The Epidemiology of Trauma, PTSD, and Other Posttrauma Disorders

Department of Epidemiology, Michigan State University College of Human Medicine, USA.
Trauma Violence & Abuse (Impact Factor: 3.27). 04/2009; 10(3):198-210. DOI: 10.1177/1524838009334448
Source: PubMed


Epidemiologic studies have reported that the majority of community residents in the United States have experienced posttraumatic stress disorder (PTSD)-level traumatic events, as defined in the DSM-IV. Only a small subset of trauma victims develops PTSD (<10%). Increased incidence of other disorders following trauma exposure occurs primarily among trauma victims with PTSD. Female victims of traumatic events are at higher risk for PTSD than male victims are. Direct evidence on the causes of the sex difference in the conditional risk of PTSD is unavailable. The available evidence suggests that the sex difference is not due to (a) the higher occurrence of sexual assault among females, (b) prior traumatic experiences, (c) preexisting depression or anxiety disorder, or (d) sex-related bias in reporting. Observed sex differences in anxiety, neuroticism, and depression, inducing effects of stressful experiences, might provide a theoretical context for further inquiry into the greater vulnerability of females to PTSD.

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    • "Meta-analysis has demonstrated reduced HCV in many neuropsychiatric disorders, including depression (McKinnon et al., 2009; Videbech and Ravnkilde, 2004), post-traumatic stress disorder (PTSD; Smith, 2005; Woon and Hedges, 2011), schizophrenia (Adriano et al., 2012), borderline personality disorder (BPD; Ruocco et al., 2012), Alzheimer's disease (Barnes et al., 2009), and mild cognitive impairment (MCI; Shi et al., 2009). Since many of these disorders show higher prevalence in women (Breslau, 2009; Johnson et al., 2003; Kessler et al., 2003; McLean et al., 2011; Moschetti et al., 2012), it is reasonable to suspect that a pre-morbid sex difference in HCV—i.e., smaller in females—contributes to this differential vulnerability. Indeed, research in rats and voles has led to the hypothesis that sexual selection for spatial ability produced an expansion of male HCV in polygynous species, including humans (Sherry et al., 1992). "
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    • "Females are twice as likely to develop PTSD compared to males (Breslau, 2009; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). However, most individuals that are exposed to a life threatening experience will not develop PTSD (Breslau, 2009) and this is largely thought to be determined by genetics. This review will focus on epigenetics and the genetic and environmental risk factors of PTSD as well as the genetics of treatment response. "
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    ABSTRACT: a b s t r a c t Posttraumatic stress disorder (PTSD) is a complex syndrome that occurs following exposure to a poten-tially life threatening traumatic event. This review summarises the literature on the genetics of PTSD including gene–environment interactions (GxE), epigenetics and genetics of treatment response. Numer-ous genes have been shown to be associated with PTSD using candidate gene approaches. Genome-wide association studies have been limited due to the large sample size required to reach statistical power. Studies have shown that GxE interactions are important for PTSD susceptibility. Epigenetics plays an important role in PTSD susceptibility and some of the most promising studies show stress and child abuse trigger epigenetic changes. Much of the molecular genetics of PTSD remains to be elucidated. However, it is clear that identifying genetic markers and environmental triggers has the potential to advance early PTSD diagnosis and therapeutic interventions and ultimately ease the personal and financial burden of this debilitating disorder.
    Journal of Anxiety Disorders 12/2014; 28(8):873-883. DOI:10.1016/j.janxdis.2014.09.014 · 2.96 Impact Factor
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    • "However the direction of association is not consistently identified (Sheen et al., 2014). Personal (and direct) experiences of trauma could also predispose to traumatic stress responses following subsequent (indirect) exposure (Breslau, 2009). Personal experience of childbirth trauma could be specifically salient for midwives (e.g., Mander, 2001). "
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    ABSTRACT: Midwives provide care in a context where life threatening or stressful events can occur. Little is known about their experiences of traumatic events or the implications for psychological health of this workforce.Objectives To investigate midwives’ experiences of traumatic perinatal events encountered whilst providing care to women, and to consider potential implications.DesignA national postal survey of UK midwives was conducted.Participants421 midwives with experience of a perinatal event involving a perceived risk to the mother or baby which elicited feelings of fear, helplessness or horror (in the midwife) completed scales assessing posttraumatic stress (PTS) symptoms, worldview beliefs and burnout.Results33% of midwives within this sample were experiencing symptoms commensurate with clinical posttraumatic stress disorder (PTSD). Empathy and previous trauma exposure (personal and whilst providing care to women) were associated with more severe PTS responses. However, predictive utility was limited, indicating a need to consider additional aspects increasing vulnerability. Symptoms of PTS were associated with negative worldview beliefs and two domains of burnout.Conclusions Midwives may experience aspects of their work as traumatic and, as a consequence, experience PTS symptomatology at clinical levels. This holds important implications for both midwives’ personal and professional wellbeing and the wellbeing of the workforce, in addition to other maternity professionals with similar roles and responsibilities. Organisational strategies are required to prepare midwives for such exposure, support midwives following traumatic perinatal events and provide effective intervention for those with significant symptoms.
    International Journal of Nursing Studies 11/2014; 52(2). DOI:10.1016/j.ijnurstu.2014.11.006 · 2.90 Impact Factor
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