Burden Of Posttraumatic Stress Disorder Research Articles

The importance of the post-disaster context in fostering human resilience

The importance of the post-disaster context in fostering human resilience

Improved social services and the burden of post-traumatic stress disorder among economically vulnerable people after a natural disaster: a modelling study

Hurricanes and other natural disasters produce public health and economic consequences that last well beyond their immediate aftermath. Resource loss is a core driver of post-traumatic stress disorder (PTSD) after large-scale traumatic events. We examined the effect of restoration of residential and housing-related financial resources on recovery from PTSD in post-disaster contexts. We built an agent-based model, empiricised with observational and experimental data, to test the effects of differing health service approaches on PTSD recovery, measured by prevalence and persistence. We tested a social services case management (SSCM) approach similar to Psychological First Aid, featuring shelter-based social service provision and linkage to mental health treatment for people who were displaced and had income loss, by comparing the treatment effectiveness of usual care alone, usual care with SSCM, stepped care alone, and stepped care with SSCM. An SSCM approach to restore housing and provide linkage to mental health services among people who were displaced and had income loss after a large-scale natural disaster resulted in between 1·56 (95% CI 1·55-1·57) and 5·73 (5·04-6·91) times as many remitted PTSD cases as non-SSCM conditions at the end of the first year, and between 1·16 (1·16-1·17) and 2·28 (2·25-2·32) times as many remitted cases at the end of the second year. Restoring economic and housing resources to populations affected by a natural disaster would significantly reduce the mental health burden in populations, particularly those with resource loss, after a disaster. US Department of Health and Human Services.

Examining the Relationship Between PTSD Symptomatology and Cigarette Smoking Among Ohio Army National Guard Soldiers

Evidence suggests that posttraumatic stress disorder (PTSD) increases risk for cigarette smoking in civilian and military populations. There is limited evidence about this relationship among National Guard, a group that may be at higher risk of behavioral health concerns compared to Active Component. The current study used cross-sectional data from a clinical subsample of soldiers (N = 455) from the Ohio Army National Guard Mental Health Initiative. Soldiers completed self-report and clinician-rated measures, including demographics, smoking status and intensity, and PTSD. Logistic and multinomial regression methods were used to explore the association between PTSD symptomatology and smoking. Higher PTSD symptom severity was modestly associated with an increased likelihood of being a current (β = 0.02, p = 0.049, OR = 1.02) and heavy smoker (β = 0.04, p = 0.003, OR = 1.04). Reporting more dysphoria or hyperarousal symptoms was modestly associated with an increased likelihood of being a heavy smoker (β = 0.04, p = 0.001, OR = 1.05; β = 0.03, p = 0.03, OR = 1.03). Those with greater PTSD severity are more likely to smoke and have more difficulty quitting; this may have implications for efforts to mitigate the burden of PTSD and smoking among National Guard personnel.

To lose an unborn child: Post-traumatic stress disorder and major depressive disorder following pregnancy loss among Israeli women.

Pregnancy loss (PL) can be a very difficult experience. However, the evidence regarding the prevalence and correlates of psychopathology following PL is inconsistent at best. The present study aimed to assess the prevalence of Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) following PL, and their differential predictors. Participants were 97 women, ages 23-47, who have experienced PL starting from the 2nd trimester. They were recruited at the Hadassah Ein-Kerem Medical Center in Jerusalem, Israel. The mean pregnancy week of loss was 27.92. Participants completed self-report questionnaires assessing PTSD (PCL-5), MDD (BDI-II), sociodemographic variables and factors related to the loss. We have found high rates of probable PTSD (33.3%) and MDD (29.4%) among our sample, as well as high PTSD-MDD comorbidity. A more advanced gestational week of loss and shorter time since PL were positively associated with both PTSD and MDD. Younger age and lower religiosity were associated with more severe PTSD, but not MDD. PL is a potentially-traumatic experience, entailing a heavy burden of PTSD and MDD. Mental health professionals are encouraged to closely monitor women following PL, particularly young mothers, who have experienced PL more recently, and at the advanced stages of pregnancy.

Trauma and PTSD in the WHO World Mental Health Surveys

ABSTRACTBackground: Although post-traumatic stress disorder (PTSD) onset-persistence is thought to vary significantly by trauma type, most epidemiological surveys are incapable of assessing this because they evaluate lifetime PTSD only for traumas nominated by respondents as their ‘worst.’Objective: To review research on associations of trauma type with PTSD in the WHO World Mental Health (WMH) surveys, a series of epidemiological surveys that obtained representative data on trauma-specific PTSD.Method: WMH Surveys in 24 countries (n = 68,894) assessed 29 lifetime traumas and evaluated PTSD twice for each respondent: once for the ‘worst’ lifetime trauma and separately for a randomly-selected trauma with weighting to adjust for individual differences in trauma exposures. PTSD onset-persistence was evaluated with the WHO Composite International Diagnostic Interview.Results: In total, 70.4% of respondents experienced lifetime traumas, with exposure averaging 3.2 traumas per capita. Substantial between-trauma differences were found in PTSD onset but less in persistence. Traumas involving interpersonal violence had highest risk. Burden of PTSD, determined by multiplying trauma prevalence by trauma-specific PTSD risk and persistence, was 77.7 person-years/100 respondents. The trauma types with highest proportions of this burden were rape (13.1%), other sexual assault (15.1%), being stalked (9.8%), and unexpected death of a loved one (11.6%). The first three of these four represent relatively uncommon traumas with high PTSD risk and the last a very common trauma with low PTSD risk. The broad category of intimate partner sexual violence accounted for nearly 42.7% of all person-years with PTSD. Prior trauma history predicted both future trauma exposure and future PTSD risk.Conclusions: Trauma exposure is common throughout the world, unequally distributed, and differential across trauma types with respect to PTSD risk. Although a substantial minority of PTSD cases remits within months after onset, mean symptom duration is considerably longer than previously recognized.

Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex," "Bruno," and "Charles"

The purpose of this study is to explore the effects of a stepped-care model of treatment on Posttraumatic Stress Disorder (PTSD) symptomatology and sequelae in United States' Veterans. The study provides a literature review of the burden of PTSD, describes current best treatment practices, and illustrates key processes in the service-delivery of these treatments. Treatment considerations are demonstrated via three hybrid case examples, which serve as vivid portrayals of Veteran clients who struggle with research-consistent PTSD symptomatology and difficulties engaging in psychotherapy. In addition to being informed by clinical examples in relevant psychological literature, these composite cases, "Alex," "Bruno," and "Charles," contain disguised aspects drawn from psychotherapy clients who have been in my caseload in a PTSD clinic. Demonstrating these clients

Beyond Binary Thinking: Providing Best Practice Treatment to Veterans with PTSD

In "Written Exposure Therapy as Step One in Reducing the Burden of PTSD: The Composite Cases of "Alex,' 'Bruno,' and 'Charles'"(Austern, 2017), I presented three composite case study examples of how veterans suffering from PTSD may benefit from written exposure to their trauma memories. For one case (Bruno), Written Exposure Therapy (WET) was the initial treatment in a stepped-care approach that culminated in Prolonged Exposure therapy. However, for the two others, WET became a standalone treatment. In two commentaries on the cases, Cigrang and Peterson (2017) and Sloan and Marx (2017) discuss the development and efficacy of WET, WET implementation strategies, and practice implications of WET (e.g., the potential to reduce clinician burnout). In my response to these commentaries, I aim to contribute to the bourgeoning discussion of how mental health providers can best incorporate this promising writing-based treatment (WET) into their existing approaches to working with veterans suffering from Post-Traumatic Stress Disorder (PTSD). My response will address themes raised by my composite case studies and by the commentaries, including how stepped-care service delivery models may have the potential to make PTSD care more efficient.

Posttraumatic stress disorder in the World Mental Health Surveys.

Traumatic events are common globally; however, comprehensive population-based cross-national data on the epidemiology of posttraumatic stress disorder (PTSD), the paradigmatic trauma-related mental disorder, are lacking. Data were analyzed from 26 population surveys in the World Health Organization World Mental Health Surveys. A total of 71 083 respondents ages 18+ participated. The Composite International Diagnostic Interview assessed exposure to traumatic events as well as 30-day, 12-month, and lifetime PTSD. Respondents were also assessed for treatment in the 12 months preceding the survey. Age of onset distributions were examined by country income level. Associations of PTSD were examined with country income, world region, and respondent demographics. The cross-national lifetime prevalence of PTSD was 3.9% in the total sample and 5.6% among the trauma exposed. Half of respondents with PTSD reported persistent symptoms. Treatment seeking in high-income countries (53.5%) was roughly double that in low-lower middle income (22.8%) and upper-middle income (28.7%) countries. Social disadvantage, including younger age, female sex, being unmarried, being less educated, having lower household income, and being unemployed, was associated with increased risk of lifetime PTSD among the trauma exposed. PTSD is prevalent cross-nationally, with half of all global cases being persistent. Only half of those with severe PTSD report receiving any treatment and only a minority receive specialty mental health care. Striking disparities in PTSD treatment exist by country income level. Increasing access to effective treatment, especially in low- and middle-income countries, remains critical for reducing the population burden of PTSD.

Life Sciences—Life Writing: PTSD as a Transdisciplinary Entity between Biomedical Explanation and Lived Experience

Since the second half of the 20th century, the life sciences have become one of the dominant explanatory models for almost every aspect of human life. Hand in hand with biomedical developments and technologies, the life sciences are constantly shaping and reshaping human lives and changing human biographies in manifold ways. The orientation towards life sciences and biomedicine from the very beginning to the end of human life is driven by the utopian notion that all forms of contingency could be technologically and medically controlled. This paper addresses the interrelatedness of life sciences and human biographies in a field where contingency and risk become essential and existential parts of lived experience: post-traumatic stress disorder (PTSD). On the one hand, this diagnostic entity is related to (neuro-)biological underpinnings of (a lack of) psychic resilience as well as to those of contemporary pharmacotherapy. On the other hand, PTSD is also understood as based on a traumatic life event, which can be accessed through and addressed by talk therapy, particularly narrative exposure therapy (NET). We argue that a novel focus on concepts of narrativity will generate pathways for an interdisciplinary understanding of PTSD by linking biological underpinnings from neurobiological findings, to brain metabolism and pharmacotherapy via the interface of psychotherapy and the specific role of narratives to the lived experience of patients and vice versa. The goal of our study is to demonstrate why therapies such as psychotherapy or pharmacotherapy are successful in controlling the disease burden of PTSD to some extent, but the restitutio ad integrum, the reestablishing of the bodily and psychic integrity remains out of reach for most PTSD patients. As a test case, we discuss the complementary methods of Traditional Chinese Medicine (TCM) and the established procedures of talk therapy (NET) to show how a methodological focus on narratives enhanced by notions of narrativity from the humanities grants access to therapeutically meaningful, enriched notions of PTSD. We focus on TCM because trauma therapy has long since become an intrinsic part of this complementary medical concept which are more widely accessible and accepted than other complementary medical practices, such as Ayurveda or homeopathy. Looking at the individual that suffers from a traumatic life event and also acknowledging the contemporary concepts of resilience, transdisciplinary concepts become particularly relevant for the medical treatment of and social reintegration of patients such as war veterans. We emphasize the necessity of a new dialogue between the life sciences and the humanities by introducing the concepts of corporeality, capability and temporality as boundary objects crucial for both the biomedical explanation, the narrative understanding and the lived experience of trauma.

Prevalence and factors associated with Posttraumatic Stress Disorder seven years after the conflict in three districts in northern Uganda (The Wayo-Nero Study).

BackgroundResearch on the prevalence of Posttraumatic Stress Disorder (PTSD) is still limited in low income countries yet PTSD can be a public health problem in post conflict areas. In order to respond to the burden of PSTD in northern Uganda, an area that experienced civil strife for over two decades, we need accurate data on its (PTSD) prevalence and the associated risk factors to facilitate public mental health planning.MethodsThis study employed a cross-sectional study design and data collection was undertaken in three districts in northern Uganda: Gulu, Amuru and Nwoya. Respondents were aged 18 years and above and were randomly selected at community level. A total of 2400 respondents were interviewed using a structured questionnaire in the three study districts. In this study, multivariate logistic regression was employed to analyze the associations of socio-demographic factors, trauma related variables and the outcome of PTSD.ResultsThe prevalence of Posttraumatic Stress Disorder (PTSD) in the study population was 11.8 % (95 % CI: 10.5 %, 13.1 %) with a prevalence of 10.9 % (95 % CI: 9.3 %, 12.5 %) among female respondents and 13.4 % (95 % CI: 11.2 %, 15.7 %) among male respondents. Quite a number of factors were strongly associated with PTSD. Overall, a respondent had experienced 9 negative life events. In a multivariate logistic regression, the factors that were strongly associated with PTSD were: exposure to war trauma events, childhood trauma, negative life events, negative copying style and food insecurity. The findings also indicate no association between sex, age and PTSD.ConclusionThe prevalence rate of PTSD in the study communities is unacceptably high. Quite a number of factors were associated with PTSD. Effective public mental health services are needed that combine treatment (medical) psychological and social welfare programs especially at community level to address the high burden of PTSD. Longitudinal studies are also recommended to continuously assess the trends in PTSD in the study communities and remedial action taken.

Exposure to Traumatic Events and Posttraumatic Stress Disorder in France: Results From the WMH Survey.

This study examined the prevalence of traumatic events and the conditional probability of posttraumatic stress disorder (PTSD) associated with both specific and broad classes of events in a nationally representative sample from France. The sample (N = 1,436) was a part of the European Study of the Epidemiology of Mental Disorders Survey (ESEMeD), under the WHO World Mental Health Surveys-2000 initiative. Overall, exposure to any traumatic event was 72.7%, which appeared to be lower than what has been reported in Sweden (80.8%), similar to data from the Netherlands (71.1%), and higher than what has been reported in Spain (54.0%), Italy (56.1%), Northern Ireland (60.6%) or the U.S (55.9%). Lifetime prevalence of PTSD was 3.9%, lower than in the United States (7.8%), Sweden (5.6%), or Northern Ireland (8.8%), but higher than in Spain (2.2%) or Italy (2.4%). Being beaten up by a romantic partner (25.0%), having a child with serious illness (23.5%), and rape (21.5%) were associated with the highest risk of PTSD. The average duration of PTSD was 5.3 years (0.2-28.1). The burden of PTSD in France appeared to come from the consequences of violence and social network events suggesting that prevention efforts might focus on limiting the occurrence of exposure to avoidable events such as violence as well as provide support for persons exposed to social network events.

The Economic Burden of PTSD in Northern Ireland.

The objective of this study was to estimate the economic costs of posttraumatic stress disorder (PTSD) among the Northern Ireland (NI) adult population. The authors present a prevalence-based, bottom-up study based primarily on data from 1,986 participants in the Northern Ireland Study of Health and Stress (NISHS). Both direct costs of treatment and indirect costs of productivity losses were included. Units of service and medication resource use were obtained from the NISHS and combined with their relevant unit costs from the Personal Social Services Research Unit and Prescription Costs Analysis data for NI. Indirect costs included the costs of incapacity days due to PTSD and presenteeism costs, with gender-specific wage rates used as the relevant unit costs. The total direct and indirect cost of PTSD in NI (2008) was £172,756,062. This figure is likely to be conservative due to the exclusion of a number of cost categories. Nevertheless, comparison of estimates of the burden of PTSD with the estimated cost of treating all adults with PTSD with the recommended treatments shows the potential for substantial economic gains to be made through extension and investment in effective evidence-based treatments.

Prevalence of Post-Traumatic Stress Disorder Due to Community Violence Among University Students in the World's Most Dangerous Megacity: A Cross-Sectional Study From Pakistan.

Community violence among the youth can lead to a number of adverse psychiatric outcomes including post-traumatic stress disorder (PTSD). However, little research has been conducted in non-Western countries to assess this problem. This study aims to fill the void by assessing the lifetime exposure to traumatic events and burden of probable PTSD among university students in Karachi, Pakistan. A cross-sectional study was conducted at four private institutions in Karachi. Self-administered questionnaires were filled out by 320 students. Lifetime exposure and symptoms of PTSD were assessed using modified Composite International Diagnostic Interview (CIDI) and Post-Traumatic Stress Disorder Checklist-Civilian Version (PCL-C) questionnaires, respectively. A PCL-C score of 44 or above was used as cutoff for probable PTSD. Pearson chi-square test was used to assess the association between PTSD and different variables at a level of significance of 5%. Ninety-three percent of the respondents reported having lifetime exposure to at least one traumatic event with sudden unexpected death of a loved one (n = 187) and assaultive violence (n = 169) being the commonest reported traumatic events. Positive association for PTSD was seen with enduring physical attacks and motor vehicle accidents. Over a quarter of the students screened positive for probable PTSD, among them almost one third were male and 17% were female. Our results indicate a high exposure to violent events and elevated rates of lifetime PTSD among urban youth. Reduction in violence and better access to mental health facilities is warranted to decrease the health burden of PTSD in Pakistan.

Posttraumatic stress disorder among earthquake survivors of the Wenchuan area (Sichuan, China)

BackgroundOn May 12, 2008, an earthquake with a power of 8.0 M on the Richter scale occurred in the Wenchuan County of Sichuan Province in southwest China, which was unprecedented in magnitude and aftermath. Approximately 70,000 people were killed and nearly 20,000 went missing. The earthquake caused a wide number of mental and physical health outcomes among survivors, and posttraumatic stress disorder (PTSD) was one of the most commonly studied.MethodsWe conducted a systematic overview to assess research achievements about PTSD in the past 6 years after the Wenchuan earthquake, including symptoms and risk factors about PTSD among Wenchuan earthquake survivors, as well as research developments in genetics, molecular biology, and treatment of PTSD.ResultsThe large body of research conducted after the Wenchuan earthquake suggests that the burden of PTSD among persons with high exposure was substantial. Adolescents and adults were among the most studied populations with high prevalence rates. Phytotherapy with Chinese herbs as well as acupuncture were rarely studied as of yet, although published data indicated promising therapy effects. Genome-wide microarray technologies are widely used in experimental mice and rat models to study PTSD mechanisms as well as in patients suffering from PTSD and other psychosomatic disorders to search for novel biomarkers and to monitor the effectiveness of treatment interventions.ConclusionUsing genomic and transcriptomic technologies, our future research will focus on the efficacy and safety of Chinese medicine to find potential interventions and effective treatments of PTSD.

Frequency of trauma exposure and Post-Traumatic Stress Disorder in Italy: analysis from the World Mental Health Survey Initiative

Epidemiological studies have examined the relative importance of Traumatic Events (TEs) in accounting for the societal burden of post-traumatic stress disorder (PTSD). However, most studies used the worst trauma experienced, which can lead to an overestimation of the conditional risk of PTSD. Although a number of epidemiological surveys on PTSD have been carried out in the United States, only a few studies in limited sample have been conducted in Italy.This study, carried out in the framework of the World Mental Health Survey Initiative, is a cross-sectional household survey of a representative sample of the Italian adult population. Lifetime prevalence of TEs and 12-month prevalence of PTSD were evaluated using the Composite International Diagnostic Interview (CIDI). Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. Network events was the most commonly reported class of TEs (29.4%). War events had the highest conditional risk of PTSD (12.2%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (24.1%) and having seen atrocities (18.2%). Being female was related to high risk of PTSD after experiencing a TE. Exposure to network events is commonly reported among Italian adults, but two TEs are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.

Association between traumatic events and post-traumatic stress disorder: results from the ESEMeD-Spain study

The relative importance of traumatic events (TEs) in accounting for the social burden of post-traumatic stress disorder (PTSD) could vary according to cross-cultural factors. In that sense, no such studies have yet been conducted in the Spanish general population. The present study aims to determine the epidemiology of trauma and PTSD in a Spanish community sample using the randomly selected TEs method. The European Study of the Epidemiology of Mental Disorders (ESEMeD)-Spain is a cross-sectional household survey of a representative sample of adult population. Lifetime prevalence of self-reported TEs and lifetime and 12-month prevalence of PTSD were evaluated using the World Health Organization (WHO) Composite International Diagnostic Interview. Reports of PTSD associated with randomly selected TEs were weighted by the individual-level probabilities of TE selection to generate estimates of population-level PTSD risk associated with each TE. Road accident was the most commonly self-reported TE (14.1%). Sexual assault had the highest conditional risk of PTSD (16.5%). The TEs that contributed most to societal PTSD burden were unexpected death of a loved one (36.4% of all cases) and sexual assault (17.2%). Being female and having a low educational level were associated with low risk of overall TE exposure and being previously married was related to higher risk. Being female was related to high risk of PTSD after experiencing a TE. Having an accident is commonly reported among Spanish adults, but two TE are responsible for the highest burden associated with PTSD: the unexpected death of someone close and sexual assault. These results can help designing public health interventions to reduce the societal PTSD burden.

Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature

American Indians and Alaska Natives (AI/ANs) experience high rates of trauma and posttraumatic stress disorder (PTSD). We reviewed existing literature to address three interrelated questions: (1) What is the prevalence of PTSD and PTSD symptoms among AI/ANs? (2) What are the inciting events, risk factors, and co-morbidities in AI/ANs, and do they differ from those in the general U.S. population? (3) Are studies available to inform clinicians about the course and treatment of PTSD in this population? We searched the PubMed and Web of Science databases and a database on AI/AN health, capturing an initial sample of 77 original English-language articles published 1992–2010. After applying exclusion criteria, we retained 37 articles on prevalence of PTSD and related symptoms among AI/AN adults. We abstracted key information and organized it in tabular format. AI/ANs experience a substantially greater burden of PTSD and related symptoms than U.S. Whites. Combat experience and interpersonal violence were consistently cited as leading causes of PTSD and related symptoms. PTSD was associated with bodily pain, lung disorders, general health problems, substance abuse, and pathological gambling. In general, inciting events, risk factors, and co-morbidities appear similar to those in the general U.S. population. Substantial research indicates a strikingly high incidence of PTSD in AI/AN populations. However, inciting events, risk factors, and co-morbidities in AI/ANs, and how they may differ from those in the general population, are poorly understood. Very few studies are available on the clinical course and treatment of PTSD in this vulnerable population.

Traumatic events and their relative PTSD burden in Northern Ireland: a consideration of the impact of the ‘Troubles’

Over a 30-year period in its recent history, daily life in Northern Ireland (NI) was characterised by civil violence, colloquially termed as the 'Troubles'. The current report examines exposure to 29 traumatic event types and the associated conditional prevalence of post-traumatic stress disorder (PTSD) among the Northern Ireland population, with a focus on the impact of traumatic events that were characteristic of the NI 'Troubles'. Results presented are based on analysis of data from the Northern Ireland Study of Health and Stress (NISHS). The NISHS is a representative epidemiological study of mental health among the NI adult population (N = 4,340) and part of the World Mental Health Survey Initiative. Perpetration of violence, physical assault by a spouse or partner and private events were the event types associated with the highest conditional prevalence of PTSD. Despite this elevated risk, collectively these events accounted for just 16.8% of the overall public burden of PTSD, given their low prevalence among the general population. Events that were characteristic of civil conflict, including unexpected death of a loved one, witnessing death or a dead body or someone seriously injured and being mugged or threatened with a weapon accounted for the highest proportion of the overall public health burden of PTSD (18.6, 9.4 and 7.8%, respectively). These findings are a feature of the higher prevalence of these events among the general population coupled with their moderate to above average risk of PTSD. Despite the formal end to conflict in NI in 1999, a substantial proportion of the adult population continue to suffer the adverse mental health effects of chronic trauma exposure. Given rates of recovery of PTSD in the absence of evidence-based treatments, it is likely that the legacy of mental ill health associated with conflict, if not adequately addressed, will endure for many years.

Prevalence of PTSD in Survivors of Stroke and Transient Ischemic Attack: A Meta-Analytic Review

Background and PurposePosttraumatic stress disorder (PTSD) is common in survivors of acute life-threatening illness, but little is known about the burden of PTSD in survivors of stroke and transient ischemic attack (TIA). This study estimated the prevalence of stroke or TIA-induced posttraumatic stress disorder (PTSD) using systematic review and meta-analysis.MethodsPotentially relevant peer-reviewed journal articles were identified by searching the Ovid MEDLINE, PsycINFO, PILOTS Database, The Cochrane Library and Scopus from inception to January 2013; all searches were conducted on January 31, 2013. Observational cohort studies that assessed PTSD with specific reference to a stroke or TIA that occurred at least 1 month prior to the PTSD assessment were included. PTSD rates and characteristics of the study and sample were abstracted from all included studies. The coding of all articles included demographics, sample size, study country, and method and timing of PTSD assessment.ResultsNine studies (N = 1,138) met our inclusion criteria. PTSD rates varied significantly across studies by timing of PTSD assessment (i.e., within 1 year of stroke/TIA versus greater than 1 year post-stroke/TIA; 55% of heterogeneity explained; Q 1 = 10.30; P = .001). Using a random effects model, the estimated rate of PTSD following stroke or TIA was 23% (95% CI, 16%–33%) within 1 year of the stroke or TIA and 11% (95% CI, 8%–14%) after 1 year.ConclusionsAlthough PTSD is commonly thought to be triggered by external events such as combat or sexual assault, these results suggest that 1 in 4 stroke or TIA survivors develop significant PTSD symptoms due to the stroke or TIA. Screening for PTSD in a large population-based prospective cohort study with cardiovascular outcome assessments is needed to yield definitive prevalence, and determine whether stroke or TIA-induced PTSD is a risk factor for subsequent cardiovascular events or mortality.

No Association Between Cumulative Traumatic Experiences and Sex in Risk for Posttraumatic Stress Disorder Among Human Immunodeficiency Virus–Positive Adults

This study examined the association between the type and number of traumatic experiences and the conditional risk for posttraumatic stress disorder (PTSD), stratified by sex, in human immunodeficiency virus (HIV). We evaluated 465 (114 male and 350 female) HIV-positive adults attending HIV clinics in Cape Town, South Africa. Demographic and clinical data were collected, and the participants were screened for current PTSD and traumatic event exposure using the Mini-International Neuropsychiatric Interview and the Life Events Checklist, respectively. The highest attributable risk for PTSD was derived from sexual assault (17.4%) and transport accidents (16.9%). Only sexual assault was significantly (p = 0.002) associated with current PTSD. Although sex had no effect on the prediction of current PTSD, HIV-infected men tended to experience more lifetime traumas than HIV-infected women, with the men having significantly higher rates of exposure than women to physical assault (p = 0.018) and assault with a weapon (p = 0.001). These data highlight the importance of considering trauma type in contributing to the burden of PTSD in HIV-infected adults.