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Recovery from DSM-IV post-traumatic stress disorder in the WHO World Mental Health surveys

Published online by Cambridge University Press:  19 July 2017

A. J. Rosellini ,
H. Liu ,
M. V. Petukhova ,
N. A. Sampson ,
S. Aguilar-Gaxiola ,
J. Alonso ,
G. Borges ,
R. Bruffaerts ,
E. J. Bromet  and
G. de Girolamo
...Show all authors
A. J. Rosellini
Affiliation:
Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
H. Liu
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
M. V. Petukhova
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
S. Aguilar-Gaxiola
Affiliation:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
J. Alonso
Affiliation:
IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University (UPF), and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
G. Borges
Affiliation:
National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
R. Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
G. de Girolamo
Affiliation:
IRCCS St John of God Clinical Research Centre/IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
P. de Jonge
Affiliation:
Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands Interdisciplinary Center Psychopathology and Emotion Regulation, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
J. Fayyad
Affiliation:
Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon
S. Florescu
Affiliation:
National School of Public Health, Management and Development, Bucharest, Romania
O. Gureje
Affiliation:
Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
J. M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
H. Hinkov
Affiliation:
National Center for Public Health and Analyses, Sofia, Bulgaria
E. G. Karam
Affiliation:
Institute for Development, Research, Advocacy & Applied Care (IDRAAC), Beirut, Lebanon Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
N. Kawakami
Affiliation:
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
K. C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
S. Lee
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
J. P. Lépine
Affiliation:
Hôpital Lariboisière-Fernand Widal, Assistance Publique Hôpitaux de Paris, Universités Paris Descartes-Paris Diderot, INSERM UMR-S 1144, Paris, France
D. Levinson
Affiliation:
Mental Health Services, Ministry of Health, Jerusalem, Israel
F. Navarro-Mateu
Affiliation:
UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
B. D. Oladeji
Affiliation:
Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
S. O'Neill
Affiliation:
School of Psychology, Ulster University, Londonderry, UK
B.-E. Pennell
Affiliation:
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
M. Piazza
Affiliation:
Universidad Cayetano Heredia, National Institute of Health, Lima, Peru
J. Posada-Villa
Affiliation:
Colegio Mayor de Cundinamarca University, Bogota, Colombia
K. M. Scott
Affiliation:
Department of Psychological Medicine, University of Otago, Dunedin, Otago, New Zealand
D. J. Stein
Affiliation:
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Y. Torres
Affiliation:
Center for Excellence on Research in Mental Health, CES University, Medellín, Colombia
M. C. Viana
Affiliation:
Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Author for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: Kessler@hcp.med.harvard.edu)
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Abstract

Background

Research on post-traumatic stress disorder (PTSD) course finds a substantial proportion of cases remit within 6 months, a majority within 2 years, and a substantial minority persists for many years. Results are inconsistent about pre-trauma predictors.

Methods

The WHO World Mental Health surveys assessed lifetime DSM-IV PTSD presence-course after one randomly-selected trauma, allowing retrospective estimates of PTSD duration. Prior traumas, childhood adversities (CAs), and other lifetime DSM-IV mental disorders were examined as predictors using discrete-time person-month survival analysis among the 1575 respondents with lifetime PTSD.

Results

20%, 27%, and 50% of cases recovered within 3, 6, and 24 months and 77% within 10 years (the longest duration allowing stable estimates). Time-related recall bias was found largely for recoveries after 24 months. Recovery was weakly related to most trauma types other than very low [odds-ratio (OR) 0.2–0.3] early-recovery (within 24 months) associated with purposefully injuring/torturing/killing and witnessing atrocities and very low later-recovery (25+ months) associated with being kidnapped. The significant ORs for prior traumas, CAs, and mental disorders were generally inconsistent between early- and later-recovery models. Cross-validated versions of final models nonetheless discriminated significantly between the 50% of respondents with highest and lowest predicted probabilities of both early-recovery (66–55% v. 43%) and later-recovery (75–68% v. 39%).

Conclusions

We found PTSD recovery trajectories similar to those in previous studies. The weak associations of pre-trauma factors with recovery, also consistent with previous studies, presumably are due to stronger influences of post-trauma factors.

Keywords

Cross-nationalepidemiologypost-traumatic stress disorderrecovery
Type
Original Articles
Information
Psychological Medicine , Volume 48 , Issue 3 , February 2018 , pp. 437 - 450
Copyright
Copyright © Cambridge University Press 2017 

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