| dc.description.abstract |
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 ini-
tiative 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 signifi-
cantly 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 men-
tal 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 pro-
portion 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 sug-
gests that screening assessments might be useful in identifying high-risk individuals for preventive
interventions. |
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