Abstract:
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 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 socio-demographics, 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 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
