Reports of Prior Exposure to Potentially Traumatic Events and PTSD in Troops Poised for Deployment

Exposure to potentially traumatic events (PTEs), posttraumatic stress disorder (PTSD) symptomatology, and the mental health status of 2,947 military personnel were assessed prior to deployment on a peacekeeping mission. Approximately 74% of the soldiers reported being exposed to at least one PTE. The mean number of PTEs reported was 2.38, most of which did not occur during previous deployments. Approximately 6% of the participants exceeded our screening criteria for PTSD and 43% endorsed elevated levels of psychological distress. These findings document a high rate of exposure to PTEs in soldiers prior to their deployment. These results also highlight the need to screen for PTEs when attempting to isolate the rates of PTSD following a specific traumatic event and to examine the effects of cumulative exposure to PTEs.     

Traumatic Event Exposure,Posttraumatic Stress Disorder,and Sleep Disturbances in a National Sample of U.S. Adults

Posttraumatic stress disorder (PTSD) is a highly prevalent, debilitating disorder found to develop after exposure to a potentially traumatic event (PTE). Individuals with PTSD often report sleep disturbances, specifically nightmares and insomnia, which are listed within the criteria for PTSD. This research examined prevalence of insomnia and nightmares within a national sample of 2,647 adults (data weighted by age and sex to correct for differences in sample distribution) who had been exposed to one or more PTEs. Prevalence of self‐reported sleep disturbance, sleep disturbances by PTE type, and gender differences were examined. All participants completed a self‐administered, structured online interview that assessed exposure to stressful events and PTSD symptoms. Among individuals who met DSM‐5 criteria for PTSD, a large majority (more than 92%) reported at least one sleep disturbance. Insomnia was relatively more prevalent than PTE‐related nightmares among individuals with PTSD and among all PTE‐exposed individuals. A higher number of PTEs experienced significantly increased the likelihood of both trauma‐related nightmares and insomnia, McFadden's pseudo R² = .07, p < .001. Women exposed to PTEs were more likely to endorse experience of insomnia, χ²(1, N = 2,647) = 99.13, p < .001, φ = .194, and nightmares compared to men, χ²(1, N = 2,648) = 82.98, p < .001, φ = .177, but this gender difference was not significant among individuals with PTSD, ps = .130 and .050, respectively. Differences in sleep disturbance prevalence by PTE type were also examined. Implications for treatment and intervention and future directions are discussed.     

Exposure to Traumatic Events and Posttraumatic Stress Disorder in France: Results From the WMH Survey

This study examined the prevalence of traumatic events and the conditional probability of posttraumatic stress disorder (PTSD) associated with both specific and broad classes of events in a nationally representative sample from France. The sample (N = 1,436) was a part of the European Study of the Epidemiology of Mental Disorders Survey (ESEMeD), under the WHO World Mental Health Surveys‐2000 initiative. Overall, exposure to any traumatic event was 72.7%, which appeared to be lower than what has been reported in Sweden (80.8%), similar to data from the Netherlands (71.1%), and higher than what has been reported in Spain (54.0%), Italy (56.1%), Northern Ireland (60.6%) or the U.S (55.9%). Lifetime prevalence of PTSD was 3.9%, lower than in the United States (7.8%), Sweden (5.6%), or Northern Ireland (8.8%), but higher than in Spain (2.2%) or Italy (2.4%). Being beaten up by a romantic partner (25.0%), having a child with serious illness (23.5%), and rape (21.5%) were associated with the highest risk of PTSD. The average duration of PTSD was 5.3 years (0.2–28.1). The burden of PTSD in France appeared to come from the consequences of violence and social network events suggesting that prevention efforts might focus on limiting the occurrence of exposure to avoidable events such as violence as well as provide support for persons exposed to social network events.     

Comparing the diagnosis of PTSD when assessing worst versus multiple traumatic events in a chronically mentally ill sample

Despite interest in the nature of the traumatic event required to meet Criterion A for posttraumatic stress disorder (PTSD) as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994), little attention has been paid to the diagnostic ramifications of linking PTSD symptoms to a single traumatic event in the context of multiple trauma exposures. In this study, 67 dually diagnosed clients with at least 2 potential Criterion A traumatic events completed the Posttraumatic Stress Diagnostic Scale twice, in counterbalanced order: once regarding their worst event and once regarding all events. When responding regarding their worst trauma, 53.7% met probable PTSD criteria. This rose to 67.2% when considering all traumas. Although preliminary, these results suggest that linking PTSD symptoms to a single traumatic event excludes a meaningful number of cases who are otherwise indistinguishable based on symptom profile.     

Post-traumatic stress disorder and postpartum depression and their reported association with recent labor and delivery: a questionnaire survey cohort

BackgroundWe aimed to investigate the index traumatic event associated with post-traumatic stress disorder (PTSD) and evaluate the timing of the onset of symptoms in relation to the recent delivery.MethodsQuestionnaire study regarding prior exposure to traumatic events, PTSD, postpartum depression (PPD) and fear of childbirth among women two to 12 months postpartum, recruited via targeted internet sites.ResultsQuestionnaires were completed by 143 women, with PPD reported by 22 (15.4%), probable PTSD by 11 (7.7%), and fear of childbirth by 14 (9.8%). Overall, 97 (67.8%) women reported a prior traumatic event: 16 (16.5%) reported the recent delivery to be the worst traumatic event and that symptoms began subsequent to this delivery; 17 (17.5%) reported the worst traumatic event was not the recent delivery but symptoms had started postpartum. Significantly higher symptom levels suggestive of PTSD and PPD were found in women whose trauma event was not delivery, yet symptoms started postpartum. Women whose traumatic event pre-dated the delivery also showed significantly higher symptom levels of PTSD. More than half of those describing PTSD related to the recent delivery presented with clinically relevant levels of fear of childbirth, compared with less than a third of women whose PTSD was related to a different event.ConclusionPTSD identified postpartum may not be linked to the recent delivery and often pre-dates it. Future studies should identify the trigger traumatic event responsible for PTSD symptoms, to enable a more accurate picture of the reasons for PTSD and fear of childbirth.     

Posttraumatic Stress Disorder in a Nationally Representative Mexican Community Sample

This study describes the public health burden of trauma exposure and posttraumatic stress disorder (PTSD) in relation to the full range of traumatic events to identify the conditional risk of PTSD from each traumatic event experienced in the Mexican population and other risk factors. The representative sample comprised a subsample (N = 2,362) of the urban participants of the Mexican National Comorbidity Survey (2001?2002). We used the World Health Organization's Composite International Diagnostic Interview (CIDI) to assess exposure to trauma and the presence of PTSD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM‐IV; American Psychiatric Association, 1994 ) in each respondents’ self‐reported worst traumatic event, as well as a randomly selected lifetime trauma. The results showed that traumatic events were extremely common in Mexico (68.8%). The estimate of lifetime PTSD in the whole population was 1.5%; among only those with a traumatic event it was 2.1%. The 12‐month prevalence of PTSD in the whole population was 0.6%; among only those with a traumatic event it was 0.8%. Violence‐related events were responsible for a large share of PTSD. Sexual violence, in particular, was one of the greatest risks for developing PTSD. These findings support the idea that trauma in Mexico should be considered a public health concern.     

Pervasive exposure to violence and posttraumatic stress disorder in a predominantly African American Urban Community: the Detroit Neighborhood Health Study

Exposure to traumatic events is common, particularly among economically disadvantaged, urban African Americans. There is, however, scant data on the psychological consequences of exposure to traumatic events in this group. We assessed experience with traumatic events and posttraumatic stress disorder (PTSD) among 1,306 randomly selected, African American residents of Detroit. Lifetime prevalence of exposure to at least 1 traumatic event was 87.2% (assault = 51.0%). African Americans from Detroit have a relatively high burden of PTSD; 17.1% of those who experienced a traumatic event met criteria for probable lifetime PTSD. Assaultive violence is pervasive and is more likely to be associated with subsequent PTSD than other types of events. Further efforts to prevent violence and increase access to mental health treatment could reduce the mental health burden in economically disadvantaged urban areas.     

Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury

In a pilot study of seriously injured accident victims, 15 patients selected in initial intake interviews were followed at 9- to 10-week intervals for 9 months after admission to a community shock-trauma center. Psychiatric diagnoses were based on a structured psychiatric interview. A total of six patients met criteria for PTSD. In two cases, PTSD was not diagnosed until 3 to 6 months after injury, primarily because of severe avoidant symptomatology. In another case, intrusive and arousal symptoms were not immediately explainable as a manifestation of PTSD, because it was mistakenly believed that the patient had been unconscious during the accident. Diagnosis in two of these would probably have been missed without frequent follow-up interviews. Findings suggest that avoidant symptoms of PTSD can interfere with diagnosis. This has important consequences for outcome studies. It is suggested that frequent follow-up after a traumatic event may reduce the level of false negatives in population studies.Presented at the 7th annual convention, International Society for Traumatic Stress Studies, October 25, 1991, Washington, D.C.     

Mild Traumatic Brain Injury Does not Produce Post-Traumatic Stress Disorder

It has been widely assumed that patients who sustain mild traumatic brain injury (MTBI) or post-concussive syndrome develop post-traumatic stress disorder (PTSD) in response to their cognitive difficulties, diminished coping skills, or other losses. This study examined 70 patients who had previously been diagnosed as having either PTSD or MTBI. Each patient was asked to provide a highly detailed chronological history of the events which preceded, followed, and occurred during the traumatic event, to indicate whether they were rendered unconscious or had amnesia for the event, and to describe the various symptoms they developed. All (100.0%) of the PTSD patients were able to provide a highly detailed and emotionally charged recollection of the events which occurred within 15 minutes of the traumatic event in comparison to none (0.0%) of the MTBI patients. None of the MTBI patients reported symptoms such as intrusive recollections of the traumatic event, nightmares, hypervigilance, phobic or startle reactions, or became upset when they were asked to describe the traumatic event or were exposed to stimuli associated with it. These data suggest that PTSD and MTBI are two mutually exclusive disorders, and that it is highly unlikely that MTBI patients develop PTSD symptoms. Furthermore, these findings suggest that clinicians should exercise considerable caution in ruling out PTSD prior to making the diagnosis of MTBI.     

Post-traumatic stress disorder symptoms following a head injury: does amnesia for the event influence the development of symptoms?

Background: There is controversy as to whether PTSD can develop following a brain injury with a loss of consciousness. However, no studies have specifically examined the influence of the memories that the individuals may or may not have on the development of symptoms. Aims: To consider how amnesia for the traumatic event effects the development and profile of traumatic stress symptoms. Method: Fifteen hundred case records from an Accident and Emergency Unit were screened to identify 371 individuals with traumatic brain injury who were sent questionnaires by post. The 53 subsequent valid responses yielded three groups: those with no memory (n = 14), untraumatic memories (n = 13) and traumatic memories (n = 26) of the index event. The IES-R was used as a screening measure followed by a structured interview (CAPS-DX) to determine caseness and provide details of symptom profile. Results: Groups with no memories or traumatic memories of the index event reported higher levels of psychological distress than the group with untraumatic memories. Ratings of PTSD symptoms were less severe in the no memory groups compared to those with traumatic memories. Conclusions: Psychological distress was associated with having traumatic or no memories of an index event. Amnesia for the event did not protect against PTSD; however, it does appear to protect against the severity and presence of specific intrusive symptoms.     

Is DSM‐IV criterion A2 associated with PTSD diagnosis and symptom severity?

The diagnostic criteria for posttraumatic stress disorder (PTSD) have received significant scrutiny. Several studies have investigated the utility of Criterion A2, the subjective emotional response to a traumatic event. The American Psychiatric Association (APA) has proposed elimination of A2 from the PTSD diagnostic criteria for DSM-5; however, there is mixed support for this recommendation and few studies have examined A2 in samples at high risk for PTSD such as veterans. In the current study of 908 veterans who screened positive for a traumatic event, A2 was not significantly associated with having been told by a doctor that the veteran had PTSD. Those who endorsed A2, however, reported greater PTSD symptom severity in the 3 DSM-IV symptom clusters of reexperiencing (d = 0.45), avoidance (d = 0.61), and hyperarousal (d = 0.44), and A2 was significantly associated with PTSD symptom severity for all 3 clusters (R(2) = .25, .25, and .27, respectively) even with trauma exposure in the model. Thus, although A2 may not be a necessary criterion for PTSD diagnosis, its association with PTSD symptom severity warrants further exploration of its utility.     

Trauma Exposure,Posttraumatic Stress Disorder Symptoms Trajectory,and Disability Level Among Hospitalized Injury Survivors in Kenya

Potentially traumatic events (PTEs) have been consistently associated with posttraumatic stress disorder (PTSD). However, the extent of association and attribution to subsequent disability has varied, with limited studies conducted in urban low‐income contexts. This longitudinal study estimated the trajectory of PTSD symptoms up to 7 months after hospitalization and the associated disability level among adult patients who had been hospitalized due to injury. Adult injury patients (N = 476) admitted to Kenyatta National Hospital in Nairobi, Kenya, were interviewed in person in the hospital, and via phone at 1, 2–3, and 4–7 months after hospital discharge. Using latent growth curve modeling, two trajectories of PTSD symptoms emerged: (a) persistently elevated PTSD symptoms (9.2%), and (b) low PTSD symptoms (90.8%). Number of PTEs experienced remained moderately associated with the elevated trajectory after controlling for in‐hospital depressive symptoms. Having previously witnessed killings or serious injuries, AOR = 2.32, 95% CI [1.07, 5.05]; being female, AOR = 4.74, 95% CI [4.53, 4.96]; elevated depressive symptoms during hospitalization, AOR = 2.96, 95% CI [1.28, 6.83]; and having no household savings/assets, AOR = 1.28, 95% CI [1.13, 1.44], were associated with the elevated PTSD symptoms trajectory class after controlling for other risk factors. Latent membership in the elevated PTSD trajectory was associated with a significantly higher level of disability several months after hospital discharge, p < .001, after controlling for injury and demographic characteristics. These results underline the associations among in‐hospital depressive symptoms, witnessing atrocities, and poverty, and an elevated PTSD symptoms trajectory.     

The Relationship of Sleep Quality and PTSD to Anxious Reactivity from Idiographic Traumatic Event Script‐Driven Imagery

Poor sleep quality has been linked to posttraumatic stress disorder (PTSD). This study provided a test of how poor sleep quality relates to real‐time assessment of anxious reactivity to idiographic traumatic event cues. Script‐driven imagery (SDI) was employed to examine reactivity to traumatic event cues among 46 women (mean age = 27.54 years, SD = 13.62; 87% Caucasian) who had experienced either physical or sexual assault. We tested 3 hypotheses: (a) individuals with PTSD would report greater anxiety reactions to SDI than trauma‐exposed individuals without PTSD, (b) poorer sleep quality would be positively related to anxiety reactions to SDI, and (c) there would be an interaction between PTSD and sleep quality such that individuals with PTSD and relatively poor sleep quality would report greater anxious reactivity to SDI than would be expected from each main effect alone. Poor sleep quality and PTSD were related to elevated anxious reactivity to trauma cues (sr² = .06). In addition, sleep quality was negatively associated with anxious reactivity among people without PTSD (sr² =.05). The current findings, in combination with longitudinal evidence, suggest that poor sleep quality following exposure to a traumatic event may be a risk factor for anxious reactivity to traumatic event cues.     

Posttraumatic Stress Disorder in a General Psychiatric Inpatient Population

This study examined the incidence of traumatic experiences and prevalence of lifetime posttraumatic stress disorder (PTSD) in a sample of 141 general hospital psychiatric inpatients. Sixty-one percent of the patients reported at least one traumatic event during their lifetime and 28% met the formal DSM-III-R criteria for a lifetime diagnosis of PTSD. A high degree of comorbidity between PTSD and other psychiatric disorders was found, but PTSD was the incident disorder in at least 50% of cases. The experience of trauma and its associated complex patterns of symptomatology suggest that PTSD complicates the process of recovery from another disorder.     

Trauma Associated With Civil Conflict and Posttraumatic Stress Disorder: Evidence From the Northern Ireland Study of Health and Stress

The authors provide epidemiological estimates of trauma, posttraumatic stress disorder (PTSD), and associated mental disorders in Northern Ireland (NI) with a focus on the impact of civil conflict using data from the NI Study of Health and Stress (NISHS), a representative epidemiological survey of adults in NI. Overall 60.6% had a lifetime traumatic event, and 39.0% experienced a presumed conflict‐related event. Men were significantly more likely to experience any traumatic event and most conflict‐related event types (p < .05). The lifetime and 12‐month prevalence of PTSD were 8.8% and 5.1%, respectively. Furthermore, the lifetime prevalence of any mental disorder among men and women who experienced a conflict‐related trauma (46.0% and 55.9%, respectively) was significantly higher than the prevalence among men and women who did not experience this type of traumatic event (27.2% and 31.1%, respectively). Given the public health burden posed by PTSD and additional impact of conflict, specific attention must be paid to the policy, service, and clinical challenge of delivering evidence‐based treatments in the wake of a tumultuous period of conflict.     

Changes in religious beliefs following trauma

Information processing theorists propose that traumatic events can lead to disruptions in the processing of information and to changes in beliefs. This study examined the relationships among trauma, posttraumatic stress disorder (PTSD), and religious beliefs. Participants included 120 individuals from community and clinical samples who participated in the DSM-IV Field Trial Study on PTSD. Results indicated that the PTSD group was more likely to report changes in religious beliefs following the first/only traumatic event, generally becoming less religious. PTSD status was not related to change in religious beliefs following the most recent event. Intrinsic religiosity was related to multiple victimization, but not PTSD. Results are discussed in terms of understanding the function of religiosity in participants' lives and future directions for research.     

Psychological Impact and Prevalence of Traumatic Events in a Student Sample in Israel; The Effect of Multiple Traumatic Events and Physical Injury

The prevalence of exposure and the psychological impact of traumatic events were studied in 983 Israeli university students. The psychological effects of exposure to single versus multiple traumatic events, and the effects of trauma-related physical injury were also examined. It was found that 67% of the respondents reported having been exposed to at least one traumatic event. Of those exposed, 6% were diagnosed as having posttraumatic stress disorder (PTSD). Men were more at risk for exposure, but women were more at risk for PTSD. Women and the physically injured showed more psychological distress following exposure. Being exposed to one type of traumatic event was associated with increased psychological distress, but being exposed to multiple types of traumatic events was associated with lowering of distress. The results are discussed in comparison with similar studies from the United States.     

Panic reactions to terrorist attacks and probable posttraumatic stress disorder in adolescents

A number of factors, including subjective reactions and appraisal of danger, influence one's reaction to a traumatic event. This study used telephone survey methodology to examine adolescent and parent reactions to the 2001 World Trade Center attacks 6 to 9 months after they occurred. The prevalence of probable posttraumatic stress disorder (PTSD) in adolescents was 12.6%; 26.2% met study criteria for probable subthreshold PTSD. A probable peri-event panic attack in adolescents was strongly associated with subsequent probable PTSD and probable subthreshold PTSD. This study suggests that the early identification of peri-event panic attacks following mass traumatic events may provide an important gateway to intervention in the subsequent development of PTSD. Future studies should use longitudinal designs to examine the course and pathogenic pathways for the development of panic, PTSD, and other anxiety disorders after exposure to disasters.     

Clinical Manifestations of Trauma Exposure in Fibromyalgia: The Role of Anxiety in the Association Between Posttraumatic Stress Symptoms and Fibromyalgia Status

Little research has investigated how traumatic experiences relate to fibromyalgia (FM). We explored the presence of trauma exposure in a sample of Spanish participants with FM and examined the associations between (a) the number and type of traumatic experiences and posttraumatic stress disorder (PTSD) symptoms and (b) the severity of clinical manifestations in FM, testing for possible mediation models. Participants were 173 FM patients and 53 healthy controls aged 24 to 66 years. Traumatic event type (physical trauma, physical and sexual abuse, psychological trauma), PTSD symptoms, pain intensity, sleep disturbance, anxiety, depression, coping style, and daily functioning were evaluated via self-report. Fibromyalgia patients reported a higher percentage of trauma exposure than controls, more traumatic experiences (mainly emotional and physical trauma), and more PTSD symptoms, Hedges’ gs/Cohen's ds = 0.42–0.76. Most FM patients reported having experienced their most distressing traumatic experience and PTSD symptoms before FM diagnosis. PTSD symptom severity was associated with more pain, sleep disturbances, anxiety, depression, coping style, and functional impairment, rs = .23–.33, ps = .025–.008. A multiple mediation analysis showed a significant indirect effect of anxiety in the association between PTSD symptoms and daily functioning. In a subset of FM patients, PTSD symptoms were associated with major clinical symptoms. The results suggest future research should explore the effectiveness of trauma-focused therapy compared to standard cognitive behavioral therapy for these patients.     

National Estimates of Exposure to Traumatic Events and PTSD Prevalence Using DSM‐IV and DSM‐5 Criteria

Prevalence of posttraumatic stress disorder (PTSD) defined according to the American Psychiatric Association's Diagnostic and Statistical Manual fifth edition (DSM‐5; 2013) and fourth edition (DSM‐IV; 1994) was compared in a national sample of U.S. adults (N = 2,953) recruited from an online panel. Exposure to traumatic events, PTSD symptoms, and functional impairment were assessed online using a highly structured, self‐administered survey. Traumatic event exposure using DSM‐5 criteria was high (89.7%), and exposure to multiple traumatic event types was the norm. PTSD caseness was determined using Same Event (i.e., all symptom criteria met to the same event type) and Composite Event (i.e., symptom criteria met to a combination of event types) definitions. Lifetime, past‐12‐month, and past 6‐month PTSD prevalence using the Same Event definition for DSM‐5 was 8.3%, 4.7%, and 3.8% respectively. All 6 DSM‐5 prevalence estimates were slightly lower than their DSM‐IV counterparts, although only 2 of these differences were statistically significant. DSM‐5 PTSD prevalence was higher among women than among men, and prevalence increased with greater traumatic event exposure. Major reasons individuals met DSM‐IV criteria, but not DSM‐5 criteria were the exclusion of nonaccidental, nonviolent deaths from Criterion A, and the new requirement of at least 1 active avoidance symptom.