Abstract
Objectives
To present current, nationally representative US findings on the past-year and lifetime prevalences, sociodemographic correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 posttraumatic stress disorder (PTSD).
Methods
Face-to-face interviews with 36,309 adults in the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III. PTSD, alcohol and drug use disorders, and selected mood, anxiety, and personality disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5.
Results
Past-year and lifetime prevalences were 4.7 and 6.1 %, higher for female, white, Native American, younger, and previously married respondents, those with <high school education and lower incomes, and rural residents. PTSD was significantly associated with a broad range of substance use, mood, anxiety, and personality disorders, and past-month disability. Among respondents with lifetime PTSD, 59.4 % sought treatment; an average of 4.5 years elapsed from disorder onset to first treatment.
Conclusions
DSM-5 PTSD is prevalent, highly comorbid, disabling, and associated with delayed help seeking. Additional research is needed to elucidate relationships identified herein, estimate PTSD-related costs, investigate hypotheses regarding etiology, course, and treatment, and support decisions about resource allocation to service delivery and research. Initiatives are needed to destigmatize PTSD, educate the public about its treatment, and encourage affected individuals to seek help.
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References
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn (DSM-IV), text revision. American Psychiatric Association, Washington, DC
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):617–627
Alegría M, Fortuna LR, Lin JY, Norris FH, Gao S, Takeuchi D, Jackson JS, Shrout PE, Valentine A (2013) Prevalence, risk, and correlates of posttraumatic stress disorder across ethnic and racial minority groups in the United States. Med Care 51(12):1114–1123
Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011) Prevalence and axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord 25(3):456–465
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602
Karam EG, Friedman MJ, Hill ED, Kessler RC, McLaughlin KA, Petukhova M, Sampson L, Shahly V, Angermeyer MC, Bromet EJ, de Girolamo G, de Graaf R, Demyttenaere K, Ferry F, Florescu SE, Haro JM, He Y, Mint MH, Karam AN, Kawakami N, Kovess-Masfety V, Medina-Mora ME, Oakley Browne MA, Posada-Villa JA, Shalev AY, Stein DJ, Viana MC, Zarkov Z, Koenen KC (2014) Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) Surveys. Depress Anxiety 31(2):130–142
Creamer M, Burgess P, McFarlane AC (2001) Posttraumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-Being. Psychol Med 31(7):1237–1247
Rosenman S (2002) Trauma and posttraumatic stress disorder in Australia: findings in the population sample of the Australian National Survey of Mental Health and Well-Being. Aust N Z J Psychiatry 36(4):515–520
Hauffa R, Rief W, Brähler E, Martin A, Mewes R, Glaesmer H (2011) Lifetime traumatic experiences and posttraumatic stress disorder in the German population. J Nerv Ment Dis 199(12):934–939
Frans O, Rimmo P-A, Aberg L, Fredrikson M (2005) Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiatr Scand 111(4):291–299
de Vries GJ, Olff M (2009) The lifetime prevalence of posttraumatic stress disorder in the Netherlands. J Trauma Stress 22(4):259–267
Bunting BP, Murphy SD, O’Neill SM, Ferry FR (2012) Lifetime prevalence of mental health disorders and delay in treatment following initial onset: evidence from the Northern Ireland Study of Health and Stress. Psychol Med 42(8):1727–1739
van Ameringen M, Mancini C, Patterson B, Boyle MH (2008) Post-traumatic stress disorder in Canada. CNS Neurosci Ther 14(3):171–181
Breslau N, Peterson EL, Poisson LM, Schultz LR, Lucia VC (2004) Estimating posttraumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychol Med 34(5):1205–1214
Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011) Personality disorders associated with full and partial posttraumatic stress disorder in the U.S. population: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Psychiatr Res 45(5):678–686
Cougle JR, Keough ME, Riccardi CJ, Sachs-Ericsson N (2009) Anxiety disorders and suicidality in the National Comorbidity Survey-Replication. J Psychiatr Res 43(9):825–829
Nock MK, Hwang I, Sampson N, Kessler RC, Angermeyer M, Beautrais A, Borges G, Bromet E, Bruffaerts R, de Girolamo G, de Graaf R, Florescu S, Gureje O, Haro JM, Hu C, Huang Y, Karam EG, Kawakami N, Kovess V, Levinson D, Posada-Villa J, Sagar R, Tomov T, Viana MC, Williams DR (2009) Cross-national analysis of the associations among mental disorders and suicidal behavior: findings from the WHO World Mental Health Surveys. PLoS Med 6(8):e1000123
Bruffaerts R, Vilagut G, Demyttenaere K, Alonso J, Alhamzawi A, Andrade LH, Benjet C, Bromet E, Bunting B, de Girolamo G, Florescu S, Gureje O, Haro JM, He Y, Hinkov H, Hu C, Karam EG, Lepine JP, Levinson D, Matschinger H, Nakane Y, Ormel J, Posada-Villa J, Scott KM, Varghese M, Williams DR, Xavier M, Kessler RC (2012) Role of common mental and physical disorders in partial disability around the world. Br J Psychiatry 200(6):454–461
Gadermann AM, Alonso J, Vilagut G, Zaslavsky AM, Kessler RC (2012) Comorbidity and disease burden in the National Comorbidity Survey Replication (NCS-R). Depress Anxiety 29(9):797–806
Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011) Medical comorbidity of full and partial posttraumatic stress disorder in U.S. adults: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med 73(8):697–707
Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJ (2007) Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med 69(3):242–248
Sledjeski EM, Speisman B, Dierker LC (2008) Does number of lifetime traumas explain the relationship between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). J Behav Med 31(4):341–349
Spitzer C, Barnow S, Völzke H, John U, Freyberger HJ, Grabe HJ (2009) Trauma, posttraumatic stress disorder, and physical illness: findings from the general population. Psychosom Med 71(9):1012–1017
Deykin EY, Keane TM, Kaloupek D, Fincke G, Rothendler J, Siegfried M, Creamer K (2001) Posttraumatic stress disorder and the use of health services. Psychosom Med 63(5):835–841
Ivanova JI, Birnbaum HG, Chen L, Duhig AM, Dayoub EJ, Kantor ES, Schiller MB, Phillips GA (2011) Cost of post-traumatic stress disorder vs major depressive disorder among patients covered by Medicaid or private insurance. Am J Manag Care 17(8):e314–e323
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5), 5th edn. American Psychiatric Press, Arlington
Friedman MJ (2013) Finalizing PTSD in DSM-5: getting here from there and where to go next. J Trauma Stress 26(5):548–556
Möller HJ, Bandelow B, Bauer M, Hampel H, Herpertz SC, Soyka M, Barnikol UB, Lista S, Severus E, Maier W (2015) DSM-5 reviewed from different angles: goal attainment, rationality, use of evidence, consequences—part 2: bipolar disorders, schizophrenia spectrum disorders, anxiety disorders, obsessive–compulsive disorders, trauma- and stressor-related disorders, personality disorders, substance-related and addictive disorders, neurocognitive disorders. Eur Arch Psychiatry Clin Neurosci 265:87–106
Grant BF, Chu A, Sigman R, Amsbary M, Kali J, Sugawara Y, Jiao R, Ren W, Goldstein R (2014) Source and accuracy statement: National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). National Institute on Alcohol Abuse and Alcoholism, Rockville
Bureau of the Census (2013) American Community Survey, 2012. Bureau of the Census, Suitland
Grant BF, Goldstein RB, Saha TD, Chou SP, Jung J, Zhang H, Pickering RP, Ruan WJ, Smith SM, Huang B, Hasin DS (2015) The epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. JAMA Psychiatry 72(8):757–766
Substance Abuse and Mental Health Services Administration (2014) Results from the 2013 National Survey on Drug Use and Health—detailed tables. Substance Abuse and Mental Health Services Administration, Rockville
Centers for Disease Control and Prevention (2014) Summary health statistics for U.S. adults: National Health Interview Survey, 2012. National Center for Health Statistics, Hyattsville
Grant BF, Goldstein RB, Chou SP, Saha TD, Ruan WJ, Huang B, Smith SM, Zhang H, Jung J, Pickering RP, Aivadyan C, Greenstein E, Hasin DS (2011) The Alcohol Use Disorder and Associated Disabilities Interview Schedule—Diagnostic and Statistical Manual of Mental Disorders, 5th edn version (AUDADIS-5). National Institute on Alcohol Abuse and Alcoholism, Rockville
Elhai JD, Miller ME, Ford JD, Biehn TL, Palmieri PA, Frueh BC (2012) Posttraumatic stress disorder in DSM-5: estimates of prevalence and symptom structure in a nonclinical sample of college students. J Anxiety Disord 26(1):58–64
Grant BF, Goldstein RB, Smith SM, Jung J, Zhang H, Chou SP, Pickering RP, Ruan WJ, Huang B, Saha TD, Aivadyan C, Greenstein E, Hasin DS (2015) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend 148(1):27–33
Hasin DS, Aivadyan C, Greenstein E, Grant BF (2011) Psychiatric Research Interview for Substance Use and Mental Disorders, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PRISM-5) version. Department of Psychiatry, Columbia University, New York
Hasin DS, Shmulewitz D, Stohl M, Greenstein E, Aivadyan C, Morita K, Saha T, Aharonovich E, Jung J, Zhang H, Nunes EV, Grant BF (2015) Procedural validity of the AUDADIS-5 depression, anxiety and posttraumatic stress disorder modules: substance abusers and others in the general population. Drug Alcohol Depend 152(1):246–256
Hasin DS, Greenstein E, Aivadyan C, Stohl M, Aharonovich E, Saha T, Goldstein R, Nunes EV, Jung J, Zhang H, Grant BF (2015) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): procedural validity of substance use disorders modules through clinical re-appraisal in a general population sample. Drug Alcohol Depend 148(1):40–46
Gandek B, Ware JE Jr, Aaronson NK, Alonso J, Apolone G, Bjorner J, Brazier J, Bullinger M, Fukuhara S, Kaasa S, Leplège A, Sullivan M (1998) Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol 51(11):1149–1158
Research Triangle Institute (2012) SUDAAN language manual, release 11.0. Research Triangle Institute, Research Triangle Park
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52(12):1048–1060
Tolin DF, Foa EB (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132(6):959–992
Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P (1998) Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 55(7):626–632
Kachadourian LK, Pilver CE, Potenza MN (2014) Trauma, PTSD, and binge and hazardous drinking among women and men: findings from a national study. J Psychiatr Res 55(1):35–43
Breslau N (2012) Epidemiology of posttraumatic stress disorder in adults. In: Beck JG, Sloan DM (eds) The Oxford handbook of traumatic stress disorders. Oxford University Press, New York, pp 84–97
Kessler RC, Rose S, Koenen KC, Karam EG, Stang PE, Stein DJ, Heeringa SG, Hill ED, Liberzon I, McLaughlin KA, McLean SA, Pennell BE, Petukhova M, Rosellini AJ, Ruscio AM, Shahly V, Shalev AY, Silove D, Zaslavsky AM, Angermeyer MC, Bromet EJ, de Almeida JM, de Girolamo G, de Jonge P, Demyttenaere K, Florescu SE, Gureje O, Haro JM, Hinkov H, Kawakami N, Kovess-Masfety V, Lee S, Medina-Mora ME, Murphy SD, Navarro-Mateu F, Piazza M, Posada-Villa J, Scott K, Torres Y, Carmen Viana M (2014) How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys. World Psychiatry 13(3):265–274
Campbell R, Dworken E, Cabral G (2009) An ecological model of the impact of sexual assault on women’s mental health. Trauma Viol Abuse 10(3):225–246
Moor A, Farchi M (2011) Is rape-related self-blame distinct from other posttraumatic attributions of blame? A comparison of severity and implications for treatment. Women Ther 34(4):447–460
Ullman SE (2007) Relationship to perpetrator, disclosure, social reactions, and PTSD symptoms in child sexual abuse survivors. J Child Sex Abus 16(1):19–36
Dong M, Anda RF, Dube SR, Giles WH, Felitti VJ (2003) The relationship of exposure to childhood sexual abuse to other forms of abuse, neglect, and household dysfunction during childhood. Child Abuse Negl 27(6):625–639
Dong M, Anda RF, Felitti VJ, Dube SR, Williamson DF, Thompson TJ, Loo CM, Giles WH (2004) The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse Negl 28(7):771–784
Breslau N (2009) The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Viol Abuse 10(3):198–210
Koenen KC, Moffitt TE, Poulton R, Martin J, Caspi A (2007) Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort. Psychol Med 37(2):181–192
Miller-Graff LE, Scrafford K, Rice C (2016) Conditional and indirect effects of age of first exposure on PTSD symptoms. Child Abuse Negl 51(1):303–312
Pratchett LC, Yehuda R (2011) Foundations of posttraumatic stress disorder: does early life trauma lead to adult posttraumatic stress disorder? Dev Psychopathol 23(2):477–491
Gil S, Caspi Y (2006) Personality traits, coping style, and perceived threat as predictors of posttraumatic stress disorder after exposure to a terrorist attack: a prospective study. Psychosom Med 68(6):904–909
May CL, Wisco BE (2015) Defining trauma: how level of exposure and proximity affect risk for posttraumatic stress disorder. Psychol Trauma 8(2):233–240
Breslau N, Davis GC, Schultz LR (2003) Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Arch Gen Psychiatry 60(3):289–294
Reed PL, Anthony JC, Breslau N (2007) Incidence of drug problems in young adults exposed to trauma and posttraumatic stress disorder: do early life experiences and predispositions matter? Arch Gen Psychiatry 64(12):1435–1442
Logue MW, Amstadter AB, Baker DG, Duncan L, Koenen KC, Liberzon I, Miller MW, Morey RA, Nievergelt CM, Ressler KJ, Smith AK, Smoller JW, Stein MB, Sumner JA, Uddin M (2015) The Psychiatric Genomics Consortium Posttraumatic Stress Disorder Workgroup: posttraumatic stress disorder enters the age of large-scale genomic collaboration. Neuropsychopharmacology 40(10):2287–2297
Smoller JW (2016) The genetics of stress-related disorders: PTSD, depression and anxiety disorders. Neuropsychopharmacology 41(1):297–319
Difede J, Olden M, Cukor J (2014) Evidence-based treatment of post-traumatic stress disorder. Annu Rev Med 65:319–332
Warner CH, Warner CM, Appenzeller GN, Hoge CW (2013) Identifying and managing posttraumatic stress disorder. Am Fam Phys 88(12):827–834
Jonas DE, Cusack K, Forneris CA, Wilkins TM, Sonis J, Middleton JC, Feltner C, Meredith D, Cavanaugh J, Brownley KA, Olmsted KR, Greenblatt A, Weil A, Gaynes BN (2013) Psychological and pharmacological treatments for adults with posttraumatic stress disorder (PTSD). In: Comparative effectiveness review no. 92. AHRQ publication no. 13-EHC011-EF. Agency for Healthcare Research and Quality, Rockville. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm. Accessed 21 October 2015
Bernardy NC, Friedman MJ (2015) Psychopharmacological strategies in the management of posttraumatic stress disorder (PTSD): what have we learned? Curr Psychiatry Rep 17(4):564
Hoskins M, Pearce J, Bethell A, Dankova L, Barbui C, Tol WA, van Ommeren M, de Jong J, Seedat S, Chen H, Bisson JI (2015) Pharmacotherapy for post-traumatic stress disorder: systematic review and meta-analysis. Br J Psychiatry 206(2):93–100
Department of Veterans Affairs; Department of Defense (2010) VA/DoD clinical practice guideline for management of post-traumatic stress. http://www.healthquality.va.gov/guidelines/MH/ptsd/cpgPTSDFULL201011612c.pdf. Accessed 29 February 2016
Forbes D, Creamer M, Bisson JI, Cohen JA, Crow BE, Foa EB, Friedman MJ, Keane TM, Kudler HS, Ursano RJ (2010) A guide to guidelines for the treatment of PTSD and related conditions. J Trauma Stress 23(5):537–552
Cohen MA, Alfonso CA, Hoffman RG, Milau V, Carrera G (2001) The impact of PTSD on treatment adherence in persons with HIV infection. Gen Hosp Psychiatry 23(5):294–296
Kronish IM, Lin JJ, Cohen BE, Voils CI, Edmondson D (2014) Posttraumatic stress disorder and medication nonadherence in patients with uncontrolled hypertension. JAMA Int Med 174(3):468–470
Ursano RJ, Bell C, Eth S, Friedman M, Norwood A, Pfefferbaum B, Pynoos JD, Zatzick DF, Benedek DM, McIntyre JS, Charles SC, Altshuler K, Cook I, Cross CD, Mellman L, Moench LA, Norquist G, Twemlow SW, Woods S, Yager J, Work Group on ASD and PTSD; Steering Committee on Practice Guidelines (2004) Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Am J Psychiatry 161(11 Suppl):3–31
Acknowledgments
The National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) is funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with supplemental support from the National Institute on Drug Abuse. This research was supported in part by the Intramural Program of the National Institutes of Health, NIAAA. All authors are employees of the National Institutes of Health.
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The institutional review boards of the National Institutes of Health and Westat, Inc., have reviewed the research protocol and provided full ethical approval. Therefore, all procedures performed in this study were in accordance with the ethical standards laid down in the 1964 declaration of Helsinki and its later amendments.
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Goldstein, R.B., Smith, S.M., Chou, S.P. et al. The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatry Psychiatr Epidemiol 51, 1137–1148 (2016). https://doi.org/10.1007/s00127-016-1208-5
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DOI: https://doi.org/10.1007/s00127-016-1208-5