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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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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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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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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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 imprisonment and risk of PTSD?

High quality evidence finds a medium-sized association between increased number of traumatic events in prison (e.g., victimisation, abuse, solitary confinement, coercion) and increased PTSD symptoms.

Moderate quality evidence finds the prevalence of PTSD in adolescents in detention centres is 8.6% for males and 18.2% for females.

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.

Intentional traumas are those that involve the deliberate infliction of harm, while unintentional exposures are those that are not planned.

What is the evidence regarding intentional and unintentional traumas and risk of PTSD?

Moderate quality evidence finds the median prevalence of PTSD after exposure to unintentional trauma decreases over time, from around 30% at one-month post-trauma to around 14% by 12 months post-trauma, while prevalence post-intentional trauma exposure increases over time (1-12 months 12% to 23%).

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.

Interpersonal traumas are those that involve interaction with other people, such as domestic abuse, while non-interpersonal traumas are those that do not involve interaction with other people, such as natural disasters.

What is the evidence for PTSD in people exposed to interpersonal versus non-interpersonal traumas?

Moderate quality evidence finds the incidence of PTSD following interpersonal trauma is around 25%, and around 10% following non-interpersonal trauma.

In boys, the incidence of PTSD following interpersonal trauma is around 17%, and around 8% following non-interpersonal trauma. In girls, the incidence of PTSD following interpersonal trauma is around 33%, and around 13% following non-interpersonal trauma.

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 migration and displacement and risk for PTSD?

Moderate to high quality evidence found a medium-sized increase in PTSD symptoms in asylum seekers in detention compared to asylum seekers not in detention. There were small associations between more PTSD symptoms and more interpersonal and material daily stress in conflict-affected migrants. There was a medium-sized association between prolonged grief disorder and more PTSD symptoms in adult refugees.

Moderate quality evidence found the prevalence of PTSD in child and adolescent asylum seekers and refugees was around 23%. Prevalence was highest in those displaced for less than two years, in asylum seekers rather than refugees, and in those resettled into refugee centres than into the community.

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.

This summary table presents the evidence for PTSD following moral injury. Moral injury involves transgressions to moral beliefs and expectations that are associated with strong emotions related to the event, including guilt, anger, and disgust.

What is the evidence for the risk of PTSD in people exposed to moral injury?

Moderate to high quality evidence found a medium-sized association between increased workplace moral injury and increased PTSD symptoms in soldiers, veterans, police, and journalists.

August 2021

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