title: Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys.
abstract: Previous research has documented significant variation in the prevalence of posttraumatic stress disorder (PTSD) depending on the type of traumatic experience (TE) and history of TE exposure, but the relatively small sample sizes in these studies resulted in a number of unresolved basic questions.
  
  
  
  To examine disaggregated associations of type of TE history with PTSD in a large cross-national community epidemiologic data set.
  
  
  
  The World Health Organization World Mental Health surveys assessed 29 TE types (lifetime exposure, age at first exposure) with DSM-IV PTSD that was associated with 1 randomly selected TE exposure (the random TE) for each respondent. Surveys were administered in 20 countries (n = 34 676 respondents) from 2001 to 2012. Data were analyzed from October 1, 2015, to September 1, 2016.
  
  
  
  Prevalence of PTSD assessed with the Composite International Diagnostic Interview.
  
  
  
  Among the 34 676 respondents (55.4% [SE, 0.6%] men and 44.6% [SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3% of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95% CI, 2.0-3.8) and witnessing atrocities (4.2; 95% CI, 1.0-17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95% CI, 1.3-7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95% CI, 0.1-0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95% CI, 1.0-1.6), experience of physical violence (OR, 1.4; 95% CI, 1.2-1.7), rape (OR, 2.5; 95% CI, 1.7-3.8), and other sexual assault (OR, 1.6; 95% CI, 1.1-2.3).
  
  
  
  The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts2Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Howard
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Maria V
authors.initials: MV
authors.lastname: Petukhova
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Sampson
authors.affiliation: Center for Reducing Health Disparities, University of California, Davis, Health System, Sacramento.
authors.forename: Sergio
authors.initials: S
authors.lastname: Aguilar-Gaxiola
authors.affiliation: Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University, Barcelona, Spain5Group 9/Program 06-Evaluation of Health Services of Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Section of Psychiatric Epidemiology-Laboratórios de Investigação Médica No. 23, Institute of Psychiatry, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Laura Helena
authors.initials: LH
authors.lastname: Andrade
authors.affiliation: Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York.
authors.forename: Evelyn J
authors.initials: EJ
authors.lastname: Bromet
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico, Fatebenefratelli, Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Centro de Investigación Biomédica en Red de Salud Mental, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.affiliation: National Center for Public Health and Analyses, Ministry of Health, Sofia, Bulgaria.
authors.forename: Hristo
authors.initials: H
authors.lastname: Hinkov
authors.affiliation: Department of Mental Health, School of Public Health, University of Tokyo, Tokyo, Japan.
authors.forename: Norito
authors.initials: N
authors.lastname: Kawakami
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors.forename: Karestan C
authors.initials: KC
authors.lastname: Koenen
authors.affiliation: Ecole des Hautes Etudes en Santé Publique, EA 4057, Paris Descartes University, Paris, France.
authors.forename: Viviane
authors.initials: V
authors.lastname: Kovess-Masfety
authors.affiliation: Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong, China.
authors.forename: Sing
authors.initials: S
authors.lastname: Lee
authors.affiliation: Dirección de Investigaciones Epidemiológicas y Psicosociales, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: Servicio Murciano de Investigación y Formación en Salud Mental, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, Instituto Murciano de Investigación Biosanitaria-Arrixaca, CIBERESP, Murcia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Navarro-Mateu
authors.affiliation: School of Psychology, Ulster University, Londonderry, Northern Ireland.
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Neill
authors.affiliation: Facultad de Salud Pública y Administración, Universidad Cayetano Heredia, Lima, Peru18National Institute of Health, Lima, Peru.
authors.forename: Marina
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Faculty of Social Sciences, Colegio Mayor de Cundinamarca University, Bogota, Colombia.
authors.forename: José
authors.initials: J
authors.lastname: Posada-Villa
authors.affiliation: Department of Psychological Medicine, University of Otago, Dunedin, New Zealand.
authors.forename: Kate M
authors.initials: KM
authors.lastname: Scott
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Victoria
authors.initials: V
authors.lastname: Shahly
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: Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
authors.forename: Margreet
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia.
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Torres
authors.affiliation: Department of Psychiatry, University College Hospital, Ibadan, Nigeria.
authors.forename: Oye
authors.initials: O
authors.lastname: Gureje
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Zaslavsky
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D000069581:Exposure to Violence / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D055500:Resilience, Psychological; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology; D014944:World Health Organization