This paper reviews recent epidemiologic studies of posttraumatic stress disorder (PTSD) in the general population. Estimates of the prevalence of exposure to traumatic events vary with the method used to ascertain trauma exposure and the definition of the stressor criterion. Changes in the DSM-IV definition of “stressor” have increased the number of traumatic events experienced in the community that can be used to diagnose PTSD and thus, the number of PTSD cases. Risk factors for PTSD in adults vary across studies. The 3 factors identified as having relatively uniform effects are 1) preexisting psychiatric disorders, 2) a family history of disorders, and 3) childhood trauma. In civilian populations, women are at a higher risk for PTSD than are men, following exposure to traumatic events. Most community residents have experienced 1 or more PTSD-level traumas in their lifetime, but only a few succumb to PTSD. Trauma victims who do not succumb to PTSD are not at an elevated risk for the subsequent onset of major depression or substance use disorders, compared with unexposed persons.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed.Washington (DC): American Psychiatric Press; 1980.
2.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed.Washington (DC): American Psychiatric Press; 1987.
3.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed.Washington (DC): American Psychiatric Press; 1994.
4.
BreslauNDavisGCAndreskiPPetersonE.Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry1991;48:216–22.
5.
NorrisFH. Epidemiology of trauma: Frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol1992;60:409–18.
6.
ResnickHSKilpatrickDGDanskyBSSaundersBEBestCL. Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol1993;61:984–91.
7.
KesslerRCSonnegaABrometENelsonCB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry1995;52:1048–60.
8.
BreslauNDavisGCPetersonESchultzL.Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry1997;54:81–7.
9.
SteinMBWalkerJRHazenALFordeDR. Full and partial posttraumatic stress disorder: Findings from a community survey. Am J Psychiatry1997;154:1114–9.
10.
BreslauNKesslerRCChilcoatHDSchultzLRDavisGCAndreskiP.Trauma and posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma. Arch Gen Psychiatry1998;55:626–32.
11.
CreamerMBurgessPMcFarlaneAC. Post-traumatic disorder: Findings from the Australian National Survey of Mental Health and Well-Being. Psychol Med2001;31:1237–47.
12.
BreslauNKesslerR.The stressor criterion in DSM-IV posttraumatic stress disorder: An empirical investigation. Biol Psychiatry2001;50:699–704.
13.
RobinsLNHelzerJECottlerLGoldingE.NIMH Diagnostic interview schedule, version III revised. St Louis (MO): Washington University; 1989.
14.
RobinsLCottlerLBucholzKComptonW.Diagnostic interview schedule for DSM-IV. St Louis (MO): Washington University; 1995.
15.
World Health Organization. Composite international diagnostic interview (CIDI, Version 2.1.). World Health Organization; Geneva: 1997.
16.
KesslerRCSonnegaABrometEHughesMNelsonCBBreslauN.Epidemiologic risk factors for trauma and PTSD. In: YehudaR, editor. Risk factors for posttraumatic stress disorder.Washington (DC): American Psychiatric Press; 1999. p 23–59.
17.
BreslauNDavisGCPetersonELSchultzL.Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry1997;54:81–7.
18.
BreslauNChilcoatHDKesslerRCDavisGC. Previous exposure and the PTSD effects of a subsequent trauma: Results from the Detroit Area Survey of Trauma. Am J Psychiatry1999;156:902–7.
19.
BreslauNChilcoatHDKesslerRCPetersonELLuciaVC. Vulnerability to assaultive violence: Further specification of the sex difference in posttraumatic stress disorder. Psychol Med1999;29:813–21.
20.
BreslauN.Epidemiology of trauma and post-traumatic stress disorder. In: YehudaR, Psychological Trauma. In: OldhamJMRibaMB, editors. Review of Psychiatry. Volume 17. Washington (DC): American Psychiatric Press; 1998. p.1–29.
21.
SteinMBWalkerJRFordeDR. Gender differences in susceptibility to posttraumatic stress disorder. Behav Res Ther2000;38:619–28.
22.
BreslauNDavisGCAndreskiP.Risk factors for PTSD related traumatic events: A prospective analysis. Am J Psychiatry1995;152:529–35.
23.
BreslauNDavisGCPetersonELSchultzLR. A second look at comorbidity in victims of trauma: The posttraumatic stress disorder major depression connection. Biol Psychiatry2000;48:902–9.
24.
BrometESonnegaAKesslerRC. Risk factors for DSM-III-R posttraumatic stress disorder: Findings from the National Comorbidity Survey. Am J Epidemiol1998;147:353–61.
25.
BrewinCRAndrewsBValentineJD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol2000;68:748–66.
26.
KendlerKSKesslerRCNealMCHeathACEavesLJ. The prediction of major depression in women: Toward an integrated etiologic model. Am J Psychiatry1993;150:1139–48.
27.
McLeodDSKoenenKCMeyerJMLyonsMJEisenSTrueW, and others. Genetic and environmental influences on the relationship among combat exposure, posttraumatic stress disorder symptoms and alcohol use. J Traumatic Stress2001;14:259–75.
28.
XianHChantarujikaongSIScherrerJFEisenSALyonsMJGoldbergJ, and others. Genetic and environmental influences on posttraumatic stress disorder, alcohol and drug dependence in twin pairs. Drug Alcohol Depend2000;61:95–102.
29.
ConnorKMDavidsonJRT. Familial risk factors in posttraumatic stress disorder. Ann N Y Acad Sci1997;821:32–51.
30.
KulkaRSchlengerWFairbankJHoughRLJordanBKMarmarCR, and others. Trauma and the Vietnam War generation: Report of findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel; 1990.
31.
JordanBKSchlengerWEHoughRKulkaRAWeissDFairbankJA, and others. Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls. Arch Gen Psychiatry1991;48:207–15.
32.
FriedmanMJHYehudaR.Post-traumatic stress disorder and comorbidity: Psychobiological approaches to differential diagnosis. In: FriedmanMJCharneyDSDeutchAY, editors. Neurobiological and clinical consequences of stress: From normal adaptation to post-traumatic stress disorder. New York: Lippincott-Raven; 1995. p 429–45.
33.
YehudaRMcFarlaneACShalevAY. Predicting the development of posttraumatic stress disorder from the acute response to a traumatic event. Biol Psychiatry1998;44:1305–13.
34.
ShalevAYFreedmanSPeriTBrandesDSaharTOrrSP. and others. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry1998;155:630–7.
35.
GaleaSAhernJResnickHKilpatrickDBucuvalasMGoldJ, and others. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med2002;346:982–7.
36.
BreslauN.Chase G, Anthony J. The uniqueness of the DSM definition of post-traumatic stress disorder: Implications for research. Psychol Med2002;32:573–6.
37.
NorthCSNixonSJShariatSMalloneeSMcMillanJCSpitznagelEL, and others. Psychiatric disorders among survivors of the Oklahoma City bombing. JAMA1999;282:755–62.
38.
BlazerDGKesslerRCMcGonagleKASwartzMS. The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. Am J Psychiatry1994;151:979–86.
39.
BreslauNDavisGCSchultzLR. Posttraumatic stress disorder and the incidence of nicotine, alcohol and drug disorders in victims of trauma. Arch Gen Psychiatry. Forthcoming.
40.
ChilcoatHDBreslauN.PTSD and drug use disorders: Testing causal pathways. Arch Gen Psychiatry1998;55:913–7.
41.
StewartSH. Alcohol abuse in individuals exposed to trauma: A critical review. Psychol Bull1996;102:83–112.
42.
GreenBLLindyJDGraceMCGleserGC. Multiple diagnosis in posttraumatic stress disorder: The role of war stressors. J Nervous Mental Dis1989;177:329–35.
