Abstract.
Post-traumatic stress disorder (PTSD) has been a controversial construct because of the complex set of factors that have been hypothesized to influence its onset and prevalence, such as compensation and withdrawal from combat duty. Epidemiology has done much to objectively clarify these controversies in the study of stratified population samples. The symptoms characterizing PTSD have been repeatedly described in large population samples where compensation is not a confounding issue and this has done much to support the validity of the construct. Epidemiology has also highlighted that the prevalence of exposure to traumatic events is far greater than was previously estimated. Emphasizing the importance of these events is accounting for the major burden of disease. Kessler (2000) has suggested the socio-economic effects of PTSD represent a burden of disease not dissimilar to that associated with depression. Traumatic events provide a unique opportunity to implement a preventative and public health approach to the management of psychiatric morbidity. Of particular importance is the apparent longevity of the influence that these events have on psychological adjustment.
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Adler A (1943) Neuropsychiatric complications in victims of Boston’s Coconut Grove disaster. JAMA 123:1098–1101
American Psychiatric Association (1980) Diagnostic and Statistical Manual of Mental Disorders (3rd ed.). Washington DC: Author
American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd ed—revised). Washington DC; Author
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington DC: American Psychiatric Press
Andrews G, Henderson S, Hall W (2001) Prevalence, comorbidity, disability and service utilisation: Overview of the Australian National Mental Health Survey. Brit J Psychiatry 178:145–153
Archibald H, Tuddenham R (1965) Persistent stress reaction after combat: A twenty year follow up. Arch Gen Psychiatry 12:475–481
Atkinson RM, Hendersen RG, Sparr LF, Deale S (1982) Assessment of Vietnam Veterans for posttraumatic stress disorder in Veterans Administration disability claims. Am J Psychiatry 139:1118–1121
Ben Shoshan D (1985) Long term effects of the Holocaust in survivors after 40 years. Masters Thesis, Tel Aviv University
Boulanger G (1985) Post-traumatic stress disorder: an old problem with a new name. In: Sonnenerg SM, Blank AS, Talbott TA (eds) The trauma of war: stress and recovery in Vietnam veterans. Washington: American Psychiatric press
Breslau N (1998) Epidemiology of trauma and posttraumatic stress disorder. In: R Yehuda (ed) Psychological Trauma. Washington DC: American Psychiatric Press,Vol. 17, pp 1–29
Breslau N, Davis GC, Andreski P, Peterson E (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 48:216–222
Breslau N, Davis GC, Andreski P (1995) Risk factors for PTSD-related traumatic events: A prospective analysis. Am J Psychiatry 152:529–535
Breslau N, Davis GC, Andreski P, Peterson EL, Schultz LR (1997) Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry 54(11):1044–1048
Breslau N, Davis GC, Schultz LR (2003) Posttraumatic stress disorder and the incidence of nicotine, alcohol, and other drug disorders in persons who have experienced trauma. Arch Gen Psychiatry 60:289–294
Bryant RA, Harvey AG (2003) Gender differences in the relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents. Aust N Z J Psychiatry 37:226–229
Buckley TC, Blanchard EB, Hickling EJ (1996) A prospective examination of delayed onset PTSD secondary to motor vehicle accidents. J Abnorm Psychol 105(4):617–625
Bullman TA, Kang HK (1994) Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. J Nerv Ment Disease 182(11):604–610
Centres for Disease Control (1988) Health Status of Vietnam Veterans: 1 Psychosocial characteristics. JAMA 259:2701–2707
Chan AO, Air TM, McFarlane AC (2003) Posttraumatic stress disorder and its impact on the economic and health costs of motor vehicle accidents in South Australia. J Clin Psychiatry 64(2):175–181
Chilcoat HD, Breslau N (1998) Posttraumatic stress disorder and drug disorders; testing causal pathways. Arch Gen Psychiatry 55:913–917
Chodoff PC (1963) Late effects of the concentration camp syndrome. Arch Gen Psychiatry 8:323–342
Cottler LB, Compton WM, Mager D, Spitznagel EL, Janca A (1992) Posttraumatic stress disorder among substance users from the general population. Am J Psychiatry 149(5):664–670
Creamer M, Burgess PM, McFarlane AC (2001) Post Traumatic Stress Disorder: Findings from the Australian National Survey of Mental Health and Wellbeing. Psychol Med 31(7):1237–1247
Davidson JR, Hughes D, Blazer DG, George LK (1991) Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 21(3):713–721
De Girolamo G, McFarlane AC (1996) The epidemiology of PTSD: a comprehensive review of the international literature. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM (eds) Ethnocultural aspects of posttraumatic stress disorder: issues, research, and clinical applications. Washington: American Psychological Association, pp 33–85
DeViva JC, Bloem WD (2003) Symptom exaggeration and compensation seeking among combat veterans with posttraumatic stress disorder. J Trauma Stress 16(5):503–507
Deykin EY, Buka SL (1997) Prevalence and risk factors for posttraumatic stress disorder among chemically dependent adolescents. Am J Psychiatry 154(6):752–757
Ehlers A, Mayou RA, Bryant B (1998) Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol 107(3):508–519
Epstein RS (1993) Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury. J Trauma Stress 6:451–458
Ferrada-Noli M, Asberg M, Ormstad K, Lundin T, Sundbom E (1998) Suicidal behavior after severe trauma. Part 1: PTSD diagnoses, psychiatric comorbidity, and assessments of suicidal behavior. J Trauma Stress 11(1):103–112
Freud S (1922) Beyond the pleasure principle, by Freud S. Authorized translation from the 2nd German ed. by Hubback CJM. London, Vienna: The International psycho-analytical press
Galea S, Vlahov D, Resnick H, Ahern J, Susser E, Gold J, Bucuvalas M, Kilpatrick D (2003) Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol 158(6):514–524
Glass AJ (1974) Mental health programs in the armed forces. In: Arieti S (ed) American Handbook Psychiatry (2nd ed). New York: Basic Books
Green BL, Lindy JD, Grace MC, Gleser GC, Leonard AC, Korol M, Winget C (1990) Buffalo creek survivors in the second decade: Stability of stress symptoms. Am J Orthopsychiatry 60(1):43–54
Harvey AG, Bryant RA (2000) Memory for acute stress disorder symptoms: a two-year prospective study. J Nerv Ment Dis 188(9):602–607
Helzer JE, Robins LN, McEvoy L (1987) Post traumatic stress disorder in the general population; Findings of the Epidemiologic Catchment Area Survey. N Engl J Med 317(26):1630–1634
Hendin H, Haas AP (1991) Suicide and guilt as manifestations of PTSD in Vietnam combat veterans. Am J Psychiatry 148(5):586–591
Herman J (1992) Trauma and Recovery. Basic Books. New York
Herrmann N, Eryavec G (1994) Delayed onset post-traumatic stress disorder in world war II veterans. Can J Psychiatry 39:439–441
Holmes TH, Rahe RH (1967) The Social Readjustment Rating Scale. J Psychosom Res 11:213–218
Ikin JF, Sim MR, Creamer MC, Forbes AB, McKenzie DP, Kelsall HL, Glass DC, McFarlane AC, Abramson MJ, Ittak P, Horsley KWA, Harrex WK, Dwyer T, Blizzard L, Delaney KR, Schwarz H (in press) Increased risk of psychological disorders and their association with war-related psychological stressors in Australian veterans of the 1991 GulfWar. Brit J Psychiatry
Jacobsen LK, Southwick SM, Kosten TR (2001) Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry 158(8):1184–1190
Kessler RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61(Suppl 5):4–12
Kessler R, Sonnega A, Bromet G, Hughes M, Nelson C, Breslau N (1999) Epidemiologic Risk Factors for Trauma and PTSD. In R Yehuda, ed. Psychological Trauma. Washington DC, American Psychiatric Press
Kessler RC, Frank RG (1997) The impact of psychiatric disorders on work loss days. Psychol Med 27(4):861–873
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52:1048–1060
Kilpatrick DG, Resnick HS (1993) Posttraumatic stress disorder associated with exposure to criminal victimization in clinical and community populations. In: Davidson JRT, Foa EB (eds) Posttraumatic stress disorder: DSM-IV and beyond (1st ed). Washington: American Psychiatric Press, pp 113–143
Khoury EL, Warheit GJ, Hargrove MC, Zimmerman RS, Vega WA, Gil AG (1997) The impact of Hurricane Andrew on deviant behavior among a multi-racial/ethnic sample of adolescents in Dade County, Florida: a longitudinal analysis. J Trauma Stress 10(1):71–91
Kramer TL, Lindy JD, Green BL, Grace MC, Leonard AC (1994) The comorbidity of post-traumatic stress disorder and suicidality in Vietnam veterans. Suicide Life Threat Behav 24(1):58–67
Kuhn D, Amsel E, O’Loughlin M, Schauble L, Leadbeater B, Yotive W (1988) The Development of Scientific Thinking Skills. San Diego, CA, US: Academic Press
Kulka RA, Schlenger WE, Fairbank JA, Hough RL, Jordan BK, Marmar CR, Weiss DS (1990) Trauma and the Vietnam War Generation: Report of the Findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel
Lim LCC (1991) Delayed Emergence of post-traumatic stress disorder. Singapore Med J 32:92–93
Marshall RP, Jorm AF, Grayson DA, O’Toole BI (1998) Posttraumatic stress disorder and other predictors of health care consumption by Vietnam veterans. Psychiatric Serv 49(12):1609–1611
Mayou R, Bryant B, Duthie R (1993) Psychiatric consequences of road traffic accidents. Brit Med J 307:647–651
McCarren M, Janes GR, Goldberg J, Eisen SA, True WR, Henderson WG (1995) A twin study of the association of post-traumatic stress disorder and combat exposure with long-term socioeconomic status in Vietnam veterans. J Trauma Stress 8(1):111–124
McFarlane AC (1988) The longitudinal course of posttraumatic morbidity. The range of outcomes and their predictors. J Nerv Ment Dis 176(1):30–39
McFarlane AC (1989) The aetiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors. Br J Psychiatry 154:221–228
McFarlane AC (1998) Epidemiological evidence about the relationship between PTSD and alcohol abuse: the nature of the association. Addict Behav 23(6):813–825
McFarlane AC (2000) The Pitfalls of History. The Problem of Knowing the Past. In: Shalev AY, Yehuda R, McFarlane AC (eds) International Handbook of Human Response to Trauma. Kluwer Academic/Plenum Publishers, New York
McFarlane AC, Papay P (1992) Multiple diagnoses in posttraumatic stress disorder in the victims of a natural disaster. Br Med J 180:498–504
Mueser KT, Drake RE, Wallach MA (1998). Dual diagnosis: a review of etiological theories. Addict Behav 23(6):717–734
Oppenheimer H, Cited in Seguin EC (1890) Traumatic neuroses. In: Sugois CE (ed) Annual of the Universal Medical Scientists: a yearly report of the progress of the general sanitary sciences throughout the world, Vol III. Philadelphia: FA,Davis, p N2
Pary R, Turns DM, Tobias CR (1986) A case of delayed recognition of posttraumatic stress disorder. Am J Psychiatry 143(7):941
Perkonigg A, Kessler RC, Storz S, Wittchen HU (2000) Traumatic events and post-traumatic stress disorder in the community: Prevalence, risk factors and comorbidity. Acta Psychiatr Scand 101:46–59
Peters L, Andrews G (1995) Procedural validity of the computerized version of the Composite International Diagnostic Interview (CIDI-Auto) in the anxiety disorders. Psychol Med 25(6):1269–1280
Pomerantz AS (1991) Delayed onset of PTSD: Delayed recognitionor latent disorder. Am J Psychiatry 148(11):1609
Prigerson HG, Slimack MJ (1999) Gender differences in clinical correlates of suicidality among young adults. J Nerv Ment Dis 187(1):23–31
Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61(6):984–991
Schnyder U, Moergeli H, Trentz O, Klaghofer R, Buddeberg C (2001) Prediction of psychiatric morbidity in severely injured accident victims at one-year follow-up. Am J Resp Crit Care Med 164:653–656
Seguin EC (1890) Traumatic neuroses. In: CE Sugois (ed) Annual of the Universal Medical Scientists: a yearly report of the progress of the general sanitary sciences throughout the world, Vol III. Philadelphia: FA Davis
Shalev AY, Freedman A, Peri T, Brandes D, Sahara T, Orr S, Pitman RK (1998) Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry 155:630–637
Solomon SD, Canino GJ (1990) Appropriateness of DSM-IIR criteria for posttraumatic stress disorder. Comp Psychiatry 31:227–237
Solomon Z (1989) Characteristic psychiatric symptomatology in PTSD veterans: a three year follow up. Psychol Med 19:927–936
Sparr L, Pankratz LD (1983) Factitious post-traumatic stress disorder. Am J Psychiatry 140:1016–1019
Steel Z, Silove D, Phan T, Bauman A (2002) Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. Lancet 360:1056–1062
Stein M, Walker J, Hazen AL, Forde DR (1997) Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 154:1114–1119
Stierlin E (1911) Nervöse und psychische Störungen nach Katastrophen (Nervous and psychic disturbances after catastrophes). Deutsches Medizinische Wochenschrift 37:2028–2035
Van Dyke C, Zilberg NJ, McKinnon JA (1985) Posttraumatic stress disorder; a 30 year delay in a World War II veteran. Am J Psychiatry 142:1070–1073
Vrana S, Lauterbach D (1994) Prevalence of traumatic events and posttraumatic psychological symptoms in a non-clinical sample of college students. J Trauma Stress 7(2):289–302
Watson CG, Kucala T, Manifold V, Vassar P, Juba M (1988) Differences Between posttraumatic stress disorder patients with delayed and undelayed onsets. J Nerv Ment Dis 176(9):568–572
Weisaeth L (1989) The stressors and the posttraumatic stress syndrome after an industrial accident. Acta Psychiatr Scand 89(Suppl 355):25–37
Wolfe J, Erickson DJ, Sharkansky EJ, King DW, King LA (1999) Course and predictors of posttraumatic stress disorder among gulf veterans: A prospective analysis. J Consult Clin Psychol 67(4):520–528
Yehuda R, McFarlane A (1997) Psychobiology of Posttraumatic Stress Disorder. Ann N Y Acad Sci 821:437–441
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McFarlane, A. The contribution of epidemiology to the study of traumatic stress. Soc Psychiatry Psychiatr Epidemiol 39, 874–882 (2004). https://doi.org/10.1007/s00127-004-0870-1
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DOI: https://doi.org/10.1007/s00127-004-0870-1