Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys

AJ Rosellini, H Liu, MV Petukhova, NA Sampson, S Aguilar-Gaxiola, J Alonso, G Borges, R Bruffaerts, E. J. Bromet, G de Girolamo, P. de Jonge, J Fayyad, S Florescu, O Gureje, J.M. Haro, H Hinkov, EG Karam, N Kawakami, KC Koenen, S LeeJ.-P. Lépine, D Levinson, F Navarro-Mateu, BD Oladeji, Siobhan O'Neill, BE Pennell, M Piazza, J Posada-Villa, KM Scott, DJ Stein, Y Torres, MC Viana, AM Zaslavsky, RC Kessler

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Background: Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within six months, a majority within two years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.
Methods: The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1,575 respondents with lifetime PTSD.
Results: 20%, 27%, and 50% of cases recovered within three, six, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low (OR=0.2-0.3) early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant odds-ratios for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66-55% versus 43%) and later-recovery (75-68% versus 39%).
Conclusions: We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.
Original languageEnglish
Pages (from-to)437-450
JournalPsychological Medicine
Issue number3
Early online date19 Jul 2017
Publication statusPublished (in print/issue) - Feb 2018


  • Cross-national
  • epidemiology
  • post-traumatic stress disorder
  • recovery


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