title: Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys.
abstract: Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues.
  
  
  
  Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk.
  
  
  
  PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%.
  
  
  
  The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.
authors.affiliation: Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya.|Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa.
authors.forename: Lukoye
authors.initials: L
authors.lastname: Atwoli
authors.affiliation: Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa.
authors.forename: Dan J
authors.initials: DJ
authors.lastname: Stein
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: King
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Petukhova
authors.affiliation: Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA.
authors.forename: Sergio
authors.initials: S
authors.lastname: Aguilar-Gaxiola
authors.affiliation: IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain.|Pompeu Fabra University (UPF), Barcelona, Spain.|CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA.
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
authors.affiliation: IRCCS St. John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Koen
authors.initials: K
authors.lastname: Demyttenaere
authors.affiliation: National School of Public Health, Management and Professional Development, Bucharest, Romania.
authors.forename: Silvia
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Maria Haro
authors.affiliation: Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon.|Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon.|Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon.
authors.forename: Elie G
authors.initials: EG
authors.lastname: Karam
authors.affiliation: Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan.
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
authors.affiliation: Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong.
authors.forename: Sing
authors.initials: S
authors.lastname: Lee
authors.affiliation: Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Descartes, Paris Diderot, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lepine
authors.affiliation: IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Navarro-Mateu
authors.affiliation: School of Psychology, University of Ulster, Londonderry, UK.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Beth-Ellen
authors.initials: BE
authors.lastname: Pennell
authors.affiliation: Universidad Peruana Cayetano Heredia, Lima, Peru.|National Institute of Health, Lima, Peru.
authors.forename: Marina
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Colegio Mayor de Cundinamarca University, Bogota, Colombia.
authors.forename: Jose
authors.initials: J
authors.lastname: Posada-Villa
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: Margreet
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
mesh_terms: D000293:Adolescent; D000328:Adult; D001208:Asia / Q000453:epidemiology; D001293:Attitude to Death; D002648:Child; D002675:Child, Preschool; D003643:Death; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008016:Life Change Events; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D012306:Risk; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D013020:South America / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: PTSD; cross-national; epidemiology; international; life events/stress; trauma