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, 34 (4), 315-326

Posttraumatic Stress Disorder Associated With Unexpected Death of a Loved One: Cross-national Findings From the World Mental Health Surveys


Posttraumatic Stress Disorder Associated With Unexpected Death of a Loved One: Cross-national Findings From the World Mental Health Surveys

Lukoye Atwoli et al. Depress Anxiety.


Background: Unexpected death of a loved one (UD) is the most commonly reported traumatic experience in cross-national surveys. However, much remains to be learned about posttraumatic stress disorder (PTSD) after this experience. The WHO World Mental Health (WMH) survey initiative provides a unique opportunity to address these issues.

Methods: Data from 19 WMH surveys (n = 78,023; 70.1% weighted response rate) were collated. Potential predictors of PTSD (respondent sociodemographics, characteristics of the death, history of prior trauma exposure, history of prior mental disorders) after a representative sample of UDs were examined using logistic regression. Simulation was used to estimate overall model strength in targeting individuals at highest PTSD risk.

Results: PTSD prevalence after UD averaged 5.2% across surveys and did not differ significantly between high-income and low-middle income countries. Significant multivariate predictors included the deceased being a spouse or child, the respondent being female and believing they could have done something to prevent the death, prior trauma exposure, and history of prior mental disorders. The final model was strongly predictive of PTSD, with the 5% of respondents having highest estimated risk including 30.6% of all cases of PTSD. Positive predictive value (i.e., the proportion of high-risk individuals who actually developed PTSD) among the 5% of respondents with highest predicted risk was 25.3%.

Conclusions: The high prevalence and meaningful risk of PTSD make UD a major public health issue. This study provides novel insights into predictors of PTSD after this experience and suggests that screening assessments might be useful in identifying high-risk individuals for preventive interventions.

Keywords: PTSD; cross-national; epidemiology; international; life events/stress; trauma.

Conflict of interest statement

Conflict of interest disclosures: Dr. Stein has received research grants and/or consultancy honoraria from Abbott, AstraZeneca, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Sun, Takeda, Tikvah, and Wyeth. Dr. Demyttenaere has served as a consultant with Servier, Lundbeck, Lundbeck Institute, AstraZeneca and Naurex. In the past three years, Dr. Kessler received support for his epidemiological studies from Sanofi Aventis, was a consultant for Johnson & Johnson Wellness and Prevention, and served on an advisory board for the Johnson & Johnson Services Inc. Lake Nona Life Project. Dr. Kessler is a co-owner of DataStat, Inc., a market research firm that carries out healthcare research. The other authors report no biomedical financial interests or potential conflicts of interest relevant to this manuscript.


Figure 1
Figure 1. AUC of PTSD model, total sample and by selected sub-groups, “Unexpected death of a loved one”, weighted analysis
Note. “Older (top half of age range)” = 30+ years old; “Younger (bottom half of age range)” < 30 years old. “Higher education” = high and high-average; “Lower education” = low and low-average.

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