Natural course of posttraumatic stress disorder: a 20-month prospective study of Turkish earthquake survivors.
OBJECTIVE
A 20-month prospective follow-up of survivors of the severe earthquake in Turkey in 1999 examined the natural course of posttraumatic stress disorder (PTSD) and the contribution of different symptom clusters to the emergence of PTSD.


METHODS
Subjects were randomly sampled in a suburb of Istanbul that was severely affected by the earthquake. A total of 464 adults were assessed with a self-report instrument for PTSD symptoms on 3 consecutive surveys that were administered 1 to 3, 6 to 10, and 18 to 20 months following the earthquake.


RESULTS
The prevalence of PTSD was 30.2% on the first survey and decreased to 26.9% and 10.6% on the second and third surveys, respectively. Female subjects showed initially higher (34.8%) PTSD rates compared with male subjects (19.1%). However, gender differences disappeared by the time of the third survey due to high spontaneous remission rates in female subjects. Low levels of chronic and delayed-onset PTSD were observed. A major contribution of the avoidance symptoms to PTSD diagnosis was identified by statistical analysis.


CONCLUSIONS
Initial PTSD following an earthquake may be as prevalent as in other natural disasters, but high rates of spontaneous remission lead to low prevalence 1.5 years following the earthquake. Initial avoidance characteristics play a major role in the emergence of PTSD.
Karamustafalioglu
Oguz K
OK
Department of Psychiatry, Sisli Eftal Teaching and Research Hospital, Istanbul, Turkey.
Zohar
Joseph
J
Güveli
Mustafa
M
Gal
Gilad
G
Bakim
Bahadir
B
Fostick
Leah
L
Karamustafalioglu
Nesrin
N
Sasson
Yehuda
Y
D000328:Adult; D004190:Disasters; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology*; D017741:Survivors / Q000523:psychology*; D014421:Turkey / Q000453:epidemiology