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-VillaNancy A Sampson, Margreet ten Have, Alan M. Zaslavsky, Ronald C Kessler

Research output: Contribution to journalArticlepeer-review

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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.
Original languageEnglish
Pages (from-to)315-326
JournalDepression and Anxiety
Issue number4
Early online date6 Dec 2016
Publication statusPublished (in print/issue) - Apr 2017


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


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