title: Posttraumatic stress disorder in the World Mental Health Surveys.
abstract: BACKGROUND
  Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking.
  
  
  METHODS
  Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics.
  
  
  RESULTS
  The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed.
  
  
  CONCLUSIONS
  PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.
authors.affiliation: Department of Epidemiology,Harvard T.H. Chan School of Public Health,Boston, Massachusetts,USA.
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authors.affiliation: Department of Epidemiology,Mailman School of Public Health,Columbia University,New York,USA.
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authors.lastname: Ratanatharathorn
authors.affiliation: Department of Psychiatry,Boston University School of Medicine and Boston Medical Center,Boston, Massachusetts,USA.
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authors.lastname: Ng
authors.affiliation: Department of Psychology,University of Washington,Seattle, Washington,USA.
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authors.affiliation: Department of Psychiatry,Stony Brook University School of Medicine,Stony Brook, New York,USA.
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authors.affiliation: Department of Psychiatry and Mental Health,University of Cape Town,Cape Town,Republic of South Africa.
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authors.initials: DJ
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authors.affiliation: Department of Psychiatry and Clinical Psychology, Faculty of Medicine,Balamand University,Beirut,Lebanon.
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authors.affiliation: Department of Psychology,University of Pennsylvania,Philadelphia, Pennsylvania,USA.
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authors.affiliation: Department of Epidemiologic and Psychosocial Research,National Institute of Psychiatry Ramón de la Fuente,Mexico City,Mexico.
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authors.affiliation: Department of Psychological Medicine,University of Otago,Dunedin, Otago,New Zealand.
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authors.affiliation: Department of Mental Health,Moi University School of Medicine,Eldoret,Kenya.
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authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
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authors.affiliation: Department of Psychological Medicine,University of Otago,Dunedin, Otago,New Zealand.
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authors.affiliation: Center for Reducing Health Disparities,UC Davis Health System,Sacramento, California,USA.
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authors.affiliation: College of Medicine,Al-Qadisiya University,Diwania governorate,Iraq.
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authors.affiliation: Health Services Research Unit,IMIM-Hospital del Mar Medical Research Institute,Pompeu Fabra University (UPF);CIBER en Epidemiología y Salud Pública (CIBERESP),Barcelona,Spain.
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authors.lastname: Alonso
authors.affiliation: School of Psychology, Ulster University,Londonderry,UK.
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authors.affiliation: National School of Public Health, Management and Professional Development,Bucharest,Romania.
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authors.affiliation: IRCCS St John of God Clinical Research Centre // IRCCS Centro S. Giovanni di Dio Fatebenefratelli,Brescia,Italy.
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authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales,Sydney,Australia.
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authors.affiliation: Department of Psychiatry,University College Hospital,Ibadan,Nigeria.
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authors.affiliation: Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona,Barcelona,Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Haro
authors.affiliation: Institute of Mental Health, Peking University,Beijing,China.
authors.forename: Y
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authors.lastname: Huang
authors.affiliation: Department of Mental Health,School of Public Health, The University of Tokyo,Tokyo,Japan.
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authors.lastname: Kawakami
authors.affiliation: Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong.
authors.forename: S
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authors.lastname: Lee
authors.affiliation: UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud IMIB-Arrixaca; CIBERESP-Murcia,Murcia,Spain.
authors.forename: F
authors.initials: F
authors.lastname: Navarro-Mateu
authors.affiliation: Survey Research Center, Institute for Social Research, University of Michigan,Ann Arbor, Michigan,USA.
authors.forename: B-E
authors.initials: BE
authors.lastname: Pennell
authors.affiliation: Universidad Cayetano Heredia,Lima,Peru.
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authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
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authors.affiliation: Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands.
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authors.lastname: Ten Have
authors.affiliation: Center for Excellence on Research in Mental Health, CES University,Medellin,Colombia.
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authors.lastname: Torres
authors.affiliation: Department of Social Medicine,Federal University of Espírito Santo,Vitoria,Brazil.
authors.forename: M C
authors.initials: MC
authors.lastname: Viana
authors.affiliation: Department of Society, Human Development, and Health,Harvard School of Public Health,Boston, Massaschusetts,USA.
authors.forename: D
authors.initials: D
authors.lastname: Williams
authors.affiliation: Chronic Diseases Research Center (CEDOC) and Department of Mental Health, Faculdade de Ciências Médicas,Universidade Nova de Lisboa,Lisbon,Portugal.
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authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
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mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000368:Aged; D019049:Developed Countries / Q000706:statistics & numerical data*; D003906:Developing Countries / Q000706:statistics & numerical data*; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006306:Health Surveys / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000628:therapy*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D014944:World Health Organization; D055815:Young Adult
keywords: Epidemiology; International; Posttraumatic stress disorder (PTSD); trauma; treatment