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      Trauma and PTSD in the WHO World Mental Health Surveys

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      European Journal of Psychotraumatology
      Taylor & Francis
      Burden of illness, disorder prevalence and persistence, epidemiology, post-traumatic stress disorder (PTSD), trauma exposure

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          Background: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’

          Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD.

          Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview.

          Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk.

          Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

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          Most cited references49

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          The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI)

          This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH‐CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio‐demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12‐month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer‐assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper‐and‐pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD‐10 and DSM‐IV criteria. Elaborate CD‐ROM‐based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection. Copyright © 2004 Whurr Publishers Ltd.
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            Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys.

            Mental disorders are major causes of disability worldwide, including in the low-income and middle-income countries least able to bear such burdens. We describe mental health care in 17 countries participating in the WHO world mental health (WMH) survey initiative and examine unmet needs for treatment. Face-to-face household surveys were undertaken with 84,850 community adult respondents in low-income or middle-income (Colombia, Lebanon, Mexico, Nigeria, China, South Africa, Ukraine) and high-income countries (Belgium, France, Germany, Israel, Italy, Japan, Netherlands, New Zealand, Spain, USA). Prevalence and severity of mental disorders over 12 months, and mental health service use, were assessed with the WMH composite international diagnostic interview. Logistic regression analysis was used to study sociodemographic predictors of receiving any 12-month services. The number of respondents using any 12-month mental health services (57 [2%; Nigeria] to 1477 [18%; USA]) was generally lower in developing than in developed countries, and the proportion receiving services tended to correspond to countries' percentages of gross domestic product spent on health care. Although seriousness of disorder was related to service use, only five (11%; China) to 46 (61%; Belgium) of patients with severe disorders received any care in the previous year. General medical sectors were the largest sources of mental health services. For respondents initiating treatments, 152 (70%; Germany) to 129 (95%; Italy) received any follow-up care, and one (10%; Nigeria) to 113 (42%; France) received treatments meeting minimum standards for adequacy. Patients who were male, married, less-educated, and at the extremes of age or income were treated less. Unmet needs for mental health treatment are pervasive and especially concerning in less-developed countries. Alleviation of these unmet needs will require expansion and optimum allocation of treatment resources.
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              Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

              Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants. (c) 2006 APA, All Rights Reserved.

                Author and article information

                On behalf of : On behalf of the WHO World Mental Health Survey Collaborators
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Taylor & Francis
                27 October 2017
                : 8
                : sup5 , Keynote papers and other highlights of ISTSS 2016
                [ a ] Department of Health Care Policy, Harvard Medical School , Boston, MA, USA
                [ b ] Center for Reducing Health Disparities, UC Davis Health System , Sacramento, CA, USA
                [ c ] Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute , Barcelona, Spain
                [ d ] Departament de Ciències Experimentals i de la Salut, Pompeu Fabra University , Barcelona, Spain
                [ e ] CIBER en Epidemiología y Salud Pública (CIBERESP) , Barcelona, Spain
                [ f ] Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muniz , Mexico City, Mexico
                [ g ] Department of Psychiatry, Stony Brook University School of Medicine , Stony Brook, NY, USA
                [ h ] Lisbon Institute of Global Mental Health and Chronic Diseases Research Center (CEDOC), Nova Medical School, Universidade Nova de Lisboa , Lisbon, Portugal
                [ i ] National Drug and Alcohol Research Centre, University of New South Wales , Sydney, Australia
                [ j ] Unit of Epidemiological and Evaluation Psychiatry, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS)-St. John of God Clinical Research Centre , Brescia, Italy
                [ k ] Sector “Mental Health”, National Center of Public Health and Analyses , Sofia, Bulgaria
                [ l ] Bamford Centre for Mental Health and Wellbeing, Ulster University , Northern Ireland
                [ m ] National School of Public Health, Management and Development , Bucharest, Romania
                [ n ] Department of Psychiatry, University College Hospital , Ibadan, Nigeria
                [ o ] Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Sant Boi de Llobregat , Barcelona, Spain
                [ p ] Institute of Mental Health, Peking University , Beijing, People’s Republic of China
                [ q ] Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University , Beirut, Lebanon
                [ r ] Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center , Beirut, Lebanon
                [ s ] Institute for Development, Research, Advocacy and Applied Care (IDRAAC) , Beirut, Lebanon
                [ t ] Department of Mental Health, School of Public Health, The University of Tokyo , Tokyo, Japan
                [ u ] Department of Psychiatry, Chinese University of Hong Kong , Tai Po, Hong Kong
                [ v ] Psychiatrie non sectorisée, Hôpital Lariboisière- Fernand Widal, Assistance Publique Hôpitaux de Paris , Paris, France
                [ w ] INSERM UMR-S 1144, Universités Paris Descartes-Paris Diderot , Paris, France
                [ x ] Mental Health Services, Ministry of Health , Jerusalem, Israel
                [ y ] UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia , Murcia, Spain
                [ z ] Survey Research Center, Institute for Social Research, University of Michigan , Ann Arbor, MI, USA
                [ aa ] Departamento Académico de Salud Pública, Administración y Ciencias Sociales, Universidad Peruana Cayetano Heredia , Lima, Peru
                [ ab ] La Unidad de Análisis y Generación de Evidencias en Salud Pública - UNAGESP, National Institute of Health , Lima, Peru
                [ ac ] Colegio Mayor de Cundinamarca University, Faculty of Social Sciences , Bogotá, Colombia
                [ ad ] Department of Psychological Medicine, University of Otago , Dunedin, New Zealand
                [ ae ] Department of Psychiatry and Mental Health, University of Cape Town , Cape Town, Republic of South Africa
                [ af ] Department of Epidemiology, Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction , Utrecht, Netherlands
                [ ag ] Center for Excellence on Research in Mental Health, CES University , Medellin, Colombia
                [ ah ] Department of Social Medicine, Federal University of Espírito Santo , Vitoria, Brazil
                [ ai ] Department of Epidemiology, Harvard T.H. Chan School of Public Health , Boston, MA, USA
                Author notes
                CONTACT Ronald C. Kessler Kessler@ 123456hcp.med.harvard.edu Department of Health Care Policy, Harvard Medical School , 180 Longwood Avenue, Boston, MA 02115, USA
                © 2017 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 2, Tables: 4, References: 62, Pages: 17
                Funded by: Fogarty International Center 10.13039/100000061
                Award ID: FIRCA R03-TW006481
                Funded by: National Institute of Mental Health 10.13039/100000025
                Award ID: R01 MH093612-01
                Funded by: National Institute of Mental Health 10.13039/100000025
                Award ID: R01 MH070884
                Funded by: National Institute of Mental Health 10.13039/100000025
                Award ID: U01-MH60220
                Funded by: National Research Council of Science and Technology (Mexico)
                Award ID: CB-2010-01-155221
                Funded by: Robert Wood Johnson Foundation 10.13039/100000867
                Award ID: Grant 044708
                Funded by: U.S. Public Health Service 10.13039/100007197
                Award ID: R01 DA016558
                Funded by: U.S. Public Health Service 10.13039/100007197
                Award ID: R01-MH069864
                Funded by: U.S. Public Health Service 10.13039/100007197
                Award ID: R13-MH066849
                The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884 and R01 MH093612-01), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/. The 2007 Australian National Survey of Mental Health and Wellbeing was funded by the Australian Government Department of Health and Ageing. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín – Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, GlaxoSmithKline, Lundbeck, Novartis, Servier, OmniPharma, Phenicia, Pfizer, UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the PanAmerican Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Portuguese Mental Health Study was carried out by the Department of Mental Health, Faculty of Medical Sciences, NOVA University of Lisbon, with collaboration of the Portuguese Catholic University, and was funded by Champalimaud Foundation, Gulbenkian Foundation, Foundation for Science and Technology (FCT) and Ministry of Health. The Romania WMH study projects ‘Policies in Mental Health Area’ and ‘National Study regarding Mental Health and Services Use’ were carried out by the National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, S.C. Cheyenne Services SRL, Statistics Netherlands and were funded by the Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Psychiatric Enquiry to General Population in Southeast Spain – Murcia (PEGASUS-Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708), and the John W. Alden Trust. Dr Dan Stein is supported by the Medical Research Council of South Africa (MRC). Corina Benjet has received funding from the (Mexican) National Council of Science and Technology (grant CB-2010-01-155221).
                Research Article
                Basic Research Article

                Clinical Psychology & Psychiatry
                burden of illness,disorder prevalence and persistence,epidemiology,post-traumatic stress disorder (ptsd),trauma exposure


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