Global prevalence of stress and trauma and related disorders
Theme leader: Carolina Salgado
Approximately 70% of the world’s population have been exposed to a traumatic life event, and the resulting mental health problems represent a major challenge to public mental health services, globally.
Under this theme we look at the prevalence of extreme stressors and traumatic events around the word and its potential consequences.
MaTRix
The Many faces of Trauma and Recovery around the world: Mapping experiences in Cultural Context
Project leaders
Stéfanie Fréel, Soraya Seedat, Chris Hoeboer, Miranda Olff
Project group
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Cherie Armour, Queen’s University, Belfast, Northern Ireland
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Rachel Bachem, University of Zurich, Switzerland
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Eric Bui, Université de Caen, France
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Maria Bragesjö, Karolinska Institutet & Stockholm Health Care Services, Stockholm, Sweden
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Bruno Coimbra, Utrecht University, The Netherlands
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Ateka Contractor, University of North Texas, USA
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Kate Ellis, American University of Cairo, Egypt
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Stéfanie Fréel, Amsterdam University Medical Center, The Netherlands
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Talya Greene, University College London, UK
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Sarah Halligan, University of Bath, UK
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Kim Heeguk, Sanji University, South Korea
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Chris Hoeboer, Amsterdam University Medical Center, The Netherlands
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Jinhee Hyun, Daegu University, South Korea
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Naved Iqbal, Jamia Millia Islamia University, India
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Darejan Javakhishvili, Iliauni University, Georgia
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Dan Jenkins, Université de Fribourg, Switzerland
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Laura Jobson, Monash University, USA
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Debbie Kaminer, University of Cape Town, South Africa
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Nancy Kassam-Adams, Children's Hospital of Philadelphia, USA
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Debra Kaysen, Stanford University, USA
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Karestan Koenen, Harvard University, USA
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Rachel Langevin, McGill University, Canada
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Max Loomes, University of New South Wales, Australia
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Andreas Maercker, University of Zurich, Switzerland
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Olivia Matshabane, Stellenbosch University, South Africa
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Fiona McEwen, King’s College London, UK
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Frank Neuner, Bielefeld University, Germany
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Miranda Olff, Amsterdam University Medical Center, The Netherlands
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Monique Pfaltz, Mid Sweden University, Sweden
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Indira Primasari, Amsterdam University Medical Center, The Netherlands
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Janne Punski-Hoogervorst, University of Haifa, Israel
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Joe Ruzek, Palo Alto University, USA
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Carolina Salgado, Universidad Catolica del Maule, Chile
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Soraya Seedat, Stellenbosch University, South Africa
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Manasi Sharma, Harvard University, USA
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Geert Smid, ARQ Centrum ’45, The Netherlands
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Sjacko Sobczak, Maastricht University, The Netherlands
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Kathy Trang, Harvard University, USA
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Luzimar Vega, US Department of Veteran Affairs, USA
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Dany Laure Wadji, McGill University, Canada
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Rachel Williamson, University of Montana, USA
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Larisa Zasiekina, Cambridge University, UK
Preliminary project summary
Cultural factors may influence the expression of trauma-related symptoms and disorders. Understanding cultural variations in, and the impact of socio- and ethno-cultural factors on, the manifestation of trauma and associated traumatic responses and trajectories, is central to assessing the cross-cultural validity of the PTSD construct. It is also crucial to informing the development and implementation of efficacious, culturally-relevant, and contextually-appropriate psychological assessments and treatments in culturally diverse settings grounded in culturally-informed healing practices. Therefore our goal is 1. to determine how cultural factors may influence the expression of trauma and trauma-related disorders including culturally-specific, conceptualizations of traumatic events, traumatic responses and healing at individual and collective level; 2. to explore cross-cultural variations in factors promoting healing across cultures. We propose a phased mixed-methods ethnographic research design including in depth interviews, surveys and a (AI supported) systematic review.
Status: preparation phase, collaborators welcome from LMIC
Please contact Stéfanie Fréel for further information.
G-Stress
A global assessment of the ICD-11 stress-related disorders
Project group
See Core collaborators and Collaborators below.
This project brings together traumatic stress experts from around the world including members of ISTSS, ESTSS, and DeGPT. Four of the collaborators are also part of the other Global Collaboration projects who such as the development of the Global Psychotrauma Screen (GPS), the e-pamphlets for adults who have experienced childhood trauma (Internet information on Childhood Abuse and Neglect ((iCAN)) the the CARTS project (ongoing).
Core Collaborators
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Menachem Ben-Ezra, School of Social Work, Ariel University, Ariel, Israel.
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Jon Bisson, School of Medicine, Cardiff University, Cardiff, UK.
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Chris Brewin, Clinical, Educational, and Health Psychology, University College London, London, UK.
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Marylene Cloitre, National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America.
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Thanos Karatzias, Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK.
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Brigitte Lueger-Schuster, Department of Applied Psychology, University of Vienna, Vienna, Austria.
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Andreas Maercker, Department of Psychology, Division of Psychopathology, University of Zurich, Zurich, Switzerland.
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Miranda Olff, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, and ARQ National Psychotrauma Center, Diemen, Netherlands.
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Neil Roberts, Cardiff & Vale University Health Board, Cardiff, UK and School of Medicine, Cardiff University, Cardiff, UK.
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Mark Shevlin, School of Psychology, Ulster University, Derry, Northern Ireland.
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Frédérique Vallières Trinity Centre for Global Health, University of Dublin, Trinity College, Dublin, Republic of Ireland.
Collaborators
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Kristina Bondjers, Uppsala University, Uppsala, Sweden.
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Wai Tong Chien, The Chinese University of Hong Kong, Hong Kong.
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Amy Chow, University of Hong Kong, Hong Kong.
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Carmen Fernández-Fillol, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Spain.
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Andres Fresno, University of Talca, Chile.
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Marieke van Gelderen, Arq Psychotrauma Expert Group, Centrum ’45, Netherlands.
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Ohad Gilbar, Bar-Ilan University, Israel.
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Sachiko Inoue, Okayama Prefectural University, Japan.
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Evaldas Kazlauskas, Vilnius University, Lithuania.
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Matthias Knefel, University of Vienna, Austria.
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Grace W.K. Ho, The Hong Kong Polytechnic University, Hong Kong.
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Eoin McElroy, University College London, UK.
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Grainne McGinty, Maynooth University, Kildare, Ireland.
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Carolina Salgado, University of Talca, Chile.
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Daja Somarasundaram, University of Jaffna, Sri Lanka.
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Jiangping Wang, Beijing Normal University, Beijing, China.
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Pei-Jung (Annie) Yang, National Chengchi University, Taiwan.
Background
Approximately 70% of the world’s population have been exposed to a traumatic life event (Benjet et al., 2016, Kessler et al., 2017), and the resulting mental health problems represent a major challenge to public mental health services, globally (Sara & Lappin, 2017). In 2018, the World Health Organization (WHO) released the 11th version of the International Classification of Diseases (ICD-11), the primary diagnostic manual used by health professionals worldwide (First, Reed, Hyman, & Saxena, 2015). All United Nations member states are committed to using the ICD-11, and relevant to psychotraumatologists, ICD-11 provides novel descriptions of stress-related psychopathology compared to the ICD-10 and the DSM-5 (American Psychiatric Association, 2013).
Under the parent category of ‘Disorders Specifically Associated with Stress’, ICD-11 defines a number of stress-related disorders including ‘Posttraumatic Stress Disorder’ (PTSD) (PB40), ‘Complex PTSD’ (CPTSD) (PB41), ‘Prolonged Grief Disorder’ (PB42), and ‘Adjustment Disorder’ (PB43). The guiding principles underlying the development on these disorders were that they should (a) maximize clinical utility by including a small number of core symptoms and (b) be internationally applicable (Maercker et al., 2013). The World Mental Health Survey consortium have provided information about the prevalence of traumatic life events, and PTSD, internationally (Benjet et al., 2016; Karam et al., 2014). While valuable, these studies utilized the now outdated DSM-IV description of PTSD.
Aims
As ICD-11 represents the primary diagnostic manual used worldwide, and includes a new and distinct model of stress-related psychopathology, it is imperative for psychotraumatology research and practice to determine the global prevalence rates of these disorders.
Methods and Output
Members of the G-Stress Project have begun to assess the current prevalence rates of the ICD-11 stress-related disorders using nationally representative samples in countries like Israel (Hyland et al., under review; Kilkelly et al., 2019), Germany (Maercker et al., 2018), United Kingdom (Maercker et al., 2018; Cloitre et al., 2018) and United States (Cloitre et al., in press). It is clear that substantially more data is needed from nations all around the world to better understand how common these disorders are. In this project, we invite members of the ISTSS’s Global Collaboration to contribute to the ongoing work that aims to ascertain the prevalence of the ICD-11 stress-related disorders around the world. By obtaining information about the prevalence rates of the ICD-11 stress-related disorder at a global level, the ISTSS’s Global Collaboration will be able to provide the scientific community with vital information about the frequency and distribution of stress- and trauma-related events, and stress-related disorders, globally. This would allow for more effective and efficient resource planning among global health professionals.
LATrauma
Trauma in Latin America
Project leaders
Adrian Arevalo, Facultad de Medicina Humana, Universidad de Piura, Perú
Carolina Salgado, Facultad de Medicina, Universidad Católica del Maule, Chile
Project group
Adrian Arevalo, Facultad de Medicina Humana, Universidad de Piura, Perú
Carolina Salgado, Facultad de Medicina, Universidad Católica del Maule, Chile
Leslie Young Facultad de Medicina Humana Universidad de Piura, Perú
Mariela Osores, Facultad de Medicina Humana, Universidad de Piura, Perú
Julia Carranza Facultad de Medicina Humana Universidad de Piura, Perú
Camila Espinoza, Faculty of Social and Behavioral Sciences, Leiden University, The Netherlands
Daniel Jiménez, Facultad de Medicina, Universidad Católica del Maule, Chile
Susana Campos, Centro de Psicología Aplicada, Facultad de Psicología, Universidad de Talca, Chile y Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes, IMHAY, Chile.
Bruno M. Coimbra, Department of Methodology & Statistics, Utrecht University, The Netherlands & Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), Brazil
Background
Little is known about the state-of-the art about research related to traumatic events and their associated disorders in Latin America considering diagnosic criteria based on DSM-5 or ICD-11.
Aims
The initial aim is to identify bibliometric characteristics of studies carried out on trauma-related disorders associated perfomred in Latin America.
Method
A team has been formed with trauma clinicians/researchers from Peru, Chile and Brazil. A bibliometric analysis will be applied.
An AI supported systematic review using ASReview - as part of the GCTS methods section - is being prepared.
Trauma exposure and trauma disorders in adolescents around the world
Project leader
Ask Elklit, Danish Center of Psychotraumatology, University of Southern Denmark, Denmark
Project group
Currently looking for collaborators, please contact the project leader if interested.
Background
Children and adolescents are not often studied in national, epidemiological studies of trauma exposure and trauma disorders. They can be hard to access, and they do not represent a strong lobby group to get help after traumatization. Nevertheless, it is important to focus on the age groups, as prevention efforts can be made to reduce trauma exposure, and intervention/treatment possibilities can help young children to relief trauma sequelae and secure recovery.
Aims
To address the challenges after trauma of this age group by national comparisons and sample analyses by informing the national political and health leaders.
Methods
Questionnaire study, preferable representative, age around 15 years (11-17), accessible thru the general school system at an age, where they have the capacity to understand and handle questions on trauma exposure and reactions.
A plan for data collection is elaborated to ensure representativity. A standard questionnaire packet is translated and back translated before it is distributed. In countries with abundant access to laptops or personal telephones and secure linkage channels, these means can be used instead of paper versions. The full questionnaire packet contains several psychological measures that serve as mediators to explain the development of PTSD and complex PTSD.
How to get involved
If you are interested please contact Ask Elklit.
Trauma and PTSD in Dutch general population and in students
Project group
Chris Hoeboer, Joris Haagen, Birit Broekman, Federica Nava, Miranda Olff
Background and Aims
As part of G-Stress, which is focusing the global prevalence of ICD-11 related disorders, this study focuses on the assessment of trauma and trauma related disorders in the Netherlands, with a further focus on sex/gender aspects as well as treatment needs and barriers.
We will investigate the following research questions:
1) What is the current prevalence rate of potentially traumatic events, PTSD and other trauma-related disorders in in the Netherlands in a representative sample of the general population as well as in a representative sample of students.
Sex/Gender focus: Are there differences in the manifestation of trauma-related symptoms related to sex and gender? Based on previous research, we expect men to have a higher prevalence of exposure to accidents and women to have a higher prevalence of exposure to sexual violence. We also women to have a higher PTSD, Complex PTSD, anxiety and depression prevalence but lower substance use disorder prevalence compared to men.
2) What is the current treatment gap and what are the treatment needs? What are barriers for seeking professional help and how does this relate to sex/gender?
Based on previous reports, we expect there to be a treatment gap and we expect that respondents might experience difficulties with accessing professional help after traumatic events during their study.
We expect male respondents to experience a larger treatment gap compared to female respondents
3) Which characteristics are related to treatment needs and the treatment gap? And how do these characteristics interact?
We expect that education level might be related to the treatment gap (with secondary vocational education be more at risk compared to applied higher education or University) as well as a larger treatment gap for types of trauma where stigma plays a role (i.e., sexual violence). We also expect that comorbidity/complexity of the complaints (e.g. complex PTSD or dissociative symptoms) to be related to less utilization of trauma-focused treatment.
Method
Cross-sectional measurement of participants in the LISS panel followed by one interview for those who agree to this.
Self-report measures:
- Demographics: e.g., gender and sexual preference
- Traumatic events, including interpersonal events specifically during study period for students: LEC-5
- Traumatic events during study (for students)
- Trauma-related disorders: GPS
- DSM-5 PTSD (current and lifetime): PCL-5
- ICD-11 PTSD and Complex PTSD: ITQ
- Depressive symptoms: PHQ-9
- Anxiety symptoms: GAD-7
- Substance abuse: ASSIST
- Quality of life EQ-5D-5L (1 item)
- Questions about past treatment and treatment needs
Interview:
- CAPS-5 for PTSD symptoms
- MINI for other trauma-related disorders
Sample size: Minimum 1425 in total
Preregistration: OSF Registries | Trauma and PTSD in Dutch general population