title: Associations between lifetime traumatic events and subsequent chronic physical conditions: a cross-national, cross-sectional study.
abstract: BACKGROUND
  Associations between lifetime traumatic event (LTE) exposures and subsequent physical ill-health are well established but it has remained unclear whether these are explained by PTSD or other mental disorders. This study examined this question and investigated whether associations varied by type and number of LTEs, across physical condition outcomes, or across countries.
  
  
  METHODS
  Cross-sectional, face-to-face household surveys of adults (18+) were conducted in 14 countries (n = 38, 051). The Composite International Diagnostic Interview assessed lifetime LTEs and DSM-IV mental disorders. Chronic physical conditions were ascertained by self-report of physician's diagnosis and year of diagnosis or onset. Survival analyses estimated associations between the number and type of LTEs with the subsequent onset of 11 physical conditions, with and without adjustment for mental disorders.
  
  
  RESULTS
  A dose-response association was found between increasing number of LTEs and odds of any physical condition onset (OR 1.5 [95% CI: 1.4-1.5] for 1 LTE; 2.1 [2.0-2.3] for 5+ LTEs), independent of all mental disorders. Associations did not vary greatly by type of LTE (except for combat and other war experience), nor across countries. A history of 1 LTE was associated with 7/11 of the physical conditions (ORs 1.3 [1.2-1.5] to 1.7 [1.4-2.0]) and a history of 5+ LTEs was associated with 9/11 physical conditions (ORs 1.8 [1.3-2.4] to 3.6 [2.0-6.5]), the exceptions being cancer and stroke.
  
  
  CONCLUSIONS
  Traumatic events are associated with adverse downstream effects on physical health, independent of PTSD and other mental disorders. Although the associations are modest they have public health implications due to the high prevalence of traumatic events and the range of common physical conditions affected. The effects of traumatic stress are a concern for all medical professionals and researchers, not just mental health specialists.
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Scott
authors.affiliation: Columbia Mailman School of Public Health, New York, New York, United States of America.
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
authors.affiliation: Center for Reducing Health Disparities (CRHD), Community Engagement Program of the Clinical Translational Science Center (CTSC), University of California Davis, School of Medicine, Sacramento, California, United States of America.
authors.forename: Sergio
authors.initials: S
authors.lastname: Aguilar-Gaxiola
authors.affiliation: Health Services Research Unit, Institut Municipal d Investigacio Medica (IMIM-Hospital del Mar), and CIBER en Epidemiologıa y Salud Publica (CIBERESP), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Center for Public Mental Health, Gösing/Wagram, Austria.
authors.forename: Matthias C
authors.initials: MC
authors.lastname: Angermeyer
authors.affiliation: Department of Epidemiologic and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.
authors.forename: Corina
authors.initials: C
authors.lastname: Benjet
authors.affiliation: Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL), Leuven, Belgium.
authors.forename: Ronny
authors.initials: R
authors.lastname: Bruffaerts
authors.affiliation: Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciencias Medicas, Universidade Nova de Lisboa, Lisbon, Portugal.
authors.forename: Jose Miguel
authors.initials: JM
authors.lastname: Caldas-de-Almeida
authors.affiliation: IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Department of Clinical Psychology, Faculty of Psychological Sciences, Hiroshima International University, Hiroshima, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Iwata
authors.affiliation: Mental Health Services, Ministry of Health, Jerusalem, Israel.
authors.forename: Daphna
authors.initials: D
authors.lastname: Levinson
authors.affiliation: Department of Psychological Medicine, Otago University, Dunedin, New Zealand.
authors.forename: Carmen C W
authors.initials: CC
authors.lastname: Lim
authors.affiliation: Psychology Research Institute, School of Psychology, University of Ulster, Londonderry, Northern Ireland.
authors.forename: Sam
authors.initials: S
authors.lastname: Murphy
authors.affiliation: University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Ormel
authors.affiliation: Colegio Mayor de Cundinamarca University, Bogota, DC, Colombia.
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D055815:Young Adult