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Risk of post-traumatic stress disorder following traumatic events in a community sample

  • J. White (a1), J. Pearce (a2), S. Morrison (a2), F. Dunstan (a3), J. I. Bisson (a2) and D. L. Fone (a3)...



Post-traumatic stress disorder (PTSD) is typically associated with high-risk population groups, but the risk of PTSD that is associated with trauma experienced in the community, and effect of changes in diagnostic criteria in DSM-5 on prevalence in the general population, is unknown.


Cross-sectional analysis of population-based data from 4558 adults aged 25–83 years resident in Caerphilly county borough, Wales, UK. Exposure to different traumatic events was assessed using categorisation of free-text descriptions of trauma. PTSD caseness was determined using items assessing Diagnostic and Statistical Manual IV (DSM-IV) and DSM-5 A criteria and the Traumatic Screening Questionnaire.


Of the 4558 participants, 1971 (47.0%) reported a traumatic event. The most common DSM-IV A1 qualifying trauma was life-threatening illnesses and injuries (13.6%). The highest risk of PTSD was associated with assaultive violence [34.1%]. The prevalence of PTSD using DSM-IV A criteria was 14.3% (95% confidence interval [CI] = 12.8, 15.9%). Using DSM-5 A criteria reduced the prevalence to 8.0 (95% CI = 6.9, 9.4%), primarily due to exclusion of DSM-IV A1 qualifying events, such as life-threatening illnesses.


Nearly one-half of a general community sample had experienced a traumatic event and of these around one in seven was a DSM-IV case of PTSD. Although the majority of research has concentrated on combat, rape and assaultive violence, life threatening illness is a more common cause of PTSD in the community. Removal of this traumatic event in DSM-5 could reduce the number of cases of PTSD by around 6.0%.


Corresponding author

* Address for correspondence: Dr J. White, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement, School of Medicine, 4th floor Neuadd Meirionnydd, Cardiff University, Heath Park, Cardiff CF14 4YS, UK. (Email:


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American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. American Psychiatric Publishing: Arlington, VA.
Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Gusman, FD, Charney, DS, Keane, TM (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress 8, 7590.
Breslau, N (2001). The epidemiology of posttraumatic stress disorder: what is the extent of the problem? Journal of Clinical Psychiatry 62 (Suppl. 17), 1622.
Breslau, N, Davis, GC, Andreski, P, Peterson, EL, Schultz, LR (1997 a). Sex differences in posttraumatic stress disorder. Archives of General Psychiatry 54, 10441048.
Breslau, N, Davis, GC, Peterson, EL, Schultz, L (1997 b). Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry 54, 8187.
Breslau, N, Kessler, RC, Chilcoat, HD, Schultz, LR, Davis, GC, Andreski, P (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626632.
Breslau, N, Wilcox, HC, Storr, CL, Lucia, VC, Anthony, JC (2004). Trauma exposure and posttraumatic stress disorder: a study of youths in urban America. Journal of Urban Health: Bulletin of the New York Academy of Medicine 81, 530544.
Brewin, CR, Rose, S, Andrews, B, Green, J, Tata, P, McEvedy, C, Turner, S, Foa, EB (2002). Brief screening instrument for post-traumatic stress disorder. British Journal of Psychiatry 181, 158162.
Brewin, CR, Lanius, RA, Novac, A, Schnyder, U, Galea, S (2009). Reformulating PTSD for DSM-5: Life after Criterion A. Journal of Traumatic Stress 22, 366373.
Cohen, J (1960). A coefficient of agreement for nominal scales. Educational and Psychological Measurement 20, 3746.
Creamer, MC, Burgess, P, McFarlane, AC (2001). Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine 31, 12371247.
Crockett, A, Rafferty, A, Higgins, V, Marshall, A (2011). Weighting the Social Surveys. ESDS Government. Retrieved 4 September 2012 from
De Vries, GJ, Olff, M (2009). The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. Journal of Traumatic Stress 22, 259267.
Elhai, JD, Miller, ME, Ford, JD, Biehn, TL, Palmieri, PA, Frueh, BC (2012). Posttraumatic stress disorder in DSM-5: Estimates of prevalence and symptom structure in a nonclinical sample of college students. Journal of Anxiety Disorders 26, 5864.
Foa, EB, Riggs, DS, Dancu, CV, Rothbaum, BO (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress 6, 459473.
Fone, DL, Dunstan, F, White, J, Kelly, M, Farewell, D, John, G, Lyons, RA, Lloyd, K (2013). Cohort profile: the caerphilly health and social needs electronic cohort study (E-CATALyST). International Journal of Epidemiology 42, 16201628.
Friedman, MJ, Resick, PA, Bryant, RA, Brewin, CR (2011). Considering PTSD for DSM-5. Depression and Anxiety 28, 750769.
Goodman, LA, Corcoran, C, Turner, K, Yuan, N, Green, BL (1998). Assessing traumatic event exposure: general issues and preliminary findings for the Stressful Life Events Screening Questionnaire. Journal of Traumatic Stress 11, 521542.
Gray, MJ, Litz, BT, Hsu, JL, Lombardo, TW (2004). Psychometric properties of the life events checklist. Assessment 11, 330341.
Helzer, JE, Robins, LN, McEvoy, L (1987). Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey. New England Journal of Medicine 317, 16301634.
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 10481060.
Kilpatrick, DG, Resnick, HS, Acierno, R (2009). Should PTSD Criterion A be retained? Journal of Traumatic Stress 22, 374383.
McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R (2009). Adult Psychiatric Morbidity in England, 2007. Results of a Household Survey. The NHS Information Centre. Retrieved 30 January 2014 from
Perkonigg, A, Kessler, RC, Storz, S, Wittchen, HU (2000). Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica 101, 4659.
Roberts, AL, Gilman, SE, Breslau, J, Breslau, N, Koenen, KC (2011). Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychological Medicine 41, 7183.
Rosen, GM, Lilienfeld, SO, Frueh, BC, McHugh, PR, Spitzer, RL (2010). Reflections on PTSD's future in DSM-V. British Journal of Psychiatry 197, 343344.
Salminen, S (2004). Have young workers more injuries than older ones? An international literature review. Journal of Safety Research 35, 513521.
Singh-Manoux, A, Guéguen, A, Ferrie, J, Shipley, M, Martikainen, P, Bonenfant, S, Goldberg, M, Marmot, M (2008). Gender differences in the association between morbidity and mortality among middle-aged men and women. American Journal of Public Health 98, 22512257.
Summerfield, D (2004). Cross-cultural perspectives on the medicalization of human suffering. In Posttraumatic Stress Disorder: Issues and Controversies (ed. Rosen, GM), pp. 233245. John Wiley: New York.


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