Subthreshold Posttraumatic Stress Disorder in the World Health Organization World Mental Health Surveys

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McLaughlin, Katie A. ^[1] ; Koenen, Karestan C. ^[2] ; Friedman, Matthew J. ^{[3, 4]} ; Ruscio, Ayelet Meron ^[5] ; Karam, Elie G. ^[6] ; Shahly, Victoria ^[7] ; Stein, Dan J. ^[8] ; Hill, Eric D. ^[7] ; Petukhova, Maria ^[7] ; Alonso, Jordi ^[9] ; Andrade, Laura Helena ^{[10, 11]} ; Angermeyer, Matthias C. ^[12] ; Borges, Guilherme ^{[13, 14]} ; de Girolamo, Giovanni ^[15] ; de Graaf, Ron ^[16] ; Demyttenaere, Koen ^[17] ; Florescu, Silvia E. ^[18] ; Mladenova, Maya ^[19] ; Posada-Villa, Jose ^[20] ; Scott, Kate M. ^[21] ; Takeshima, Tadashi ^[22] ; Kessler, Ronald C. ^[7]

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^[1] Univ Washington, Dept Psychol, Seattle, WA 98195 - USA

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

^[3] US Dept Vet Affairs, Natl Ctr PTSD, Hanover, NH - USA

^[4] Geisel Sch Med Dartmouth, Hanover, NH - USA

^[5] Univ Penn, Dept Psychol, Philadelphia, PA 19104 - USA

^[6] Balamand Univ, St George Hosp Univ Med Ctr, Inst Dev Res Advocacy & Appl Care, Med Inst Neuropsychol Disorders, Fac Med, Beirut - Lebanon

^[7] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 - USA

^[8] Univ Cape Town, Dept Psychiat & Mental Hlth, ZA-7925 Cape Town - South Africa

^[9] Univ Pompeu Fabra, Hlth Serv Res Unit, Inst Hosp Mar Invest Med, Consorcio Invest Biomed Red Epidemiol & Salud Pub, Barcelona - Spain

^[10] Univ Sao Paulo, Sch Med, Inst Psychiat, Sao Paulo - Brazil

^[11] Univ Sao Paulo, Sch Med, Sect Psychiat Epidemiology LIM 23, Dept Psychiat, Sao Paulo - Brazil

^[12] Ctr Publ Mental Hlth, Gosing Am Wagram - Austria

^[13] Natl Inst Psychiat Mexico, Dept Epidemiol Res, Div Epidemiol & Psychosocial Res, Mexico City, DF - Mexico

^[14] Metropolitan Autonomous Univ, Mexico City, DF - Mexico

^[15] Ctr S Giovanni di Dio Fatebenefratelli, Ist Ricovero & Cura Carattere Sci, Brescia - Italy

^[16] Netherlands Inst Mental Hlth & Addict, Utrecht - Netherlands

^[17] Univ Hosp Gasthuisberg, Dept Psychiat, Leuven - Belgium

^[18] Natl Sch Publ Hlth Management & Profess Dev, Hlth Serv Res & Evaluat Ctr, Bulgarian Ctr Human Relat, Bucharest - Romania

^[19] New Bulgarian Univ, Sofia - Bulgaria

^[20] Univ Colegio Mayor Cundinamarca, Dept Psychiat, Bogota - Colombia

^[21] Univ Otago, Dept Psychol Med, Dunedin - New Zealand

^[22] Natl Ctr Neurol & Psychiat, Natl Inst Mental Hlth, Kodaira, Tokyo - Japan

• Tipo de documento: Artigo Científico
• Fonte: BIOLOGICAL PSYCHIATRY; v. 77, n. 4, p. 375-384, FEB 15 2015.
• Citações Web of Science: 50

Resumo

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. (AU)

• Processo FAPESP: 03/00204-3 - Estudo epidemiológico dos transtornos psiquiátricos na região metropolitana de São Paulo: prevalências, fatores de risco e sobrecarga social e econômica
• Beneficiário: Laura Helena Silveira Guerra de Andrade
• Modalidade de apoio: Auxílio à Pesquisa - Temático