Exposure to at least one trauma is required for a diagnosis of PTSD. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma. Differences in trauma characteristics, along with differences in personal characteristics, may affect the risk of developing PTSD.

What is the evidence for abuse and violence and risk for PTSD?

Moderate to high quality evidence found a large association between exposure to sexual assault and subsequent PTSD-related conditions. There were medium-sized increases in PTSD symptoms following exposure to bullying, racism, and childhood sexual or physical abuse. There were no significant associations between PTSD and neglect or witnessing interpersonal violence in childhood.

Moderate quality evidence found a medium-sized association between victimisation from intimate partner violence and PTSD, and a small association between perpetration of intimate partner violence and PTSD. These associations were similar for males and females.

Moderate to high quality evidence found a small association between greater level of exposure to mass shootings (closer proximity, longer duration) and increased PTSD symptoms in those exposed.

August 2021

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Personal characteristics, such as age, can influence one’s degree of risk for developing post-traumatic stress disorder. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for effects of age on risk for PTSD?

Moderate to high quality evidence found small associations between younger age and more PTSD symptoms in women following childbirth, and in professionals indirectly exposed to trauma through their therapeutic work with trauma victims. Moderate quality evidence found small associations between older age and more symptoms following burn injuries, and following earthquakes.

There was a medium-sized effect of more PTSD symptoms in older adults (>60-65 years) than younger adults (<60 years) following exposure to any natural disaster. However, there was also a medium-sized effect of less severe PTSD symptoms in older adults following exposure to any man-made disaster. Review authors suggest the disparity in findings between natural and human-induced disasters may be explained by older adults being less likely to receive advanced warnings or to evacuate during a natural disaster, and therefore may experience greater disruption or perceived loss, while previous experiences may better prepare older people to cope with man-made disasters.

There were no effects of age on risk of PTSD after a fall in elderly people (age 65 to 90 compared to over 90 years), following a traumatic brain injury at any age, and in combat-exposed military personnel and veterans.

August 2021

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Exposure to at least one trauma is required for a diagnosis of PTSD. Both direct and indirect exposure to trauma can increase the risk of PTSD. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma resulting in death. Differences in trauma characteristics, along with differences in personal characteristics, may affect the risk of developing PTSD.

What is the evidence for bereavement and risk of PTSD?

Moderate to low quality evidence found the prevalence of PTSD in mothers ranged from 23% to 49.1% within 3 months post-loss, from 0.6% to 37% between 3 months and 12 months post-loss, and from 3.3% to 15.2% by 18 years post-loss. In fathers, prevalence of PTSD ranged from 5% to 8.4% between 7 weeks and 18 years post-loss.

Moderate to high quality evidence found an increased risk of PTSD in bereaved people after exposure to any trauma compared to non-bereaved people after exposure to any trauma.

Moderate quality evidence finds the incidence of PTSD in bereaved individuals following earthquakes is around 39% compared to around 20% for individuals who are not bereaved following earthquakes. This represents a medium-sized effect of increased risk of PTSD in bereaved individuals. This was apparent in both adults and children.

Around 19% of people who were bereaved due to homicide of a loved one met criteria for lifetime PTSD. Around 5% met criteria for current PTSD. Homicidally bereaved people were more likely than non-homicidally bereaved people to report past-year PTSD symptoms. Twice as many parents whose children were murdered met PTSD criteria two years post-loss compared to parents who lost their child due to accident or suicide. There were no differences in rates of PTSD by five years. There were also no differences in PTSD symptoms between homicidally bereaved people and victims of physical or sexual assault.

August 2021

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Personal characteristics, such as cognitive and psychological factors, can influence one’s degree of risk for developing PTSD. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for cognitive and psychological factors on risk for PTSD?

Moderate quality evidence found shorter post-trauma amnesia and more memory of the traumatic event in people with a traumatic brain injury were associated with increased risk of PTSD. There were also associations between depressed mood, poor cognition, distress, and anxiety in people with a spinal cord injury and increased PTSD symptoms.

Moderate to high quality evidence found depression and anxiety, negative subjective and objective birth experiences, fear of childbirth, history of PTSD, negative emotions, dissociation, poor coping and stress, previous psychological problems, and lack of control were all associated with increased risk of PTSD in women following childbirth.

Moderate quality evidence found risk factors associated with PTSD following a burn injury include more life threat perception, intrusion symptoms, substance use disorders, avoidance symptoms, dissociation, negative emotions or distress, acute stress symptoms, having previous psychiatric disorders, need for psychological treatment, more anxiety and depression, having low openness and low narcissism, and feeling responsible for the burn injury.

Moderate to high quality evidence found rates of PTSD following a coronavirus infection (severe acute respiratory syndrome [SARS], Middle East respiratory syndrome [MERS], or coronavirus disease 2019 [COVID-19]) were greater in people with a sense of lack of control.

Moderate to high quality evidence found significant associations between more PTSD symptoms in children and adolescents exposed to any trauma and the following risk factors: post-trauma thought suppression, post-trauma blame others, post-trauma distraction, post-trauma psychological problem, peri-trauma fear, peri-trauma perceived life threat, post-trauma parental psychological problem, pre-trauma low intelligence, pre-trauma low self-esteem, pre-trauma psychological problem, and pre-trauma parent psychological problem. Moderate to low quality evidence found a medium-sized effect of increased rates of PTSD in adults and children who experienced fear during earthquakes.

Moderate quality evidence found good negative predictive power and moderate positive predictive power of acute stress disorder in predicting PTSD. Positive predictive power is the proportion of people who developed PTSD who initially met the criteria for acute stress disorder. Negative predictive power is the proportion of people who did not develop PTSD who did not initially meet the criteria for acute stress disorder.

August 2021

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Exposure to at least one trauma is required for a diagnosis of PTSD. Both direct and indirect exposure to trauma can increase the risk of PTSD. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma. Differences in trauma characteristics, along with differences in personal characteristics, may affect the risk of developing PTSD.

What is the evidence for PTSD in people directly or indirectly exposed to traumas?

Moderate quality evidence finds the prevalence of PTSD in direct victims of terrorist attacks after one year is between 33% and 39%, while indirect victims showed lower prevalence rates (community = 4%, rescue teams = 5-6%, family and friends = 3-13.8%).

Moderate to high quality evidence found small associations between increased PTSD symptoms and higher caseload volume and frequency, and more personal trauma history, in health professionals exposed to secondary workplace trauma. Lower PTSD symptoms in these professionals were associated with more social support, work support, trauma training, experience, and older age. There was also a medium-sized effect of increased PTSD symptoms in health workers exposed to critical incidents (health emergencies) compared to health workers not exposed to critical incidents. The effect was larger after 4 weeks post-incident than before 4 weeks post-incident.

Moderate to high quality evidence found a large effect of more PTSD symptoms in parents of chronically ill children than in parents of healthy children. Rates were highest in parents of children with epilepsy or diabetes, in mothers, in parents of children with more illness severity, longer treatment duration and intensity and in parents of children with PTSD symptoms. Rates were lowest in parents of children with longer illness duration, longer time since active treatment and in those with more social support.

Moderate to high quality evidence found a small association between increased exposure to televised mass trauma and increased PTSD symptoms. There was also a small effect of increased rates of PTSD in people exposed to longer vs. shorter COVID-19 media reporting.

August 2021

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Exposure to at least one trauma is required for a diagnosis of PTSD. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma. Differences in trauma characteristics, including the severity and type of exposure, can affect the risk of developing PTSD. Personal characteristics such as age and sex also influence risk.

What is the evidence for PTSD in people exposed to disasters?

Moderate quality evidence found a large increase in PTSD symptoms in people exposed to natural disasters compared to those not exposed. There were small to medium-sized associations between exposure to disasters and increased PTSD symptoms in youth (≤18 years). The association was strongest in females, in children exposed to disasters with a higher death toll, in those in close proximity to the disaster, and in those with increased perceived threat and distress. There was a medium-sized increase in PTSD symptoms in older adults (60-65 years) than younger adults following exposure to natural disasters. However, there was also a medium-sized decrease in PTSD symptoms in older adults than younger adults following exposure to man-made disasters. Review authors suggest this may be explained by older adults having less likelihood of evacuating during a natural disaster, while previous experiences may better prepare older people to cope with human-induced disasters.

The incidence rate of PTSD after a flood is around 16%. Incidence rates after a flood were highest within six months and in people who experienced severe flood intensity. The incidence rate of PTSD after an earthquake is around 24%. Incidence rates after an earthquake were highest within nine months, in females, and in people who had damage to their houses. Being older, trapped, experiencing fear, injury, bereavement, and witnessing injury/death during the earthquake were all related to greater risk of PTSD. Having a higher education was associated with more PTSD in children but less PTSD in adults following an earthquake.

August 2021

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Personal characteristics, such as level of education, can influence one’s degree of risk for developing post-traumatic stress disorder. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for education and risk for PTSD?

Moderate to high quality evidence found a small effect of fewer years of education increased the risk of PTSD in women following childbirth.

Moderate to low quality evidence found having more years at school was associated with more PTSD in children exposed to earthquakes but having less years at school was associated with more PTSD in adults exposed to earthquakes.

There were no associations in people with a traumatic brain injury.

August 2021

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Exposure to at least one trauma is required for a diagnosis of PTSD. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma. Differences in trauma characteristics, including the severity and type of exposure, can affect the risk of developing PTSD. Personal characteristics such as age and sex also influence risk.

What is the evidence regarding epidemics and pandemics and risk of PTSD?

Moderate to high quality evidence found the overall prevalence of PTSD symptoms during coronavirus outbreaks (Middle East respiratory syndrome [MERS], severe acute respiratory syndrome [SARS], and coronavirus disease 2019 [COVID-19]) is around 18%. PTSD symptoms are more common in coronavirus patients (29-32%) than in healthcare workers (18%) or in the general population (12%). Rates of depression and anxiety disorders are both around 15% during coronavirus outbreaks.

Rates of PTSD symptoms were higher during the MERS and SARS outbreaks than during the COVID-19 outbreak, although the full effects of the COVID-19 outbreak have not yet been established. Rates of PTSD symptoms were higher in healthcare workers during the outbreaks than after the outbreaks. Patients and the general population showed higher rates of PTSD symptoms after the outbreaks than during the outbreaks. In coronavirus patients, rates of PTSD symptoms were highest in females, in infected healthcare workers, in people with a previous physical illness, and in people with avascular necrosis. Rates were highest in people with functional impairment, pain, or a sense of lack of control. For COVID-19 specifically, there were small increases in the rates of PTSD in patients compared to non-patients, and in people exposed to longer versus shorter COVID-19 media reporting.

The prevalence of PTSD during and following pandemic infections that required quarantine measures for their management was 21.65%. This was similar to the rates of distress, depression, and anxiety during and following these pandemics.

August 2021

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Personal characteristics can influence one’s degree of risk for developing PTSD. How such personal characteristics may effect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence for ethnicity and risk for PTSD?

Moderate to high quality evidence found a small association between increased risk of PTSD following childbirth in White vs. other participants.

Moderate to low quality evidence found a small association between increased PTSD symptoms following Hurricane Katrina and increased minority ethnicity.

Moderate quality evidence found the rate of PTSD was higher in Black samples than in White samples (49% vs. 29%) after road traffic accidents.

Moderate to high quality evidence found a small association between increased PTSD symptoms following any trauma in children and adolescents and increased Black or minority ethnicity.

Moderate to high quality evidence found no association between ethnicity and PTSD symptoms in professionals indirectly exposed to trauma through their therapeutic work with trauma victims.

August 2021

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Personal characteristics, such as family factors, can influence one’s degree of risk for developing PTSD. How such personal characteristics may affect the development of PTSD would be influenced by other personal characteristics as well as differences in the trauma experience itself.

What is the evidence on family and social factors on risk for PTSD?

Moderate to low quality found small increases in rates of PTSD following earthquakes in adults with low vs. high SES, low vs. high employment, and low vs. high social support. This quality evidence also found a small increase in PTSD symptoms following a burn injury in unmarried vs. married patients.

Moderate to high quality evidence found low social support was associated with more PTSD symptoms following childbirth. There were no associations between PTSD following childbirth and socio-economic factors or marital status. This quality evidence also found associations between more PTSD symptoms in children and adolescents following any trauma and poor family functioning, low social support, low SES, and pre- and post-trauma parental psychological problems.

August 2021

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