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

Lukoye Atwoli, Dan J. Stein, Andrew King, Maria Petukhova, Sergio Aguilar-Gaxiola, Jordi Alonso, Evelyn J Bromet, Giovanni de Girolamo, Koen Demyttenaere, Silvia Florescu, Josep Maria Haro, Elie G. Karam, Norito Kawakami, Sing Lee, Jean-Pierre Lepine, Fernando Navarro-Mateu, Siobhan O'Neill, Beth-Ellen Pennell, Marina Piazza, Jose Posada-Villa & 4 others Nancy A Sampson, Margreet ten Have, Alan M. Zaslavsky, Ronald C Kessler

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.
LanguageEnglish
Pages315-326
JournalDepression and Anxiety
Volume34
Issue number4
Early online date6 Dec 2016
DOIs
Publication statusPublished - Apr 2017

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Post-Traumatic Stress Disorders
Health Surveys
Mental Health
Mental Disorders
Global Health
Wounds and Injuries
Spouses
Surveys and Questionnaires
Public Health
Logistic Models
Demography

Keywords

  • cross-national
  • epidemiology
  • international
  • life events/stress
  • PTSD
  • trauma

Cite this

Atwoli, L., Stein, D. J., King, A., Petukhova, M., Aguilar-Gaxiola, S., Alonso, J., ... Kessler, R. C. (2017). Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the World Mental Health Surveys. Depression and Anxiety, 34(4), 315-326. https://doi.org/10.1002/da.22579
Atwoli, Lukoye ; Stein, Dan J. ; King, Andrew ; Petukhova, Maria ; Aguilar-Gaxiola, Sergio ; Alonso, Jordi ; Bromet, Evelyn J ; de Girolamo, Giovanni ; Demyttenaere, Koen ; Florescu, Silvia ; Haro, Josep Maria ; Karam, Elie G. ; Kawakami, Norito ; Lee, Sing ; Lepine, Jean-Pierre ; Navarro-Mateu, Fernando ; O'Neill, Siobhan ; Pennell, Beth-Ellen ; Piazza, Marina ; Posada-Villa, Jose ; Sampson, Nancy A ; ten Have, Margreet ; Zaslavsky, Alan M. ; Kessler, Ronald C. / Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the World Mental Health Surveys. In: Depression and Anxiety. 2017 ; Vol. 34, No. 4. pp. 315-326.
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abstract = "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.",
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Atwoli, L, Stein, DJ, King, A, Petukhova, M, Aguilar-Gaxiola, S, Alonso, J, Bromet, EJ, de Girolamo, G, Demyttenaere, K, Florescu, S, Haro, JM, Karam, EG, Kawakami, N, Lee, S, Lepine, J-P, Navarro-Mateu, F, O'Neill, S, Pennell, B-E, Piazza, M, Posada-Villa, J, Sampson, NA, ten Have, M, Zaslavsky, AM & Kessler, RC 2017, 'Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the World Mental Health Surveys', Depression and Anxiety, vol. 34, no. 4, pp. 315-326. https://doi.org/10.1002/da.22579

Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the World Mental Health Surveys. / Atwoli, Lukoye; Stein, Dan J.; King, Andrew; Petukhova, Maria; Aguilar-Gaxiola, Sergio; Alonso, Jordi; Bromet, Evelyn J; de Girolamo, Giovanni; Demyttenaere, Koen; Florescu, Silvia; Haro, Josep Maria; Karam, Elie G.; Kawakami, Norito; Lee, Sing; Lepine, Jean-Pierre; Navarro-Mateu, Fernando; O'Neill, Siobhan; Pennell, Beth-Ellen; Piazza, Marina; Posada-Villa, Jose; Sampson, Nancy A; ten Have, Margreet; Zaslavsky, Alan M.; Kessler, Ronald C.

In: Depression and Anxiety, Vol. 34, No. 4, 04.2017, p. 315-326.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the World Mental Health Surveys

AU - Atwoli, Lukoye

AU - Stein, Dan J.

AU - King, Andrew

AU - Petukhova, Maria

AU - Aguilar-Gaxiola, Sergio

AU - Alonso, Jordi

AU - Bromet, Evelyn J

AU - de Girolamo, Giovanni

AU - Demyttenaere, Koen

AU - Florescu, Silvia

AU - Haro, Josep Maria

AU - Karam, Elie G.

AU - Kawakami, Norito

AU - Lee, Sing

AU - Lepine, Jean-Pierre

AU - Navarro-Mateu, Fernando

AU - O'Neill, Siobhan

AU - Pennell, Beth-Ellen

AU - Piazza, Marina

AU - Posada-Villa, Jose

AU - Sampson, Nancy A

AU - ten Have, Margreet

AU - Zaslavsky, Alan M.

AU - Kessler, Ronald C

PY - 2017/4

Y1 - 2017/4

N2 - 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.

AB - 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.

KW - cross-national

KW - epidemiology

KW - international

KW - life events/stress

KW - PTSD

KW - trauma

U2 - 10.1002/da.22579

DO - 10.1002/da.22579

M3 - Article

VL - 34

SP - 315

EP - 326

JO - Depression and Anxiety

T2 - Depression and Anxiety

JF - Depression and Anxiety

SN - 1091-4269

IS - 4

ER -