Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the World Mental Health Surveys

Background: 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 PTSD after this experience. The WHO World Mental Health (WMH) Survey Initiative provides a unique opportunity to address these issues.
Methods: Data from 19 WMH surveys (n=78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent socio-demographics, 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.
Results: PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high 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%.
Conclusions: 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.