Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys

Author(s):Show less -

Stein, Dan J. ^[1] ; Koenen, Karestan C. ^[2] ; Friedman, Matthew J. ^[3] ; Hill, Eric ^[4] ; McLaughlin, Katie A. ^[5] ; Petukhova, Maria ^[4] ; Ruscio, Ayelet Meron ^[6] ; Shahly, Victoria ^[4] ; Spiegel, David ^[7] ; Borges, Guilherme ^[8] ; Bunting, Brendan ^[9] ; Caldas-de-Almeida, Jose Miguel ^{[10, 11]} ; de Girolamo, Giovanni ^[12] ; Demyttenaere, Koen ^[13] ; Florescu, Silvia ^[14] ; Maria Haro, Josep ^[15] ; Karam, Elie G. ^[16] ; Kovess-Masfety, Viviane ^{[17, 18]} ; Lee, Sing ^[19] ; Matschinger, Herbert ^[20] ; Mladenova, Maya ^[21] ; Posada-Villa, Jose ^[22] ; Tachimori, Hisateru ^[23] ; Viana, Maria Carmen ^[24] ; Kessler, Ronald C. ^[4]

Affiliation:Show less -

^[1] Univ Cape Town, Dept Psychiat & Mental Hlth, ZA-7925 Cape Town - South Africa

^[2] Columbia Univ, Dept Epidemiol, Mailman Sch Publ Hlth, New York, NY - USA

^[3] US Dept Vet Affairs, Natl Ctr Posttraumat Stress Disorder, Hanover, NH - USA

^[4] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 - USA

^[5] Harvard Univ, Sch Med, Div Gen Pediat, Childrens Hosp Boston, Boston, MA 02115 - USA

^[6] Univ Penn, Dept Psychol, Philadelphia, PA 19104 - USA

^[7] Stanford Univ, Dept Psychiat & Behav Sci, Sch Med, Stanford, CA 94305 - USA

^[8] Natl Inst Psychiat Mexico, Div Epidemiol & Psychosocial Res, Dept Epidemiol Res, Mexico City, DF - Mexico

^[9] Univ Ulster, Psychol Res Inst, Coleraine BT52 1SA, Londonderry - North Ireland

^[10] Univ Nova Lisboa, Fac Ciencias Med, Dept Mental Hlth, P-1200 Lisbon - Portugal

^[11] Univ Nova Lisboa, Fac Ciencias Med, Chron Dis Res Ctr, P-1200 Lisbon - Portugal

^[12] Ctr S Giovanni Dio Fatebenefratelli, Ist Ricovero & Cura Carattere Sci, Brescia - Italy

^[13] Univ Hosp Gasthuisberg, Dept Psychiat, B-3000 Louvain - Belgium

^[14] Natl Sch Publ Hlth Management & Profess Dev, Hlth Serv Res & Evaluat Ctr, Bucharest - Romania

^[15] Ctr Invest Biomed Red Salud Mental, Barcelona - Spain

^[16] Balamand Univ, Fac Med, Inst Dev Res Advocacy & Appl Care, Med Inst Neuropsychol Disorders, St George Hosp Un, Beirut - Lebanon

^[17] Univ Paris 05, Equipes Accueil 4069, Paris - France

^[18] Ecole Hautes Etud Sante Publ, Sch Publ Hlth, Dept Epidemiol, Paris - France

^[19] Chinese Univ Hong Kong, Dept Psychiat, Hong Kong, Hong Kong - Peoples R China

^[20] Univ Leipzig, Inst Social Med Occupat Hlth & Publ Hlth, Publ Hlth Res Unit, D-04109 Leipzig - Germany

^[21] New Bulgarian Univ, Sofia - Bulgaria

^[22] Pontificia Univ Javeriana, Inst Colombiano Sistema Nervioso, Bogota - Colombia

^[23] Natl Ctr Neurol & Psychiat, Natl Inst Mental Hlth, Tokyo - Japan

^[24] Univ Fed Espirito Santo, Dept Social Med, Vitoria - Brazil

• Document type: Journal article
• Source: BIOLOGICAL PSYCHIATRY; v. 73, n. 4, p. 302-312, FEB 15 2013.
• Web of Science Citations: 120

Abstract

Background: Although the proposal for a dissociative subtype of posttraumatic stress disorder (PTSD) in DSM-5 is supported by considerable clinical and neurobiological evidence, this evidence comes mostly from referred samples in Western countries. Cross-national population epidemiologic surveys were analyzed to evaluate generalizability of the subtype in more diverse samples. Methods: Interviews were administered to 25,018 respondents in 16 countries in the World Health Organization World Mental Health Surveys. The Composite International Diagnostic Interview was used to assess 12-month DSM-IV PTSD and other common DSM-IV disorders. Items from a checklist of past-month nonspecific psychological distress were used to assess dissociative symptoms of depersonalization and derealization. Differences between PTSD with and without these dissociative symptoms were examined across a variety of domains, including index trauma characteristics, prior trauma history, childhood adversity, sociodemographic characteristics, psychiatric comorbidity, functional impairment, and treatment seeking. Results: Dissociative symptoms were present in 14.4% of respondents with 12-month DSM-IV/Composite International Diagnostic Interview PTSD and did not differ between high and low/middle income countries. Symptoms of dissociation in PTSD were associated with high counts of re-experiencing symptoms and net of these symptom counts with male sex, childhood onset of PTSD, high exposure to prior (to the onset of PTSD) traumatic events and childhood adversities, prior histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality. Conclusion: These results provide community epidemiologic data documenting the value of the dissociative subtype in distinguishing a meaningful proportion of severe and impairing cases of PTSD that have distinct correlates across a diverse set of countries. (AU)

• FAPESP's process: 03/00204-3 - Epidemiological study of psychiatric disorders in the São Paulo Metropolitan Region: prevalence, risk factors, and social and economical burden
• Grantee: Laura Helena Silveira Guerra de Andrade
• Support Opportunities: Research Projects - Thematic Grants