title: A Paradox in Individual Versus National Mental Health Vulnerability: Are Higher Resource Levels Associated With Higher Disorder Prevalence?
abstract: An earlier study (Dückers, Alisic, & Brewin, 2016) found that countries with greater social and economic resources were characterized by a higher lifetime prevalence of posttraumatic stress disorder (PTSD). Here, we present a similar analysis of national population survey data to examine this vulnerability paradox in relation to other disorders. We predicted the lifetime prevalence of any mental health disorder (i.e., anxiety, mood, substance, and externalizing disorders) in 17 countries based on trauma exposure and country vulnerability data. A substantial proportion of variance in all disorder categories, 32.9% to 53.9%, could be explained by trauma exposure. Explained variance increased by 5 and up to 40 percentage points after adding the variable of vulnerability to the equation. Higher exposure and lower vulnerability levels were accompanied by a higher prevalence in any mental disorder, with the largest effect size in mood disorders (R2= .76). The interaction between exposure and vulnerability did not explain significant additional variance as it did for PTSD. Because a PTSD diagnosis links psychological, physical, and functional symptoms explicitly to trauma exposure, this might mean that populations in less-vulnerable countries are more likely to attribute health complaints to exposure. The results of this study suggest that country-level data can help to better explain the multilayered mechanisms of resilience and vulnerability in the context of trauma.
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, Utrecht, The Netherlands.|Impact-National Knowledge and Advice Centre for Psychosocial Care Concerning Critical Incidents, Arq Psychotrauma Expert Group, Diemen, The Netherlands.
authors.forename: Michel L A
authors.initials: ML
authors.lastname: Dückers
authors.affiliation: Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.
authors.forename: Chris R
authors.initials: CR
authors.lastname: Brewin
mesh_terms: D000704:Analysis of Variance; D014943:Global Health; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D001523:Mental Disorders / Q000453:epidemiology*; D011159:Population Surveillance; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D035862:Vulnerable Populations / Q000523:psychology*