Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys
Corresponding Author
Lukoye Atwoli
Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Correspondence
Lukoye Atwoli, Department of Mental Health, Moi University School of Medicine, P.O. Box 4606, Eldoret 30100, Kenya.
Email: [email protected]
Search for more papers by this authorDan J. Stein
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Search for more papers by this authorAndrew King
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorMaria Petukhova
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorSergio Aguilar-Gaxiola
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
Search for more papers by this authorJordi Alonso
IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain
Pompeu Fabra University (UPF), Barcelona, Spain
CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Search for more papers by this authorEvelyn J. Bromet
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
Search for more papers by this authorGiovanni de Girolamo
IRCCS St. John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
Search for more papers by this authorKoen Demyttenaere
Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
Search for more papers by this authorSilvia Florescu
National School of Public Health, Management and Professional Development, Bucharest, Romania
Search for more papers by this authorJosep Maria Haro
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorElie G. Karam
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Search for more papers by this authorNorito Kawakami
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorSing Lee
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Search for more papers by this authorJean-Pierre Lepine
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Descartes, Paris Diderot, France
Search for more papers by this authorFernando Navarro-Mateu
IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain
Search for more papers by this authorSiobhan O'Neill
School of Psychology, University of Ulster, Londonderry, UK
Search for more papers by this authorBeth-Ellen Pennell
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
Search for more papers by this authorMarina Piazza
Universidad Peruana Cayetano Heredia, Lima, Peru
National Institute of Health, Lima, Peru
Search for more papers by this authorJose Posada-Villa
Colegio Mayor de Cundinamarca University, Bogota, Colombia
Search for more papers by this authorNancy A. Sampson
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorMargreet ten Have
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Search for more papers by this authorAlan M. Zaslavsky
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorRonald C. Kessler
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authoron behalf of the WHO World Mental Health Survey Collaborators
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorCorresponding Author
Lukoye Atwoli
Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Correspondence
Lukoye Atwoli, Department of Mental Health, Moi University School of Medicine, P.O. Box 4606, Eldoret 30100, Kenya.
Email: [email protected]
Search for more papers by this authorDan J. Stein
Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Search for more papers by this authorAndrew King
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorMaria Petukhova
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorSergio Aguilar-Gaxiola
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
Search for more papers by this authorJordi Alonso
IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain
Pompeu Fabra University (UPF), Barcelona, Spain
CIBER en Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
Search for more papers by this authorEvelyn J. Bromet
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
Search for more papers by this authorGiovanni de Girolamo
IRCCS St. John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
Search for more papers by this authorKoen Demyttenaere
Department of Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
Search for more papers by this authorSilvia Florescu
National School of Public Health, Management and Professional Development, Bucharest, Romania
Search for more papers by this authorJosep Maria Haro
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
Search for more papers by this authorElie G. Karam
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center, Beirut, Lebanon
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Search for more papers by this authorNorito Kawakami
Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
Search for more papers by this authorSing Lee
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Search for more papers by this authorJean-Pierre Lepine
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Descartes, Paris Diderot, France
Search for more papers by this authorFernando Navarro-Mateu
IMIB-Arrixaca, CIBERESP-Murcia, Subdirección General de Salud Mental y Asistencia Psiquiátrica, Servicio Murciano de Salud, El Palmar (Murcia), Murcia, Spain
Search for more papers by this authorSiobhan O'Neill
School of Psychology, University of Ulster, Londonderry, UK
Search for more papers by this authorBeth-Ellen Pennell
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
Search for more papers by this authorMarina Piazza
Universidad Peruana Cayetano Heredia, Lima, Peru
National Institute of Health, Lima, Peru
Search for more papers by this authorJose Posada-Villa
Colegio Mayor de Cundinamarca University, Bogota, Colombia
Search for more papers by this authorNancy A. Sampson
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorMargreet ten Have
Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
Search for more papers by this authorAlan M. Zaslavsky
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorRonald C. Kessler
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authoron behalf of the WHO World Mental Health Survey Collaborators
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Search for more papers by this authorAbstract
Background
Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues.
Methods
Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk.
Results
PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%.
Conclusions
The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.
Supporting Information
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REFERENCES
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revised). Washington, DC: American Psychiatric Press.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., DSM-5). Arlington, VA: Author.
10.1176/appi.books.9780890425596 Google Scholar
- Atwoli, L., Stein, D. J., Koenen, K. C., & McLaughlin, K. A. (2015). Epidemiology of posttraumatic stress disorder: Prevalence, correlates and consequences. Current Opinion in Psychiatry, 28, 307–311. doi:10.1097/yco.0000000000000167
- Atwoli, L., Stein, D. J., Williams, D. R., McLaughlin, K. A., Petukhova, M., Kessler, R. C., & Koenen, K. C. (2013). Trauma and posttraumatic stress disorder in South Africa: Analysis from the South African stress and health study. BMC Psychiatry, 13, 182. doi:10.1186/1471-244x-13-182
- Benjet, C., Bromet, E., Karam, E. G., Kessler, R. C., McLaughlin, K. A., Ruscio, A. M., … Koenen, K. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health survey consortium. Psychological Medicine, 46, 327–343. doi:10.1017/s0033291715001981
- Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55, 626–632.
- Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting & Clinical Psychology, 68, 748–766.
- Carmassi, C., Dell'Osso, L., Manni, C., Candini, V., Dagani, J., Iozzino, L., … de Girolamo, G. (2014). Frequency of trauma exposure and Post-Traumatic Stress Disorder in Italy: Analysis from the World Mental Health survey initiative. Journal of Psychiatric Research, 59, 77–84. doi:10.1016/j.jpsychires.2014.09.006
- Cozza, S. J., Fisher, J. E., Mauro, C., Zhou, J., Ortiz, C. D., Skritskaya, N., … Shear, M. K. (2016). Performance of DSM-5 persistent complex bereavement disorder criteria in a community sample of bereaved military family members. American Journal of Psychiatry, 173(9), 919–929. doi:10.1176/appi.ajp.2016.15111442
- DiGangi, J. A., Gomez, D., Mendoza, L., Jason, L. A., Keys, C. B., & Koenen, K. C. (2013). Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature. Clinical Psychology Review, 33, 728–744. doi:10.1016/j.cpr.2013.05.002
- Dohrenwend, B. P., Turner, J. B., Turse, N. A., Adams, B. G., Koenen, K. C., & Marshall, R. (2006). The psychological risks of Vietnam for U.S. veterans: A revisit with new data and methods. Science, 313, 979–982. doi:10.1126/science.1128944
- Endo, K., Yonemoto, N., & Yamada, M. (2015). Interventions for bereaved parents following a child's death: A systematic review. Palliative Medicine, 29, 590–604. doi:10.1177/0269216315576674
- Ferry, F., Bunting, B., Murphy, S., O'Neill, S., Stein, D., & Koenen, K. (2014). Traumatic events and their relative PTSD burden in Northern Ireland: A consideration of the impact of the “Troubles.” Social Psychiatry and Psychiatric Epidemiology, 49, 435–446. doi:10.1007/s00127-013-0757-0
- Friedman, M. J. (2013). Finalizing PTSD in DSM-5: Getting here from there and where to go next. Journal of Traumatic Stress, 26, 548–556. doi:10.1002/jts.21840
- Galatzer-Levy, I. R., Karstoft, K. I., Statnikov, A., & Shalev, A. Y. (2014). Quantitative forecasting of PTSD from early trauma responses: A machine learning application. Journal of Psychiatric Research, 59, 68–76. doi:10.1016/j.jpsychires.2014.08.017
- Gardner, M., & Altman, D. S. (2000). Statistics with confidence: Confidence intervals and statistical guidelines. London: BMJ Books.
- Hanley, J. A., & McNeil, B. J. (1983). A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology, 148, 839–843. doi:10.1148/radiology.148.3.6878708
- Harkness, J., Pennell, B.-P., Villar, A., Gebler, N., Aguilar-Gaxiola, S., & Bilgen, I. (2008). Translation procedures and translation assessment in the World Mental Health survey initiative. In R. C. Kessler & T. B. Üstün (Eds.), The WHO World Mental Health surveys: Global perspectives on the epidemiology of mental disorders (pp. 91–113). New York, NY: Cambridge University Press.
- Haro, J. M., Arbabzadeh-Bouchez, S., Brugha, T. S., de Girolamo, G., Guyer, M. E., Jin, R., … Kessler, R. C. (2006). Concordance of the composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. International Journal of Methods in Psychiatric Research, 15, 167–180.
- Heeringa, S. G., Hubbard, F., Mneimneh, Z. N., Chiu, W. T., Sampson, N. A., & Berglund, P. A. (2008). Sample designs and sampling procedures. In R. C. Kessler & T. B. Üstün (Eds.), The WHO World Mental Health surveys: Global perspectives on the epidemiology of mental disorders (pp. 14–32). New York, NY: Cambridge University Press.
- Karstoft, K. I., Galatzer-Levy, I. R., Statnikov, A., Li, Z., Shalev, A. Y., & Members of the Jerusalem Trauma Outreach and Prevention Study (J-TOPS) Group. (2015). Bridging a translational gap: Using machine learning to improve the prediction of PTSD. BMC Psychiatry, 15, 30. doi:10.1186/s12888-015-0399-8
- Kawakami, N., Tsuchiya, M., Umeda, M., Koenen, K. C., & Kessler, R. C. (2014). Trauma and posttraumatic stress disorder in Japan: Results from the World Mental Health Japan survey. Journal of Psychiatric Research, 53, 157–165. doi:10.1016/jpsychires.2014.01.015; https://doi.org/10.1016/jpsychires.2014.01.015
- Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., … Williams, D. R. (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health surveys. British Journal of Psychiatry, 197, 378–385. doi:10.1192/bjp.bp.110.080499
- Kessler, R. C., Rose, S., Koenen, K. C., Karam, E. G., Stang, P. E., Stein, D. J., … Carmen Viana, M. (2014). How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health surveys. World Psychiatry, 13, 265–274. doi:10.1002/wps.20150
- Kessler, R. C., & Ustun, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93–121.
- R. C. Kessler, & T. B. Ustun (Eds.). (2008). The WHO World Mental Health surveys: Global perspectives on the epidemiology of mental disorders. New York, NY: Cambridge University Press.
- Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: Unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry, 171, 864–871. doi:10.1176/appi.ajp.2014.13081132
- Knäuper, B., Cannell, C. F., Schwarz, N., Bruce, M. L., & Kessler, R. C. (1999). Improving accuracy of major depression age-of-onset reports in the US National Comorbidity Survey. International Journal of Methods in Psychiatric Research, 8, 39–48.
10.1002/mpr.55 Google Scholar
- Kristensen, P., Weisaeth, L., & Heir, T. (2012). Bereavement and mental health after sudden and violent losses: A review. Psychiatry, 75, 76–97. doi:10.1521/psyc.2012.75.1.76
- Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement for categorical data. Biometrics, 33, 159–174.
- Larsen, S. E., & Pacella, M. L. (2016). Comparing the effect of DSM-congruent traumas vs. DSM-incongruent stressors on PTSD symptoms: A meta-analytic review. Journal of Anxiety Disorders, 38, 37–46. doi:10.1016/j.janxdis.2016.01.001
- Lobb, E. A., Kristjanson, L. J., Aoun, S. M., Monterosso, L., Halkett, G. K., & Davies, A. (2010). Predictors of complicated grief: A systematic review of empirical studies. Death Studies, 34, 673–698. doi: 10.1080/07481187.2010.496686
- Maercker, A., & Znoj, H. (2010). The younger sibling of PTSD: Similarities and differences between complicated grief and posttraumatic stress disorder. European Journal of Psychotraumatology, 1, doi: 10.3402/ejpt.v1i0.5558
- Olaya, B., Alonso, J., Atwoli, L., Kessler, R. C., Vilagut, G., & Haro, J. M. (2014). Association between traumatic events and post-traumatic stress disorder: Results from the ESEMeD-Spain study. Epidemiology and Psychiatric Sciences,, 24, 172–183. doi:10.1017/S2045796014000092
- Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129, 52–73.
- Peduzzi, P., Concato, J., Kemper, E., Holford, T. R., & Feinstein, A. R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology, 49, 1373–1379.
- Pennell, B.-E., Mneimneh, Z., Bowers, A., Chardoul, S., Wells, J. E., Viana, M. C., … Vilagut, G. (2008). Implementation of the World Mental Health surveys. In R. C. Kessler & T. B. Üstün (Eds.), The WHO World Mental Health surveys: Global perspectives on the epidemiology of mental disorders (pp. 33–57). New York, NY: Cambridge University Press.
- Reed, J. F., III (2007). Better binomial confidence intervals. Journal of Modern Applied Statistical Methods, 6(1), 153–161.
10.22237/jmasm/1177992840 Google Scholar
- Roemer, L., Litz, B. T., Orsillo, S. M., Ehlich, P. J., & Friedman, M. J. (1998). Increases in retrospective accounts of war-zone exposure over time: The role of PTSD symptom severity. Journal of Traumatic Stress, 11, 597–605. doi:10.1023/a:1024469116047
- SAS Institute, Inc. (2008). . Cary, NC: Author.
- Scott, K. M., Al-Hamzawi, A. O., Andrade, L. H., Borges, G., Caldas-de-Almeida, J. M., Fiestas, F., … Kessler, R. C. (2014). Associations between subjective social status and DSM-IV mental disorders: Results from the World Mental Health surveys. JAMA Psychiatry, 71, 1400–1408. doi:10.1001/jamapsychiatry.2014.1337
- Simon, N. M. (2013). Treating complicated grief. Journal of the American Medical Association, 310, 416–423. doi:10.1001/jama.2013.8614
- Smith, G. C., Seaman, S. R., Wood, A. M., Royston, P., & White, I. R. (2014). Correcting for optimistic prediction in small data sets. American Journal of Epidemiology, 180, 318–324. doi:10.1093/aje/kwu140
- Wolter, K. M. (1985). Introduction to variance estimation. New York, NY: Springer-Verlag.
- World Bank (2016). Data: Countries and economies. Retrieved from http://data.worldbank.org/country
- Zisook, S., Chentsova-Dutton, Y., & Shuchter, S. R. (1998). PTSD following bereavement. Annals of Clinical Psychiatry, 10, 157–163.
- Zoellner, L. A., Foa, E. B., Brigidi, B. D., & Przeworski, A. (2000). Are trauma victims susceptible to “false memories?” Journal of Abnormal Psychology, 109, 517–524.
- Zou, K. H., O'Malley, A. J., & Mauri, L. (2007). Receiver-operating characteristic analysis for evaluating diagnostic tests and predictive models. Circulation, 115, 654–657. doi:10.1161/circulationaha.105.594929
