The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium.
BACKGROUND
Considerable research has documented that exposure to traumatic events has negative effects on physical and mental health. Much less research has examined the predictors of traumatic event exposure. Increased understanding of risk factors for exposure to traumatic events could be of considerable value in targeting preventive interventions and anticipating service needs.


METHODS
General population surveys in 24 countries with a combined sample of 68 894 adult respondents across six continents assessed exposure to 29 traumatic event types. Differences in prevalence were examined with cross-tabulations. Exploratory factor analysis was conducted to determine whether traumatic event types clustered into interpretable factors. Survival analysis was carried out to examine associations of sociodemographic characteristics and prior traumatic events with subsequent exposure.


RESULTS
Over 70% of respondents reported a traumatic event; 30.5% were exposed to four or more. Five types - witnessing death or serious injury, the unexpected death of a loved one, being mugged, being in a life-threatening automobile accident, and experiencing a life-threatening illness or injury - accounted for over half of all exposures. Exposure varied by country, sociodemographics and history of prior traumatic events. Being married was the most consistent protective factor. Exposure to interpersonal violence had the strongest associations with subsequent traumatic events.


CONCLUSIONS
Given the near ubiquity of exposure, limited resources may best be dedicated to those that are more likely to be further exposed such as victims of interpersonal violence. Identifying mechanisms that account for the associations of prior interpersonal violence with subsequent trauma is critical to develop interventions to prevent revictimization.
Department of Epidemiology and Psychosocial Research,Instituto Nacional de Psiquiatría Ramón de la Fuente,Mexico City,Mexico.
C
C
Benjet
Department of Psychiatry,Stony Brook University School of Medicine,New York,NY,USA.
E
E
Bromet
Department of Psychiatry and Clinical Psychology,Balamand University,Beirut,Lebanon.
E G
EG
Karam
Department of Health Care Policy,Harvard University Medical School,Boston,MA,USA.
R C
RC
Kessler
Department of Psychology,University of Washington,Seattle,WA,USA.
K A
KA
McLaughlin
Department of Psychology,University of Pennsylvania,Philadelphia,PA,USA.
A M
AM
Ruscio
Department of Health Care Policy,Harvard University Medical School,Boston,MA,USA.
V
V
Shahly
Department of Psychiatry and Mental Health,University of Cape Town,Cape Town,Republic of South Africa.
D J
DJ
Stein
Department of Health Care Policy,Harvard University Medical School,Boston,MA,USA.
M
M
Petukhova
Department of Health Care Policy,Harvard University Medical School,Boston,MA,USA.
E
E
Hill
IMIM-Hospital del Mar Research Institute,Parc de Salut Mar;Pompeu Fabra University (UPF);and CIBER en Epidemiología y Salud Pública (CIBERESP),Spain.
J
J
Alonso
Moi University School of Medicine,Eldoret,Uasin Gishu,Kenya.
L
L
Atwoli
School of Psychology,University of Ulster,Northern Ireland,UK.
B
B
Bunting
Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL),Campus Gasthuisberg,Leuven,Belgium.
R
R
Bruffaerts
Chronic Diseases Research Center (CEDOC) and Department of Mental Health,Faculdade de Ciências Médicas,Universidade Nova de Lisboa,Lisbon,Portugal.
J M
JM
Caldas-de-Almeida
IRCCS St John of God Clinical Research Centre,Brescia,Italy.
G
G
de Girolamo
National School of Public Health,Management and Professional Development,Bucharest,Romania.
S
S
Florescu
Department of Psychiatry,University College Hospital,Ibadan,Nigeria.
O
O
Gureje
Institute of Mental Health,Peking University,Beijing,People's Republic of China.
Y
Y
Huang
Hôpital Lariboisière Fernand Widal,Assistance Publique Hôpitaux de Paris,University Paris Diderot and Paris Descartes,Paris,France.
J P
JP
Lepine
Department of Mental Health,School of Public Health,The University of Tokyo,Tokyo,Japan.
N
N
Kawakami
Paris Descartes University,Paris,France.
Viviane
V
Kovess-Masfety
Department of Epidemiology and Psychosocial Research,Instituto Nacional de Psiquiatría Ramón de la Fuente,Mexico City,Mexico.
M E
ME
Medina-Mora
IMIB-Arrixaca,CIBERESP-Murcia,Subdirección General de Salud Mental y Asistencia Psiquiátrica,Servicio Murciano de Salud,El Palmar (Murcia),Spain.
F
F
Navarro-Mateu
National Institute of Health,Lima,Peru.
M
M
Piazza
Colegio Mayor de Cundinamarca University,Bogota,Colombia.
J
J
Posada-Villa
Department of Psychological Medicine,University of Otago,Dunedin,New Zealand.
K M
KM
Scott
NYU School of Medicine,New York,NY,USA.
A
A
Shalev
National Drug and Alcohol Research Centre,University of New South Wales,Sydney,Australia.
T
T
Slade
Netherlands Institute of Mental Health and Addiction,Utrecht,the Netherlands.
M
M
ten Have
Center for Excellence on Research in Mental Health,CES University,Medellin,Colombia.
Y
Y
Torres
Department of Social Medicine,Federal University of Espírito Santo,Vitoria,Brazil.
M C
MC
Viana
Directorate Mental Health,National Center of Public Health and Analyses,Sofia,Bulgaria.
Z
Z
Zarkov
Department of Epidemiology,Harvard TH Chan School of Public Health,Boston,MA,USA.
K C
KC
Koenen
D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D019548:Crime Victims / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000453:epidemiology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007391:International Cooperation; D016015:Logistic Models; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D065840:Protective Factors; D000067073:Psychological Trauma / Q000453:epidemiology*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
Disasters; epidemiology; injury; revictimization; trauma; violence