Direct vs. indirect exposure

Can direct and indirect exposure to trauma increase the risk of PTSD?

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

Image: ©Kalinovsky Dmitry, 2014 –

Last updated at: 2:49 am, 8th October 2021
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