Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys.
Association of DSM-IV Posttraumatic Stress Disorder With Traumatic Experience Type and History in the World Health Organization World Mental Health Surveys.
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DOI：
10.1001/jamapsychiatry.2016.3783
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发表时间：
2017-03-01
期刊：
影响因子：
25.8
通讯作者：
World Health Organization World Mental Health Survey Collaborators
中科院分区：
文献类型：
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作者：
Liu H;Petukhova MV;Sampson NA;Aguilar-Gaxiola S;Alonso J;Andrade LH;Bromet EJ;de Girolamo G;Haro JM;Hinkov H;Kawakami N;Koenen KC;Kovess-Masfety V;Lee S;Medina-Mora ME;Navarro-Mateu F;O'Neill S;Piazza M;Posada-Villa J;Scott KM;Shahly V;Stein DJ;Ten Have M;Torres Y;Gureje O;Zaslavsky AM;Kessler RC;World Health Organization World Mental Health Survey Collaborators
先前的研究已经记录了创伤后应激障碍（PTSD）患病率的显着差异，具体取决于创伤经历（TE）的类型和TE暴露史，但这些研究中的样本量相对较小，导致了许多未解决的基本问题。在大型跨国社区流行病学数据集中检查 TE 病史类型与 PTSD 的分类关联。世界卫生组织的世界心理健康调查评估了 29 种 TE 类型（终生暴露、首次暴露年龄）与 DSM-IV PTSD，这与每个受访者随机选择的 1 次 TE 暴露（随机 TE）相关。 2001 年至 2012 年在 20 个国家（n = 34 676 名受访者）进行了调查。对 2015 年 10 月 1 日至 2016 年 9 月 1 日期间的数据进行了分析。通过综合国际诊断访谈评估了 PTSD 的患病率。在 34 676 名受访者中（55.4% [SE，0.6%] 男性和 44.6% [SE，0.6%] 女性；平均 [SE] 年龄，43.7 [0.2] 岁），加权 70.3% 的受访者报告了终生 TE 暴露（平均 [SE] 暴露次数，在有任何 TE 的受访者中为 4.5 [0.04]）。与随机 TE 相关的 PTSD 加权（按 TE 频率）患病率为 4.0%。涉及性暴力（2.7；95% CI，2.0-3.8）和目击暴行（4.2；95% CI，1.0-17.8）的 TE 的 PTSD 比值比（OR）较高。之前接触过一些（但不是全部）同类型的 TE 与随机 TE 后的 PTSD 脆弱性（例如，身体攻击；OR，3.2；95% CI，1.3-7.9）或复原力（例如，参与宗派暴力；OR，0.3；95% CI，0.1-0.9）增加相关。早期研究发现，在所有随机 TE 类型中，更一般的 TE 暴露史与 PTSD 易感性增加相关，这一发现得到了重复，但这种普遍的易感性仅限于以前涉及暴力的 TE，包括参与有组织暴力（OR，1.3；95% CI，1.0–1.6）、身体暴力经历（OR，1.4；95% CI，1.2–1.7）、强奸（OR，2.5；95% CI，1.0–1.6）、强奸（OR，2.5；95% CI，1.0–1.6）。 95% CI，1.7–3.8）和其他性侵犯（OR，1.6；95% CI，1.1–2.3）。世界心理健康调查结果加深了人们对 PTSD 风险随 TE 类型和 TE 接触史的变化程度的了解。先前关于与涉及攻击性暴力的 TE 相关的 PTSD 风险升高的研究结果通过仅在重复发生时表现出一致而得到完善。某些类型的先前 TE 暴露与复原力的增加有关，而不是脆弱性的增加，这将有关 TE 历史的文献与有关逆境后复原力的文献联系起来。这些结果对于为未来研究中对这些规范进行更有针对性的调查提供实证依据很有价值。
Previous research has documented significant variation in the prevalence of posttraumatic stress disorder (PTSD) depending on the type of traumatic experience (TE) and history of TE exposure, but the relatively small sample sizes in these studies resulted in a number of unresolved basic questions. To examine disaggregated associations of type of TE history with PTSD in a large cross-national community epidemiologic data set. The World Health Organization World Mental Health surveys assessed 29 TE types (lifetime exposure, age at first exposure) with DSM-IV PTSD that was associated with 1 randomly selected TE exposure (the random TE) for each respondent. Surveys were administered in 20 countries (n = 34 676 respondents) from 2001 to 2012. Data were analyzed from October 1, 2015, to September 1, 2016. Prevalence of PTSD assessed with the Composite International Diagnostic Interview. Among the 34 676 respondents (55.4% [SE, 0.6%] men and 44.6% [SE, 0.6%] women; mean [SE] age, 43.7 [0.2] years), lifetime TE exposure was reported by a weighted 70.3% of respondents (mean [SE] number of exposures, 4.5 [0.04] among respondents with any TE). Weighted (by TE frequency) prevalence of PTSD associated with random TEs was 4.0%. Odds ratios (ORs) of PTSD were elevated for TEs involving sexual violence (2.7; 95% CI, 2.0–3.8) and witnessing atrocities (4.2; 95% CI, 1.0–17.8). Prior exposure to some, but not all, same-type TEs was associated with increased vulnerability (eg, physical assault; OR, 3.2; 95% CI, 1.3–7.9) or resilience (eg, participation in sectarian violence; OR, 0.3; 95% CI, 0.1–0.9) to PTSD after the random TE. The finding of earlier studies that more general history of TE exposure was associated with increased vulnerability to PTSD across the full range of random TE types was replicated, but this generalized vulnerability was limited to prior TEs involving violence, including participation in organized violence (OR, 1.3; 95% CI, 1.0–1.6), experience of physical violence (OR, 1.4; 95% CI, 1.2–1.7), rape (OR, 2.5; 95% CI, 1.7–3.8), and other sexual assault (OR, 1.6; 95% CI, 1.1–2.3). The World Mental Health survey findings advance understanding of the extent to which PTSD risk varies with the type of TE and history of TE exposure. Previous findings about the elevated PTSD risk associated with TEs involving assaultive violence was refined by showing agreement only for repeated occurrences. Some types of prior TE exposures are associated with increased resilience rather than increased vulnerability, connecting the literature on TE history with the literature on resilience after adversity. These results are valuable in providing an empirical rationale for more focused investigations of these specifications in future studies.