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WHO analysis expands on trauma, PTSD association

Analysis of a large cross-national community sample indicated previous traumatic experiences were generally associated with PTSD, though generalized risk was limited to previous exposure to violence and sexual assault.

“One line of research on this topic shows that PTSD prevalence is highest for [traumatic experiences] involving interpersonal violence. Another line of research suggests that TE history is a risk factor for subsequent PTSD, with prior [traumatic experiences] involving violence possibly of special importance,” Howard Liu, SM, of Harvard Medical School, and colleagues wrote. “However, these studies did not examine prior [traumatic experiences]comprehensively, making it unclear whether the special importance of [traumatic experiences] involving interpersonal violence is limited to personal experience of this violence or includes witnessing extreme violence; whether all types of prior [traumatic experiences] are equally important or only those involving violence; whether repeated exposure to similar [traumatic experiences] is of special importance; and whether some prior [traumatic experiences]inoculate against future PTSD by building resilience.”

To determine associations of type of traumatic experience history with PTSD, researchers administered WHO World Mental Health surveys that assessed 29 types of traumatic experiences and DSM-IV PTSD in 20 countries from 2001 to 2012. Study participants (n = 34,676) had a mean age of 43.7 years.

Risk for PTSD was higher among participants with traumatic experiences involving sexual violence (OR = 2.7; 95% CI, 2-3.8) and witnessing atrocities (OR = 4.2; 95% CI, 1-17.8).

Prior lifetime group-level, same-type traumatic experiences was significantly associated with PTSD (P = .01).

Prior exposure to physical violence in the presence of a prior same-type traumatic experience (OR = 3.2; 95% CI, 1.3-7.9) was associated with increased risk for PTSD, while participation in organized violence in the presence of a prior same-type traumatic experience (OR = 0.2; 95% CI, 0.1-0.8) was associated with decreased risk.

Current findings replicated previous findings that associated increased risk for PTSD with a general history of traumatic experiences, however; generalized risk was limited to prior traumatic experiences involving violence, including participation in organized violence (OR = 1.3; 95% CI, 1-1.6), 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).

“Although leaving many questions unresolved about causal pathways and mechanisms, these results are valuable in advancing understanding of the complex ways in which specific [traumatic experiences] types and histories are associated with PTSD and in providing an empirical foundation for more focused investigations of these specifications in future studies,” the researchers concluded. – by Amanda Oldt

Disclosure: Liu reports no relevant financial disclosures. Please see the study for a full list of relevant financial disclosures.