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The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas

Molecular Psychiatry volume 23, pages 1892–1899 (2018)Cite this article

Abstract

Although earlier trauma exposure is known to predict posttraumatic stress disorder (PTSD) after subsequent traumas, it is unclear whether this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pretrauma vulnerability to PTSD. We examined this issue in the World Health Organization (WHO) World Mental Health (WMH) Surveys with 34 676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (odds ratio (OR)=1.3–2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior and substance disorders before random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5–4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization and rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 years (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas.

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The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884 and R01 MH093612-01), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork and consultation on data analysis. None of the funders had any role in the design, analysis, interpretation of results or preparation of this paper.

A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/. The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The Bulgarian Epidemiological Study of common mental disorders EPIBUL is supported by the Ministry of Health and the National Center for Public Health Protection. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The Mental Health Study Medellín–Colombia was carried out and supported jointly by the Center for Excellence on Research in Mental Health (CES University) and the Secretary of Health of Medellín. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123, and EAHC 20081308), (the Piedmont Region (Italy)), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP) and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Israel National Health Survey is funded by the Ministry of Health with support from the Israel National Institute for Health Policy and Health Services Research and the National Insurance Institute of Israel. The World Mental Health Japan (WMHJ) Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare. The Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health/Fogarty International Center (R03 TW006481-01), anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from Algorithm, AstraZeneca, Benta, Bella Pharma, Eli Lilly, Glaxo Smith Kline, Lundbeck, Novartis, Servier, OmniPharma, Phenicia, Pfizer and UPO. The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544- H), with supplemental support from the PanAmerican Health Organization (PAHO). Te Rau Hinengaro: The New Zealand Mental Health Survey (NZMHS) is supported by the New Zealand Ministry of Health, Alcohol Advisory Council, and the Health Research Council. The Northern Ireland Study of Mental Health was funded by the Health & Social Care Research & Development Division of the Public Health Agency. The Peruvian World Mental Health Study was funded by the National Institute of Health of the Ministry of Health of Peru. The Romania WMH study projects ‘Policies in Mental Health Area’ and ‘National Study regarding Mental Health and Services Use’ were carried out by National School of Public Health & Health Services Management (former National Institute for Research & Development in Health), with technical support of Metro Media Transilvania, the National Institute of Statistics-National Centre for Training in Statistics, SC Cheyenne Services SRL, Statistics Netherlands and were funded by Ministry of Public Health (former Ministry of Health) with supplemental support of Eli Lilly Romania SRL. The South Africa Stress and Health Study (SASH) is supported by the US National Institute of Mental Health (R01-MH059575) and National Institute of Drug Abuse with supplemental funding from the South African Department of Health and the University of Michigan. The Psychiatric Enquiry to General Population in Southeast Spain–Murcia (PEGASUS-Murcia) Project has been financed by the Regional Health Authorities of Murcia (Servicio Murciano de Salud and Consejería de Sanidad y Política Social) and Fundación para la Formación e Investigación Sanitarias (FFIS) of Murcia. The Ukraine Comorbid Mental Disorders during Periods of Social Disruption (CMDPSD) study is funded by the US National Institute of Mental Health (RO1-MH61905). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the National Institute of Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (RWJF; Grant 044708) and the John W. Alden Trust. DJS is supported by the Medical Research Council of South Africa (MRC). The work of HL was supported in part by a training grant from the National Institute of Mental Health (T32 MH017119).

The WHO World Mental Health Survey collaborators

Sergio Aguilar-Gaxiola, Ali Al-Hamzawi, Mohammed Salih Al-Kaisy, Jordi Alonso, Laura Helena Andrade, Corina Benjet, Guilherme Borges, Evelyn J Bromet, Ronny Bruffaerts, Brendan Bunting, Jose Miguel Caldas de Almeida, Graça Cardoso, Somnath Chatterji, Alfredo H Cia, Louisa Degenhardt, Koen Demyttenaere, John Fayyad, Silvia Florescu, Giovanni de Girolamo, Oye Gureje, Josep Maria Haro, Yanling He, Hristo Hinkov, Chi-yi Hu, Yueqin Huang, Peter de Jonge, Aimee Nasser Karam, Elie G Karam, Norito Kawakami, Ronald C Kessler, Andrzej Kiejna, Viviane Kovess-Masfety, Sing Lee, Jean-Pierre Lepine, Daphna Levinson, John McGrath, Maria Elena Medina-Mora, Jacek Moskalewicz, Fernando Navarro-Mateu, Beth-Ellen Pennell, Marina Piazza, Jose Posada-Villa, Kate M Scott, Tim Slade, Juan Carlos Stagnaro, Dan J Stein, Margreet ten Have, Yolanda Torres, Maria Carmen Viana, Harvey Whiteford, David R Williams, Bogdan Wojtyniak.

Disclaimer

The views and opinions expressed in this paper are those of the authors and do not necessarily represent the views or policies of the World Health Organization, other sponsoring organizations, agencies or governments.

Author information

Author notes

  1. The members of WHO World Mental Health Survey Collaborators are listed above the References.

Authors and Affiliations

  1. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    R C Kessler, H Liu, M V Petukhova, N A Sampson, V Shahly & A M Zaslavsky

  2. Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA

    S Aguilar-Gaxiola

  3. Health Services Research Unit, IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University (UPF) and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain

    J Alonso

  4. Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA

    E J Bromet

  5. Department of Psychiatry, University College Hospital, Ibadan, Nigeria

    O Gureje

  6. Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon

    E G Karam

  7. Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon

    E G Karam

  8. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    K C Koenen & H Liu

  9. Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong

    S Lee

  10. Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA

    B-E Pennell

  11. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa

    D J Stein & L Atwoli

  12. Department of Mental Health, Moi University School of Medicine, Eldoret, Kenya

    L Atwoli

  13. National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico

    G Borges

  14. School of Psychology, Ulster University, Londonderry, UK

    B Bunting

  15. IRCCS St John of God Clinical Research Centre//IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy

    G de Girolamo

  16. Ukrainian Psychiatric Association, Kiev, Ukraine

    S F Gluzman

  17. Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain

    J M Haro

  18. National Center for Public Health and Analyses, Sofia, Bulgaria

    H Hinkov

  19. Department of Mental Health, School of Public Health, The University of Tokyo, Tokyo, Japan

    N Kawakami

  20. Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France

    V Kovess-Masfety

  21. UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain

    F Navarro-Mateu

  22. Colegio Mayor de Cundinamarca University, Bogota, Colombia

    J Posada-Villa

  23. Department of Psychological Medicine, University of Otago, Dunedin, New Zealand

    K M Scott

  24. Department of Psychiatry, NYU Langone Medical Center, New York City, NY, USA

    A Y Shalev

  25. Trimbos-Instituut, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

    M ten Have

  26. Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia

    Y Torres

  27. Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil

    M C Viana

Authors
  1. R C Kessler
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  2. S Aguilar-Gaxiola
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  3. J Alonso
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  4. E J Bromet
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  5. O Gureje
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  6. E G Karam
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  7. K C Koenen
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  8. S Lee
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  9. H Liu
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  10. B-E Pennell
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  11. M V Petukhova
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  12. N A Sampson
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  13. V Shahly
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  14. D J Stein
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  15. L Atwoli
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  16. G Borges
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  17. B Bunting
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  18. G de Girolamo
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  19. S F Gluzman
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  20. J M Haro
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  21. H Hinkov
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  22. N Kawakami
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  23. V Kovess-Masfety
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  24. F Navarro-Mateu
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  25. J Posada-Villa
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  26. K M Scott
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  27. A Y Shalev
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  28. M ten Have
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  29. Y Torres
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  30. M C Viana
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  31. A M Zaslavsky
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on behalf of the WHO World Mental Health Survey Collaborators

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Correspondence to R C Kessler.

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Conflict of Interest

In the past 3 years, RCK received support for his epidemiological studies from Sanofi Aventis; was a consultant for Johnson & Johnson Wellness and Prevention, Shire, Takeda; and served on an advisory board for the Johnson & Johnson Services Lake Nona Life Project. RCK is a co-owner of DataStat, a market research firm that carries out healthcare research. In the past 3 years, DJS has received research grants and/or consultancy honoraria from Biocodex, Lundbeck, Servier and Sun. The other authors declare no conflict of interest.

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Kessler, R.C., Aguilar-Gaxiola, S., Alonso, J. et al. The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas. Mol Psychiatry 23, 1892–1899 (2018). https://doi.org/10.1038/mp.2017.194

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