eCommons@AKU eCommons@AKU
Internal Medicine, East Africa Medical College, East Africa
1-2017
Post-traumatic stress disorder associated with natural and Post-traumatic stress disorder associated with natural and
human-made disasters in the World Mental Health Surveys human-made disasters in the World Mental Health Surveys
Evelyn J. Bromet
Lukoye Atwoli
Norito Kawakami
Fernando Navarro-Mateu
P Piotrowski
See next page for additional authors
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Authors Authors
Evelyn J. Bromet, Lukoye Atwoli, Norito Kawakami, Fernando Navarro-Mateu, P Piotrowski, A J. King,
Sergio Aguilar-Gaxiola, Jordi Alonso, Brentan Bunting, and Koen Demyttenaere
Post-traumatic stress disorder associated with natural and
human-made disasters in the World Mental Health Surveys
E. J. Bromet
1,*
, L. Atwoli
2
, N. Kawakami
3
, F. Navarro-Mateu
4
, P. Piotrowski
5
, A. J. King
6
, S.
Aguilar-Gaxiola
7
, J. Alonso
8,9,10
, B. Bunting
11
, K. Demyttenaere
12
, S. Florescu
13
, G. de
Girolamo
14
, S. Gluzman
15
, J. M. Haro
16
, P. de Jonge
17
, E. G. Karam
18,19,20
, S. Lee
21
, V.
Kovess-Masfety
22
, M. E. Medina-Mora
23
, Z. Mneimneh
24
, B.-E. Pennell
24
, J. Posada-Villa
25
,
D. Salmerón
26
, T. Takeshima
27
, and R. C. Kessler
6
1
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
2
Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya
3
Department of
Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan
4
Subdirección
General de Salud Mental, Servicio Murciano de Salud, IMIB-Arrixaca, CIBER de Epidemiología y
Salud Pública (CIBERESP), Murcia, Spain
5
Department of Psychiatry, Wroclaw Medical
University, Wroclaw, Poland
6
Department of Health Care Policy, Harvard Medical School, Boston,
MA, USA
7
University of California Davis School of Medicine, Sacramento, CA, USA
8
IMIM-
Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain
9
Pompeu Fabra
University (UPF), Barcelona, Spain
10
CIBER en Epidemiología y Salud Pública (CIBERESP),
Barcelona, Spain
11
School of Psychology, University of Ulster, Londonderry, UK
12
Department of
Psychiatry, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium
13
National School of Public Health, Management and Professional Development, Bucharest,
Romania
14
IRCCS St. John of God Clinical Research Centre, Brescia, Italy
15
Ukrainian
Psychiatric Association, Kiev, Ukraine
16
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat
de Barcelona, Barcelona, Spain
17
Department of Psychiatry, Interdisciplinary Center,
Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen,
University of Groningen, Groningen, The Netherlands
18
Department of Psychiatry and Clinical
Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
19
Department of
Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut,
Lebanon
20
Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut,
Lebanon
21
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
22
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,
Paris, France
23
Ramon de la Fuente Muñiz National Institute of Psychiatry, Mexico City, Mexico
24
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI,
*
Address for correspondence: E. J. Bromet, Ph.D., Department of Psychiatry, Stony Brook University, Health Sciences Center,
T10-060Z1, Stony Brook, NY 11794, USA. (evelyn.bromet@stonybrookmedicine.edu).
Declaration of Interest
In the past 3 years, Dr Kessler has served as a consultant for or received research support from Johnson & Johnson Wellness and
Prevention, the Lake Nona Life Project, and Shire Pharmaceuticals. Dr Kessler is a co-owner of DataStat, Inc., a market research
company that carries out healthcare research. The other authors report no biomedical financial interests or potential conflicts of
interest.
Supplementary material
The supplementary material for this article can be found at http://dx.doi.org/10.1017/S0033291716002026.
HHS Public Access
Author manuscript
Psychol Med
. Author manuscript; available in PMC 2017 July 01.
Published in final edited form as:
Psychol Med
. 2017 January ; 47(2): 227–241. doi:10.1017/S0033291716002026.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
USA
25
Colegio Mayor de Cundinamarca University, Bogota, Colombia
26
Department of
Epidemiology, Department of Health and Social Sciences, Murcia Regional Health Council, IMIB-
Arrixaca, CIBER Epidemiología y Salud Pública (CIBERESP), Universidad de Murcia, Murcia,
Spain
27
Department of Health and Welfare for the Disabled, Health and Welfare Bureau,
Kawasaki City, Japan
Abstract
Background—Research on post-traumatic stress disorder (PTSD) following natural and human-
made disasters has been undertaken for more than three decades. Although PTSD prevalence
estimates vary widely, most are in the 20–40% range in disaster-focused studies but considerably
lower (3–5%) in the few general population epidemiological surveys that evaluated disaster-related
PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide
an opportunity to examine disaster-related PTSD in representative general population surveys
across a much wider range of sites than in previous studies.
Method—Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-
income countries had enough respondents for a risk factor analysis. Predictors considered were
socio-demographics, disaster characteristics, and pre-disaster vulnerability factors (childhood
family adversities, prior traumatic experiences, and prior mental disorders).
Results—Disaster-related PTSD prevalence was 0.0–3.8% among adult (ages 18+) WMH
respondents and was significantly related to high education, serious injury or death of someone
close, forced displacement from home, and pre-existing vulnerabilities (prior childhood family
adversities, other traumas, and mental disorders). Of PTSD cases 44.5% were among the 5% of
respondents classified by the model as having highest PTSD risk.
Conclusion—Disaster-related PTSD is uncommon in high-income WMH countries. Risk factors
are consistent with prior research: severity of exposure, history of prior stress exposure, and pre-
existing mental disorders. The high concentration of PTSD among respondents with high
predicted risk in our model supports the focus of screening assessments that identify disaster
survivors most in need of preventive interventions.
Keywords
Disaster; post-traumatic stress disorder; PTSD
Introduction
Natural and human-made disasters are increasingly common occurrences around the globe
(Lopes
et al.
2014; Warsini
et al.
2014). Systematic research on development of post-
traumatic stress disorder (PTSD) following disasters has been undertaken for more than
three decades, with most studies reporting only short-term consequences. Recent reviews
suggest that between 20% (North, 2014) and 40% (Neria
et al.
2008) of survivors develop
PTSD, but the range across studies is extremely broad (5–60% following natural disasters;
25–75% following human-made disasters) (Galea
et al.
2005) due to differences in the
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characteristics/locations of disasters and methodological differences in studies (Norris
et al.
2006; Goldmann & Galea, 2014).
A handful of general population epidemiological surveys retrospectively assessed lifetime
exposure to disasters and prevalence of post-disaster PTSD. The first such study, the
National Comorbidity Survey (NCS; Kessler
et al.
1995), found that much lower proportions
of disaster survivors developed post-disaster PTSD (3.7% of men, 5.4% of women) than in
disaster-focused studies. More recent community epidemiological surveys in Europe (Ferry
et al.
2014; Olaya
et al.
2015) and the United States (Breslau
et al.
1998, 2013) found similar
results. Importantly, PTSD prevalence estimates in these surveys were considerably higher
for some other lifetime traumatic experiences (Molnar
et al.
2001; Darves-Bornoz
et al.
2008; Olaya
et al.
2015), suggesting that the low post-disaster PTSD prevalence estimates
were not due to recall bias. The discrepancy between these low prevalence estimates in
representative community samples and much higher estimates in post-disaster surveys raises
the question whether demand characteristics and unrepresentative samples led to upwardly
biased estimates in post-disaster surveys (Bonanno
et al.
2010).
We attempt to shed light on this question by presenting data on prevalence-correlates of
disaster-related PTSD in the WHO World Mental Health (WMH) Surveys. Measures of
severity of exposure to disaster-related stressors are among the strongest risk factors for
PTSD in post-disaster surveys (Fergusson
et al.
2014; Goldmann & Galea, 2014; Bromet
et
al.
2016). Other key risk factors include pre-disaster psychopathology, female gender,
younger age at the time of the disaster, and early childhood adversity (Sayed
et al.
2015). We
use information about these potential predictors to examine PTSD prevalence and correlates
among respondents in a series of WMH surveys who reported lifetime exposure to disasters.
Method and materials
Samples
Data come from the 18 WMH surveys that used an expanded assessment of PTSD
(described below) to examine PTSD associated with
randomly selected
traumatic
experiences (Table 1). These surveys included 10 in countries classified by The World Bank
(2012) as high-income countries [national surveys in Belgium, France, Germany, Italy, The
Netherlands, Northern Ireland, Spain, United States, along with regional surveys in Japan (a
number of metropolitan areas) and Spain (Murcia)] and eight in countries classified as low-/
middle-income countries (national surveys in Lebanon, Peru, Romania, South Africa, and
Ukraine along with surveys of all non-rural areas in Colombia and Mexico and a separate
regional survey in Medellin, Colombia). Each survey was based on a probability sample of
household residents in the target population using a multi-stage clustered area probability
design. Response rates had weighted averages of 84.7% in low-/lower-middle-income
countries, 79.8% in upper-middle-income countries, 63.5% in high-income countries, and
70.3% overall. Four surveys had response rates below the minimally acceptable level of 60%
(45.9% in France, 50.6% in Belgium, 55.1% in Japan, 56.4% in The Netherlands). A
detailed description of sampling procedures is presented elsewhere (Heeringa
et al.
2008).
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