPTSD than PTSD. Among traumatic stressors occurring in childhood, sexual and physical abuse by caregivers were identified as events associated with risk for CPTSD, whereas sexual assault by noncaregivers and abduction were risk factors for PTSD. Adverse childhood events were associated with both PTSD and CPTSD, and equally so. Individuals with CPTSD reported substantially higher psychiatric burden and lower levels of psychological well‐being compared to those with PTSD and those with neither diagnosis.     

Trauma Associated With Civil Conflict and Posttraumatic Stress Disorder: Evidence From the Northern Ireland Study of Health and Stress

The authors provide epidemiological estimates of trauma, posttraumatic stress disorder (PTSD), and associated mental disorders in Northern Ireland (NI) with a focus on the impact of civil conflict using data from the NI Study of Health and Stress (NISHS), a representative epidemiological survey of adults in NI. Overall 60.6% had a lifetime traumatic event, and 39.0% experienced a presumed conflict‐related event. Men were significantly more likely to experience any traumatic event and most conflict‐related event types (p < .05). The lifetime and 12‐month prevalence of PTSD were 8.8% and 5.1%, respectively. Furthermore, the lifetime prevalence of any mental disorder among men and women who experienced a conflict‐related trauma (46.0% and 55.9%, respectively) was significantly higher than the prevalence among men and women who did not experience this type of traumatic event (27.2% and 31.1%, respectively). Given the public health burden posed by PTSD and additional impact of conflict, specific attention must be paid to the policy, service, and clinical challenge of delivering evidence‐based treatments in the wake of a tumultuous period of conflict.     

Trauma Exposure and Posttraumatic Stress Disorder in Adolescents: A National Survey in Switzerland

There are a limited number of epidemiological studies that have focused on trauma exposure and prevalence of posttraumatic stress disorder (PTSD) in representative general population samples of adolescents, especially outside of the United States. We therefore aimed to assess the lifetime prevalence of traumatic events (TEs) and current prevalence of PTSD, and to examine demographic risk factors for TEs and PTSD in a representative sample of adolescents. Data were collected by a school survey among a sample of 6,787 9th‐grade students in Switzerland. Roughly 56% of the adolescents (females 56.6%; males 55.7%) reported having experienced at least 1 TE. Non‐Swiss nationality (OR = 1.80), not living with both biological parents (OR = 1.64), and lower parental education (OR = 1.18) were associated with a higher risk of trauma exposure. The current prevalence of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM‐IV‐TR; American Psychiatric Association, 2000) criteria was 4.2% (females 6.2%; males 2.4%). Female gender (OR = 2.70), not living with both biological parents (OR = 1.47), lower parental education (OR = 1.51), and exposure to multiple TEs (OR = 9.56) were significant risk factors for PTSD. Results suggest considerably high rates of TEs and PTSD among adolescents. Intervention efforts must be intensified to reduce trauma exposure and treat PTSD.     

Combat, Dissociation, and Posttraumatic Stress Disorder in Australian Vietnam Veterans

The specificity of various wartime stressors for different posttraumatic stress disorder (PTSD) symptoms is inconsistently reported in the literature. Combat, wounding, and peritraumatic dissociation have not been assessed together in their effects on each of the various PTSD symptom clusters. This cohort study of a random sample of male Australian Army Vietnam veterans yielded psychiatric assessments of 641 subjects. PTSD measures comprised symptom criteria for reexperiencing, numbing and avoidance, hyperarousal, and PTSD diagnosis both lifetime and current within the past month. Logistic regression is used to examine the effects of combat, wounding, and peritraumatic dissociation together on PTSD. Combat experiences comprised four components derived from a principal components analysis of combat experiences: direct combat exposure, exposure to death and injury, exposure to civilian death and injury, and exposure to mutilation. Each was differentially related to reexperiencing, avoidance, hyperarousal, and PTSD diagnosis. Being wounded was not related to lifetime or current PTSD and peritraumatic dissociation was related to all diagnostic components of PTSD in the presence of other variables.     

The Dopamine D3 Receptor Gene and Posttraumatic Stress Disorder

The dopamine D₃ receptor (DRD3) gene has been implicated in schizophrenia, autism, and substance use‐disorders and is related to emotion reactivity, executive functioning, and stress‐responding, processes impaired in posttraumatic stress disorder (PTSD). The aim of this candidate gene study was to evaluate DRD3 polymorphisms for association with PTSD. The discovery sample was trauma‐exposed White, non‐Hispanic U.S. veterans and their trauma‐exposed intimate partners (N = 491); 60.3% met criteria for lifetime PTSD. The replication sample was 601 trauma‐exposed African American participants living in Detroit, Michigan; 23.6% met criteria for lifetime PTSD. Genotyping was based on high‐density bead chips. In the discovery sample, 4 single nucleotide polymorphisms (SNPs), rs2134655, rs201252087, rs4646996, and rs9868039, showed evidence of association with PTSD and withstood correction for multiple testing. The minor alleles were associated with reduced risk for PTSD (OR range = 0.59 to 0.69). In the replication sample, rs2251177, located 149 base pairs away from the most significant SNP in the discovery sample, was nominally associated with PTSD in men (OR = 0.32). Although the precise role of the D₃ receptor in PTSD is not yet known, its role in executive functioning and emotional reactivity, and the sensitivity of the dopamine system to environmental stressors could potentially explain this association.     

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.     

Changes in Trauma‐Related Emotions Following Treatment With Dialectical Behavior Therapy for Posttraumatic Stress Disorder After Childhood Abuse

Dialectical behavior therapy for posttraumatic stress disorder (DBT‐PTSD) is a trauma‐focused therapy shown to reduce core PTSD symptoms, such as intrusions, hyperarousal, and avoidance. Preliminary data indicate effects on elevated trauma‐related emotions (e.g., guilt and shame) and possibly radical acceptance of the traumatic event. However, it is unclear if improvements in these variables are significant after controlling for changes in core PTSD symptoms and to what extent nonclinical levels are obtained. In the current study, 42 individuals who met criteria for PTSD after childhood abuse and were participating in a 3‐month residential DBT‐PTSD program were evaluated at the start of the exposure phase of DBT‐PTSD and the end of treatment; a nonclinical sample with a history of childhood abuse was the reference group. Multivariate analyses of variance and multivariate analyses of covariance controlling for change in core PTSD symptoms were used to evaluate changes in several elevated trauma‐related emotions (fear, anger, guilt, shame, disgust, sadness, and helplessness) and in radical acceptance. In a repeated measures multivariate analyses of variance, both elevated trauma‐related emotions and radical acceptance significantly improved during DBT‐PTSD, λ = 0.34, p < .001; η² = .56; t(40) = ?5.66, p < .001, SMD = 0.88, even after controlling for changes in PTSD symptoms, λ = 0.35, p < .001, η² = .65; Λ = 0.86, p = .018, η² = .14, respectively. Posttreatment, 31.0% (for acceptance) to 76.2% (for guilt) of participants showed nonclinical levels of the investigated outcomes, suggesting that both trauma‐related emotions and radical acceptance changed after the 3‐month residential DBT‐PTSD program.     

Traumatic Stress Symptomatology After Child Maltreatment and Single Traumatic Events: Different Profiles

The sequelae of child maltreatment tend to extend current posttraumatic stress disorder (PTSD) symptoms. This study examined this assumption, hypothesizing that (a) PTSD and trauma‐related symptoms are more severe after single trauma than after child maltreatment; (b) symptoms unrelated to trauma are more severe after child maltreatment than after single trauma; and (c) a comorbid association of clinical PTSD with trauma‐related symptoms is more prevalent after single trauma, whereas a comorbid association of clinical PTSD with trauma unrelated symptoms is more prevalent after child maltreatment. The Trauma Symptom Checklist for Children (TSCC) assessed PTSD and trauma‐related symptoms in 256 children (83 children exposed to single trauma, 173 to child maltreatment). The Strengths and Difficulties Questionnaire (SDQ) assessed trauma‐unrelated symptoms. Single‐trauma children reported significantly more severe PTSD and trauma‐related symptoms. Significantly more severe trauma unrelated symptoms were reported after child maltreatment. A significant relation was found between clinical PTSD and more severe trauma‐related symptoms in both samples. Likelihood of children meeting PTSD symptoms after trauma seems to decrease when traumatization becomes more complex. Findings support our assumption that symptomatology of maltreated children extends current PTSD symptoms.     

Rape, sex partnership, and substance use consequences in women veterans

The association of rape history and sexual partnership with alcohol and drug use consequences in women veterans is unknown. Midwestern women veterans (N = 1,004) completed a retrospective telephone interview assessing demographics, rape history, substance abuse and dependence, depression, and posttraumatic stress disorder (PTSD). One third met lifetime criteria for substance use disorder (SUD), half reported lifetime completed rape, a third childhood rape, one quarter in-military rape, 11% sex with women. Lifetime SUD was higher for women with rape history (64% vs. 44%). Women with women as sex partners had significantly higher rates of all measures of rape, and also lifetime substance use disorder. Postmilitary rape, sex partnership, and current depression were significantly associated with lifetime SUD in multivariate models (odds ratio = 2.3, 3.6, 2.1, respectively). Many women veterans have a high need for comprehensive mental health services.     

Posttraumatic Stress Disorder and Substance Use Disorder Comorbidity Among Individuals With Physical Disabilities:Findings From the National Comorbidity Survey Replication

Co‐occurring posttraumatic stress disorder (PTSD) and substance use disorder (SUD) affects multiple domains of functioning and presents complex challenges to recovery. Using data from the National Comorbidity Study Replication, a national epidemiological study of mental disorders (weighted N = 4,883), the current study sought to determine the prevalence of PTSD and SUD, the symptom presentation of these disorders, and help‐seeking behaviors in relation to PTSD and SUD among individuals with physical disabilities (weighted n = 491; nondisabled weighted n = 4,392). Results indicated that individuals with physical disabilities exhibited higher rates of PTSD, SUD, and comorbid PTSD/SUD than nondisabled individuals. For example, they were 2.6 times more likely to meet criteria for lifetime PTSD, 1.5 times more likely for lifetime SUD, and 3.6 times more likely for lifetime PTSD/SUD compared to their nondisabled peers. Additionally, individuals with physical disabilities endorsed more recent/severe PTSD symptoms and more lifetime trauma events than nondisabled individuals with an average of 5 different trauma events compared to 3 in the nondisabled group. No significant pattern of differences was noted for SUD symptom presentation, or for receipt of lifetime or past‐year PTSD or SUD treatment. Implications of these findings and recommendations for future research are discussed.     

Posttraumatic Stress Disorder in a General Psychiatric Inpatient Population

This study examined the incidence of traumatic experiences and prevalence of lifetime posttraumatic stress disorder (PTSD) in a sample of 141 general hospital psychiatric inpatients. Sixty-one percent of the patients reported at least one traumatic event during their lifetime and 28% met the formal DSM-III-R criteria for a lifetime diagnosis of PTSD. A high degree of comorbidity between PTSD and other psychiatric disorders was found, but PTSD was the incident disorder in at least 50% of cases. The experience of trauma and its associated complex patterns of symptomatology suggest that PTSD complicates the process of recovery from another disorder.     

A prospective examination of post-traumatic stress disorder in rape victims

Post-traumatic stress disorder (PTSD) and related psychopathology were examined in 95 female rape victims beginning soon after the assault (mean=12.64 days). Subjects were assessed weekly for 12 weeks. Ninety-four percent of women met symptomatic criteria for PTSD at Assessment 1, decreasing to 65% at Assessment 4 (mean=35 days postassault), and 47% at Assessment 12 (mean=94 days postassault). PTSD and related psychopathology decreased sharply between Assessments 1 and 4 for all women. Women whose PTSD persisted throughout the 3-month study did not show improvement after the fourth assessment; women who did not meet criteria for PTSD 3 months postassault showed steady improvement over time. This pattern was evidenced even after initial PTSD severity was statistically controlled. Moreover, PTSD status at 3 months postassault could be predicted with a high degree of accuracy by two brief self-report measures administered at the first assessment. The implications of the present findings and directions for future research are discussed.     

Posttraumatic Stress Disorder and Family Functioning in Adolescent Cancer

Twenty three adolescents with a history of cancer, 27 physically abused adolescents, and 23 healthy, nonabused adolescents were administered structured posttraumatic stress disorder (PTSD) interviews and self-report questionnaires regarding family functioning. Thirty five percent of adolescent cancer subjects met criteria for lifetime PTSD as compared to only 7% of the abused adolescents: 17% of the cancer subjects and 11% of the abuse subjects met criteria for current PTSD. Adolescents with cancer viewed their mothers and fathers as significantly more caring and more protective than the comparison and abused adolescents. Cancer subjects who met criteria for lifetime PTSD save their families as significantly more chaotic than those who did not have PTSD. Eighty three percent of cancer subjects who had lifetime PTSD also had mothers who had PTSD.     

Dangers on the road: A longitudinal examination of passenger‐initiated violence against bus drivers

This study examined the impact of workplace violence against 109 bus drivers over a 1‐year span. Workplace violence is related to both psychological and work‐related consequences. Our findings showed that bus drivers experienced a wide range of violence at work and the psychological consequences were devastating: Half of the participants met the diagnostic criteria for acute stress disorder within the first month following the index event. Majority of them experienced at least moderate levels of post‐traumatic stress disorder (PTSD) problems over the 1‐year span. About 9.3% of participants showed a delayed onset of PTSD 6 months after. Furthermore, counter‐supportive behaviours and reexposure to violence played important roles in the maintenance of PTSD symptoms over time. Even though PTSD symptoms per se did not relate to bus driver's confidence in coping with aggressive passengers, the immediate post‐traumatic reaction—symptoms of acute stress disorder—showed a significant long‐term negative effect on bus drivers' confidence in dealing with aggressive passengers 12 months after. This study provided empirical evidence of the changing nature of PTSD symptoms over time among bus drivers.     

Effects of trauma‐focused psychotherapy upon war refugees

The aim of this study is to evaluate the effects of a trauma‐focused psychotherapy upon war refugees from Bosnia. Seventy refugees who met the criteria for posttraumatic stress disorder (PTSD) and somatoform disorders were included. The first 35 refugees were offered psychotherapy and the following 35 refugees received usual care. Outcome variables were changes in self‐reported PTSD symptoms, psychological symptoms, and health status. At 12‐month follow‐up, participants in the intervention group reported significantly lower scores on the PTSD scale and the measure of psychological symptoms than the comparison group participants. Our results suggest that psychotherapy reduces symptoms of PTSD and somatoform disorders among war refugees even in the presence of insecure residence status.     

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.     

Child sexual abuse and posttraumatic stress disorder: the role of age at first use of substances and lifetime traumatic events

This study explores cross-sectional relationships among childhood sexual abuse (CSA), lifetime traumatic events (LTEs), age at first use of substances, and posttraumatic stress disorder (PTSD) in 644 low-income substance abusing women. History of CSA covaried with earlier age at substance use and higher reported rates of LTEs. Association between first use and LTEs was inconclusive. Both CSA and LTEs predicted PTSD with a partial mediation effect by LTEs. However, first use did not mediate the relationship between CSA and LTEs, rather, CSA directly contributed to increased rates of LTEs.     

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.