TY - JOUR
T1 - Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys
AU - Mclaughlin, Katie A.
AU - Koenen, Karestan C.
AU - Friedman, Matthew J.
AU - Ruscio, Ayelet Meron
AU - Karam, Elie G.
AU - Shahly, Victoria
AU - Stein, Dan J.
AU - Hill, Eric D.
AU - Petukhova, Maria
AU - Alonso, Jordi
AU - Andrade, Laura Helena
AU - Angermeyer, Matthias C.
AU - Borges, Guilherme
AU - De Girolamo, Giovanni
AU - De Graaf, Ron
AU - Demyttenaere, Koen
AU - Florescu, Silvia E.
AU - Mladenova, Maya
AU - Posada-Villa, Jose
AU - Scott, Kate M.
AU - Takeshima, Tadashi
AU - Kessler, Ronald C.
N1 - Funding Information:
The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation Thematic Project Grant No. 03/00204-3. The Colombian National Study of Mental Health is supported by the Ministry of Social Protection. The Bulgarian Epidemiological Study of common mental disorders (EPIBUL) is supported by the Ministry of Health and the National Center for Public Health Protection. The European Study of the Epidemiology of Mental Disorders (ESEMeD) project is funded by the European Commission (Contracts QLG5-1999-01042, Health and Consumer Affairs (SANCO) 2004123, and Executive Agency for Health and Consumers (EACH) 20081308); the Piedmont Region, Italy; Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (Grant No. Fund for Health of Spain (FIS) 00/0028); Ministerio de Ciencia y Tecnología, Spain (Grant No. SAF 2000-158-CE); Departament de Salut, Generalitat de Catalunya, Spain; Instituto de Salud Carlos III (Grant Nos. Networked Biomedical Research Centres (CIBER) CB06/02/0046 and Cooperative Health Research Thematic Networks (RETICS) RD06/0011 REM-TAP); and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The World Mental Health Japan Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (Grant Nos. H13-SHOGAI-023, H14-TOKUBETSU-026, and H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Mexican National Comorbidity Survey is supported by The National Institute of Psychiatry Ramon de la Fuente (Grant No. INPRFMDIES 4280) and by the National Council on Science and Technology (Grant No. CONACyT-G30544-H), with supplemental support from the PanAmerican Health Organization. Te Rau Hinengaro: The New Zealand Mental Health Survey is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and Health Research Council. The Romania WMH study projects “Policies in Mental Health Area” and “National Study regarding Mental Health and Services Use” were carried out by the National School of Public Health & Health Services Management (former National Institute for Research & Development in Health, present National School of Public Health Management & Professional Development, Bucharest), with technical support of Metro Media Transilvania, the National Institute of Statistics—National Centre for Training in Statistics, SC, Cheyenne Services SRL, and Statistics Netherlands, and were funded by the Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The U.S. National Comorbidity Survey Replication is supported by the National Institute of Mental Health (Grant No. U01-MH60220) with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (Grant No. 044708), and the John W. Alden Trust.
Funding Information:
DJS has received research grants or consultancy honoraria or both from Abbott Laboratories, AstraZeneca, Eli Lilly and Company, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Takeda, Tikvah, and Wyeth. KD has served on advisory boards and speaker bureaus for and has research grants from AstraZeneca, Eli Lilly and Company, GlaxoSmithKline, Lundbeck, Takeda, and Servier. RCK has been a consultant for AstraZeneca, Analysis Group, Bristol-Myers Squibb, Cerner Galt, Eli Lilly and Company, GlaxoSmithKline, HealthCore, Health Dialog, Hoffmann-LaRoche, Integrated Benefits Institute, Wellness & Prevention, Inc., John Snow, Inc., Kaiser Permanente, Lake Nona Institute, Matria Healthcare, Mensante, Merck & Co, Ortho-McNeil Janssen Scientific Affairs, Pfizer, Primary Care Network, Research Triangle Institute, Sanofi-Aventis Groupe, Shire, SRA International, Inc., Takeda Global Research & Development, Transcept Pharmaceuticals, and Wyeth-Ayerst; has served on advisory boards for Appliance Computing Ii, Eli Lilly and Company, Mindsite, Ortho-McNeil Janssen Scientific Affairs, Johnson & Johnson, Plus One Health Management, and Wyeth-Ayerst; has had research support for epidemiologic studies from Analysis Group, Bristol-Myers Squibb, Eli Lilly and Company, EPI-Q, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Janssen Scientific Affairs, Pfizer, Sanofi-Aventis Groupe, Shire, and Walgreens; and owns 25% share in DataStat, Inc. All other authors report no biomedical financial interests or potential conflicts of interest.
Funding Information:
This work, carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative, was supported by the National Institute of Mental Health (Grant Nos. R01 MH070884 and R01 MH093612-01), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (Grant Nos. R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (Grant No. FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this article. A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/ .
PY - 2015
Y1 - 2015
N2 - BACKGROUND: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition. METHODS: The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid feardistress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions. RESULTS: Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones. CONCLUSIONS: Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.
AB - BACKGROUND: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition. METHODS: The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid feardistress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions. RESULTS: Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones. CONCLUSIONS: Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.
KW - Epidemiology
KW - Nosology
KW - PTSD
KW - Partial PTSD
KW - Posttraumatic stress disorder
KW - Subthreshold PTSD
UR - http://www.scopus.com/inward/record.url?scp=84922656433&partnerID=8YFLogxK
U2 - 10.1016/j.biopsych.2014.03.028
DO - 10.1016/j.biopsych.2014.03.028
M3 - Article
C2 - 24842116
AN - SCOPUS:84922656433
SN - 0006-3223
VL - 77
SP - 375
EP - 384
JO - Biological Psychiatry
JF - Biological Psychiatry
IS - 4
ER -