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

A. J. Rosellini, H. Liu, M. V. Petukhova, N. A. Sampson, S. Aguilar-Gaxiola, J. Alonso, G. Borges, R. Bruffaerts, E. J. Bromet, G. de Girolamo, P. de Jonge, J. Fayyad, S. Florescu, O. Gureje, J. M. Haro, H. Hinkov, E. G. Karam, N. Kawakami, K. C. Koenen, S. LeeJ. P. Lépine, D. Levinson, F. Navarro-Mateu, B. D. Oladeji, S. O'Neill, B-E Pennell, M. Piazza, J. Posada-Villa, K. M. Scott, D. J. Stein, Y. Torres, M. C. Viana, A. M. Zaslavsky, R. C. Kessler

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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.

Original languageEnglish
Pages (from-to)437-450
Number of pages14
JournalPsychological Medicine
Volume48
Issue number3
Early online date19-Jul-2017
DOIs
Publication statusPublished - Feb-2018

Keywords

  • Journal Article
  • LONG-TERM
  • PTSD
  • RISK
  • PREDICTORS
  • COMMUNITY
  • REMISSION
  • SYMPTOMS
  • VERSION
  • TRAUMA
  • ADULTS

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