Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode. Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey. Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years. Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas. (Arch Gen Psychiatry. 1995;52:1048-1060)

Posttraumatic stress disorder in the National Comorbidity Survey.

BACKGROUND Mental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders.

METHOD We searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966-1993) with the search terms mental disorders', 'brain injury', 'eating disorders', 'epilepsy', 'suicide attempt', 'psychosurgery', with 'mortality' and 'follow-up studies', and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder.

RESULTS Of 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated.

CONCLUSIONS If these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.

Suicide as an outcome for mental disorders. A meta-analysis.

Background Understanding the prevalence of schizophrenia has important implications for both health service planning and risk factor epidemiology. The aims of this review are to systematically identify and collate studies describing the prevalence of schizophrenia, to summarize the findings of these studies, and to explore selected factors that may influence prevalence estimates. Methods and Findings Studies with original data related to the prevalence of schizophrenia (published 1965–2002) were identified via searching electronic databases, reviewing citations, and writing to authors. These studies were divided into ‘‘core’’ studies, ‘‘migrant’’ studies, and studies based on ‘‘other special groups.’’ Between- and within-study filters were applied in order to identify discrete prevalence estimates. Cumulative plots of prevalence estimates were made and the distributions described when the underlying estimates were sorted according to prevalence type (point, period, lifetime, and lifetime morbid risk). Based on combined prevalence estimates, the influence of selected key variables was examined (sex, urbanicity, migrant status, country economic index, and study quality). A total of 1,721 prevalence estimates from 188 studies were identified. These estimates were drawn from 46 countries, and were based on an estimated 154,140 potentially overlapping prevalent cases. We identified 132 core studies, 15 migrant studies, and 41 studies based on other special groups. The median values per 1,000 persons (10%–90% quantiles) for the distributions for point, period, lifetime, and lifetime morbid risk were 4.6 (1.9–10.0), 3.3 (1.3– 8.2), 4.0 (1.6–12.1), and 7.2 (3.1–27.1), respectively. Based on combined prevalence estimates, we found no significant difference (a) between males and females, or (b) between urban, rural, and mixed sites. The prevalence of schizophrenia in migrants was higher compared to nativeborn individuals: the migrant-to-native-born ratio median (10%–90% quantile) was 1.8 (0.9–6.4). When sites were grouped by economic status, prevalence estimates from ‘‘least developed’’ countries were significantly lower than those from both ‘‘emerging’’ and ‘‘developed’’ sites (p = 0.04). Studies that scored higher on a quality score had significantly higher prevalence estimates ( p= 0.02).

https://espace.library.uq.edu.au/view/UQ:75868/UQ_PV_75868.pdf

A systematic review of the prevalence of schizophrenia.

Meta-analyses of studies yielding sex-specific risk of potentially traumatic events (PTEs) and posttraumatic stress disorder (PTSD) indicated that female participants were more likely than male participants to meet criteria for PTSD, although they were less likely to experience PTEs. Female participants were more likely than male participants to experience sexual assault and child sexual abuse, but less likely to experience accidents, nonsexual assaults, witnessing death or injury, disaster or fire, and combat or war. Among victims of specific PTEs (excluding sexual assault or abuse), female participants exhibited greater PTSD. Thus, sex differences in risk of exposure to particular types of PTE can only partially account for the differential PTSD risk in male and female participants.

/pdf/sex-differences-in-trauma-and-posttraumatic-stress-disorder-2z87gssboo.pdf

Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research.

Background The scope of the terrorist attacks of September 11, 2001, was unprecedented in the United States. We assessed the prevalence and correlates of acute post-traumatic stress disorder (PTSD) and depression among residents of Manhattan five to eight weeks after the attacks. Methods We used random-digit dialing to contact a representative sample of adults living south of 110th Street in Manhattan. Participants were asked about demographic characteristics, exposure to the events of September 11, and psychological symptoms after the attacks. Results Among 1008 adults interviewed, 7.5 percent reported symptoms consistent with a diagnosis of current PTSD related to the attacks, and 9.7 percent reported symptoms consistent with current depression (with “current“ defined as occurring within the previous 30 days). Among respondents who lived south of Canal Street (i.e., near the World Trade Center), the prevalence of PTSD was 20.0 percent. Predictors of PTSD in a multivariate model were Hispanic ethnicity, ...

/pdf/psychological-sequelae-of-the-september-11-terrorist-attacks-3p9kbucmmt.pdf

Psychological sequelae of the September 11 terrorist attacks in New York City

This paper reports lifetime rates for posttraumatic stress disorder (PTSD) in two rural northwest communities. One community was affected by a major natural disaster, the eruption of Mt. St. Helens. Following an epidemiology study of this disaster, community-wide patterns of PTSD were identified. Disaster-related, combat, sexual assault, and all other types of PTSD are presented for men and women. Symptom patterns from these distinct PTSD stressors are compared along with concurrent psychiatric disorders. The findings are discussed with other studies that use a broader definition of disaster stress response syndromes. This comparison identifies a limitation of PTSD diagnostic criteria that may significantly underestimate community rates. Language: en

Community patterns of posttraumatic stress disorders.

This study employed data from two Congressionally mandated efforts (the American Indian Vietnam Veterans Project and the National Vietnam Veterans Readjustment Study) to examine differential prevalence of posttraumatic stress disorder (PTSD) among 5 ethnically defined samples of male Vietnam theater veterans. Lay interviews assessed individual experiences before, during, and after the war from 1,798 male Vietnam theater veterans. Clinical reinterviews using the SCID were conducted with subsamples (N = 487). The prevalence of both 1-month and lifetime PTSD was higher for the 2 American Indian samples than for Whites. Once logistic regressions controlled for differential exposure to war-zone stress, ethnicity was no longer a significant predictor of PTSD.

/pdf/the-prevalence-of-posttraumatic-stress-disorder-among-1yt25hxobm.pdf

The Prevalence of Posttraumatic Stress Disorder Among American Indian Vietnam Veterans: Disparities and Context

(1973). Psychiatric Epidemiology of an Indian Village. Psychiatry: Vol. 36, No. 1, pp. 70-81.

Psychiatric epidemiology of an Indian village.

In a pilot study of depression among American Indians, 86 patients from three different tribal cultures were evaluated utilizing systematic diagnostic criteria. Similarity of symptom patterns was greater than differences between those patient groups drawn from the tribes and m comparison to non-Indian patterns of depression. Among the Indian patients major depression occurred in three distinct subgroups: an uncomplicated pattern, a secondary depression in association with a past history of alcoholism, and a complicated depression superimposed upon an underlying chronic depression or personality disorder. Each of these three disorders requires a distinctive diagnostic approach and each disorder may be influenced by cultural factors. High rates of depression among American Indians have been widely reported by treating clinicians (Shore & Manson, 1981). In addition, increased suicide rates among certain Indian tribes have been confirmed by various investigators (Shore, 1975; Kraus & Bailer, 1979; Levy & Kunitz, 1971). These findings have been attributed to rapid cultural change, epidemic patterns of alcohol abuse, increased rates of physical illness, accidents and deaths, and demoralization secondary to enforced dependency. This paper reports the first phase of a research project on major depression in three American Indian tribes. The study was designed to explore the relationship of depression to several of the above

A pilot study of depression among American Indian patients with research diagnostic criteria.

Growing evidence suggests that neuropsychological assessment via videoconference shows good agreement with traditional in-person assessment. However, there are few published studies regarding patient acceptability of this methodology, particularly in individuals with cognitive impairment. In this study we sought to evaluate patient preferences and acceptability of teleneuropsychology to further shed light on the viability of this cognitive assessment medium. We examined acceptability of videoconference-based neuropsychological assessment among healthy aging individuals and in subjects with mild cognitive impairment or early stage Alzheimer disease. We found that teleneuropsychology appears to be well accepted by consumers. Our results reflected 98% satisfaction, and roughly two-thirds of participants indicated no preference between traditional face-to-face testing and examination by teleneuropsychology. Furthermore, even participants with cognitive impairment showed good acceptability of teleneuropsycholo...

James H. Shore

Papers

Community patterns of posttraumatic stress disorders.

The Prevalence of Posttraumatic Stress Disorder Among American Indian Vietnam Veterans: Disparities and Context

Psychiatric epidemiology of an Indian village.

A pilot study of depression among American Indian patients with research diagnostic criteria.

Consumer Acceptability of Brief Videoconference-based Neuropsychological Assessment in Older Individuals with and without Cognitive Impairment