Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys.

Journal: Depression and anxiety

Volume: 34

Issue: 4

Year of Publication: 2017

Affiliated Institutions:  Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA. Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA. IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA. IRCCS St. John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy. Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium. National School of Public Health, Management and Professional Development, Bucharest, Romania. Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon. Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan. Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong. Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S , University Paris Descartes, Paris Diderot, France. IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain. School of Psychology, University of Ulster, Londonderry, UK. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA. Universidad Peruana Cayetano Heredia, Lima, Peru. Colegio Mayor de Cundinamarca University, Bogota, Colombia. Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.

Abstract summary 

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.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.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%.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 & Co-authors:  Atwoli Stein King Petukhova Aguilar-Gaxiola Alonso Bromet de Girolamo Demyttenaere Florescu Maria Haro Karam Kawakami Lee Lepine Navarro-Mateu O'Neill Pennell Piazza Posada-Villa Sampson Ten Have Zaslavsky Kessler

Study Outcome 

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Statistics
Citations :  American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revised. Washington, DC: American Psychiatric Press; 2000.
Authors :  25
Identifiers
Doi : 10.1002/da.22579
SSN : 1520-6394
Study Population
Female
Mesh Terms
Adolescent
Other Terms
PTSD;cross-national;epidemiology;international;life events/stress;trauma
Study Design
Study Approach
Country of Study
Kenya
Publication Country
United States