Journal
BIOLOGICAL PSYCHIATRY
Volume 77, Issue 4, Pages 375-384Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.biopsych.2014.03.028
Keywords
Epidemiology; Nosology; Partial PTSD; Posttraumatic stress disorder; PTSD; Subthreshold PTSD
Categories
Funding
- National Institute of Mental Health [R01 MH070884, R01 MH093612-01, U01-MH60220]
- John D. and Catherine T. MacArthur Foundation
- Pfizer Foundation
- United States Public Health Service [R13-MH066849, R01-MH069864, R01 DA016558]
- Fogarty International Center [FIRCA R03-TW006481]
- Pan American Health Organization
- Eli Lilly and Company
- Ortho-McNeil Pharmaceutical
- GlaxoSmithKline
- Bristol-Myers Squibb
- State of Sao Paulo Research Foundation Thematic Project [03/00204-3]
- Ministry of Social Protection
- Ministry of Health
- National Center for Public Health Protection
- European Commission [QLG5-1999-01042, 2004123, 20081308]
- Piedmont Region, Italy
- Fondo de Investigacion Sanitaria
- Instituto de Salud Carlos III, Spain [00/0028]
- Ministerio de Ciencia y Tecnologia, Spain [SAF 2000-158-CE]
- Departament de Salut, Generalitat de Catalunya, Spain
- Instituto de Salud Carlos III [CB06/02/0046, RD06/0011 REM-TAP]
- Grant for Research on Psychiatric and Neurological Diseases and Mental Health [H13-SHOGAI-023, H14-TOKUBETSU-026, H16-KOKORO-013]
- Japan Ministry of Health, Labour and Welfare
- National Institute of Psychiatry Ramon de la Fuente [INPRFMDIES 4280]
- National Council on Science and Technology [CONACyT-G30544-H]
- PanAmerican Health Organization
- New Zealand Ministry of Health, Alcohol Advisory Council
- Health Research Council
- Ministry of Public Health (former Ministry of Health)
- Substance Abuse and Mental Health Services Administration
- Robert Wood Johnson Foundation [044708]
- John W. Alden Trust
- Abbott Laboratories
- AstraZeneca
- Jazz Pharmaceuticals
- Johnson Johnson
- Lundbeck
- Orion
- Pfizer
- Pharmacia
- Roche
- Servier
- Solvay
- Sumitomo
- Takeda
- Tikvah
- Wyeth
- Analysis Group
- EPIQ
- Johnson & Johnson Pharmaceuticals
- Ortho-McNeil Janssen Scientific Affairs
- Sanofi-Aventis Groupe
- Shire
- Walgreens
- DataStat, Inc
- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [03/00204-3] Funding Source: FAPESP
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BACKGROUND: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition. METHODS: The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid feardistress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions. RESULTS: Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones. CONCLUSIONS: Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.
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