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Remission from post-traumatic stress disorder in the general population

Published online by Cambridge University Press:  14 December 2011

C. Chapman ,
K. Mills ,
T. Slade ,
A. C. McFarlane ,
R. A. Bryant ,
M. Creamer ,
D. Silove  and
M. Teesson
C. Chapman*
Affiliation:
The National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
K. Mills
Affiliation:
The National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
T. Slade
Affiliation:
The National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
A. C. McFarlane
Affiliation:
Centre for Traumatic Stress Studies, University of Adelaide, SA, Australia
R. A. Bryant
Affiliation:
School of Psychology, University of New South Wales, NSW, Australia
M. Creamer
Affiliation:
Australian Centre for Post-traumatic Mental Health, Department of Psychiatry, University of Melbourne, VIC, Australia
D. Silove
Affiliation:
Psychiatry Research and Teaching Unit, School of Psychiatry, University of New South Wales, NSW, Australia
M. Teesson
Affiliation:
The National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
*
*Address for correspondence: Dr C. Chapman (Issakidis), National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia. (Email: [email protected])
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Abstract

Background

Few studies have focused on post-traumatic stress disorder (PTSD) remission in the population, none have modelled remission beyond age 54 years and none have explored in detail the correlates of remission from PTSD. This study examined trauma experience, symptom severity, co-morbidity, service use and time to PTSD remission in a large population sample.

Method

Data came from respondents (n=8841) of the 2007 Australian National Survey of Mental Health and Wellbeing (NSMHWB). A modified version of the World Health Organization's World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to determine the presence and age of onset of DSM-IV PTSD and other mental and substance use disorders, type, age, and number of lifetime traumas, severity of re-experiencing, avoidance and hypervigilance symptoms and presence and timing of service use.

Results

Projected lifetime remission rate was 92% and median time to remission was 14 years. Those who experienced childhood trauma, interpersonal violence, severe symptoms or a secondary anxiety or affective disorder were less likely to remit from PTSD and reported longer median times to remission compared to those with other trauma experiences, less severe symptoms or no co-morbidity.

Conclusions

Although most people in the population with PTSD eventually remit, a significant minority report symptoms decades after onset. Those who experience childhood trauma or interpersonal violence should be a high priority for intervention.

Keywords

Australiaepidemiologypost-traumatic stress disorderremission
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 8 , August 2012 , pp. 1695 - 1703
Copyright
Copyright © Cambridge University Press 2011

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References

Alonso, J, Petukhova, M, Vilagut, G, Chatterji, S, Heeringa, S, Ustun, TB, Alhamzawi, AO, Viana, MC, Angermeyer, M, Bromet, E, Bruffaerts, R, de Girolamo, G, Florescu, S, Gureje, O, Haro, JM, Hinkov, H, Hu, CY, Karam, EG, Kovess, V, Levinson, D, Medina-Mora, ME, Nakamura, Y, Ormel, J, Posada-Villa, J, Sagar, R, Scott, KM, Tsang, A, Williams, DR, Kessler, RC (2010). Days out of role due to common physical and mental conditions: results from the WHO World Mental Health surveys. Molecular Psychiatry. Published online: 12 October 2010. doi:10.1038/mp.2010.101.Google ScholarPubMed
Averill, PM, Beck, JG (2000). Posttraumatic stress disorder in older adults: a conceptual review. Journal of Anxiety Disorders 14, 133–156.CrossRefGoogle ScholarPubMed
Breslau, N (2009). The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma, Violence and Abuse 10, 198–210.CrossRefGoogle ScholarPubMed
Breslau, N, Chilcoat, HD, Kessler, RC, Davis, GC (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. American Journal of Psychiatry 156, 902–907.CrossRefGoogle ScholarPubMed
Breslau, N, Davis, GC, Peterson, EL, Schultz, LR (2000). A second look at comorbidity in victims of trauma: the posttraumatic stress disorder-major depression connection. Biological Psychiatry 48, 902–909.CrossRefGoogle Scholar
Breslau, N, Kessler, RC, Chilcoat, HD, Schultz, LR, Davis, GC, Andreski, P (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry 55, 626–632.CrossRefGoogle ScholarPubMed
Breslau, N, Peterson, EL, Schultz, LR (2008). A second look at prior trauma and the posttraumatic stress disorder effects of subsequent trauma. Archives of General Psychiatry 65, 431–437.CrossRefGoogle ScholarPubMed
Bryant, RA (2003). Early predictors of posttraumatic stress disorder. Biological Psychiatry 53, 789–795.CrossRefGoogle ScholarPubMed
Bryant, RA (2010). The complexity of complex PTSD. American Journal of Psychiatry 167, 879–881.CrossRefGoogle ScholarPubMed
Bryant, RA, O'Donnell, ML, Creamer, M, McFarlane, AC, Clark, CR, Silove, D (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry 167, 312–320.CrossRefGoogle ScholarPubMed
Busuttil, W (2004). Presentations and management of post traumatic stress disorder and the elderly: a need for investigation. International Journal of Geriatric Psychiatry 19, 429–439.CrossRefGoogle ScholarPubMed
Byers, AL, Yaffe, K, Covinsky, KE, Friedman, MB, Bruce, ML (2010). High occurrence of mood and anxiety disorders among older adults: the National Comorbidity Survey Replication. Archives of General Psychiatry 67, 489–496.CrossRefGoogle ScholarPubMed
Creamer, M, Burgess, P, McFarlane, AC (2001). Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychological Medicine 31, 1237–1247.CrossRefGoogle ScholarPubMed
Grambsch, PM, Therneau, TM (1994). Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81, 515–526.CrossRefGoogle Scholar
Hien, DA, Jiang, HP, Campbell, ANC, Hu, MC, Miele, GM, Cohen, LR, Brigham, GS, Capstick, C, Kulaga, A, Robinson, J, Suarez-Morales, L, Nunes, EV (2010). Do treatment improvements in PTSD severity affect substance use outcomes? A secondary analysis from a randomized clinical trial in NIDA's clinical trials network. American Journal of Psychiatry 167, 95–101.CrossRefGoogle ScholarPubMed
Hosmer, DW, Lemeshow, S (1999). Applied Survival Analysis. John Wiley & Sons, Inc.: New York.Google Scholar
Jonas, S, Bebbington, P, McManus, S, Meltzer, H, Jenkins, R, Kuipers, E, Cooper, C, King, M, Brugha, T (2011). Sexual abuse and psychiatric disorder in England: results from the 2007 Adult Psychiatric Morbidity Survey. Psychological Medicine 41, 709–719.CrossRefGoogle ScholarPubMed
Kessler, RC, Angermeyer, M, Anthony, JC, de Graaf, R, Demyttenaere, K, Gasquet, I, de Girolamo, G, Gluzman, S, Gureje, O, Haro, JM, Kawakami, N, Karam, A, Levinson, D, Medina Mora, ME, Oakley Browne, MA, Posada-Villa, J, Stein, DJ, Adley Tsang, CH, Aguilar-Gaxiola, S, Alonso, J, Lee, S, Heeringa, S, Pennell, BE, Berglund, P, Gruber, MJ, Petukhova, M, Chatterji, S, Ustun, TB (2007). Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry 6, 168–176.Google ScholarPubMed
Kessler, RC, Chiu, WT, Demler, O, Merikangas, KR, Walters, EE (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 617–627.CrossRefGoogle ScholarPubMed
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 1048–1060.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Khoury, L, Tang, YL, Bradley, B, Cubells, JF, Ressler, KJ (2010). Substance use, childhood traumatic experience, and posttraumatic stress disorder in an urban civilian population. Depression and Anxiety 27, 1077–1086.CrossRefGoogle Scholar
Kolassa, I, Ertl, V, Eckart, C, Kolassa, S, Onyut, LP, Elbert, T (2010). Spontaneous remission from PTSD depends on the number of traumatic event types experienced. Psychological Trauma: Theory Research, Practice and Policy 2, 169–174.CrossRefGoogle Scholar
Marshall, GN, Miles, JNV, Stewart, SH (2010). Anxiety sensitivity and PTSD symptom severity are reciprocally related: evidence from a longitudinal study of physical trauma survivors. Journal of Abnormal Psychology 119, 143–150.CrossRefGoogle ScholarPubMed
McFarlane, AC (2000). Posttraumatic stress disorder: a model of the longitudinal course and the role of risk factors. Journal of Clinical Psychiatry 61 (Suppl. 5), 15–20; discussion 21–23.Google Scholar
McLaughlin, KA, Berglund, P, Gruber, MJ, Kessler, RC, Sampson, NA, Zaslavsky, AM (2011). Recovery from PTSD following Hurricane Katrina. Depression and Anxiety 28, 439–446.CrossRefGoogle ScholarPubMed
McLaughlin, KA, Conron, KJ, Koenen, KC, Gilman, SE (2010). Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults. Psychological Medicine 40, 1647–1658.CrossRefGoogle Scholar
Mills, KL (2009). ‘Between pain and nothing, I choose nothing’: trauma, post-traumatic stress disorder and substance use. Addiction 104, 1607–1609.CrossRefGoogle ScholarPubMed
Mills, KL, McFarlane, AC, Slade, T, Creamer, M, Silove, D, Teesson, M, Bryant, R (2011). Assessing the prevalence of trauma exposure in epidemiological surveys. Australian and New Zealand Journal of Psychiatry 45, 407–415.CrossRefGoogle ScholarPubMed
Perkonigg, A, Pfister, H, Stein, MB, Hofler, M, Lieb, R, Maercker, A, Wittchen, HU (2005). Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults. American Journal of Psychiatry 162, 1320–1327.CrossRefGoogle Scholar
Pietrzak, RH, Goldstein, RB, Southwick, SM, Grant, BF (2011). Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Anxiety Disorders 25, 456–465.CrossRefGoogle ScholarPubMed
Rolfsnes, ES, Idsoe, T (2011). School-based intervention programs for PTSD symptoms: a review and meta-analysis. Journal of Traumatic Stress 24, 155–165.CrossRefGoogle ScholarPubMed
Seedat, S, Scott, KM, Angermeyer, MC, Berglund, P, Bromet, EJ, Brugha, TS, Demyttenaere, K, de Girolamo, G, Haro, JM, Jin, R, Karam, EG, Kovess-Masfety, V, Levinson, D, Medina Mora, ME, Ono, Y, Ormel, J, Pennell, BE, Posada-Villa, J, Sampson, NA, Williams, D, Kessler, RC (2009). Cross-national associations between gender and mental disorders in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry 66, 785–795.CrossRefGoogle ScholarPubMed
Silverman, WK, Pina, AA, Viswesvaran, C (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology 37, 105–130.CrossRefGoogle ScholarPubMed
Slade, T, Johnston, A, Oakley Browne, MA, Andrews, G, Whiteford, H (2009). 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Australian and New Zealand Journal of Psychiatry 43, 594–605.CrossRefGoogle ScholarPubMed
Smid, GE, Mooren, TT, van der Mast, RC, Gersons, BP, Kleber, RJ (2009). Delayed posttraumatic stress disorder: systematic review, meta-analysis, and meta-regression analysis of prospective studies. Journal of Clinical Psychiatry 70, 1572–1582.CrossRefGoogle ScholarPubMed
Wang, PS, Lane, M, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629–640.CrossRefGoogle ScholarPubMed
Yule, W, Bolton, D, Udwin, O, Boyle, S, O'Ryan, D, Nurrish, J (2000). The long-term psychological effects of a disaster experienced in adolescence: I. The incidence and course of PTSD. Journal of Child Psychology and Psychiatry 41, 503–511.CrossRefGoogle ScholarPubMed
Zlotnick, C, Rodriguez, BF, Weisberg, RB, Bruce, SE, Spencer, MA, Culpepper, L, Keller, MB (2004). Chronicity in posttraumatic stress disorder and predictors of the course of posttraumatic stress disorder among primary care patients. Journal of Nervous and Mental Disease 192, 153–159.CrossRefGoogle ScholarPubMed
Zlotnick, C, Warshaw, M, Shea, MT, Allsworth, J, Pearlstein, T, Keller, MB (1999). Chronicity in posttraumatic stress disorder (PTSD) and predictors of course of comorbid PTSD in patients with anxiety disorders. Journal of Traumatic Stress 12, 89–100.CrossRefGoogle ScholarPubMed