Prevalence represents the overall proportion of individuals in a population who have the disorder of interest. It is different from incidence, which represents only the new cases that have developed over a particular time period. Point prevalence is the proportion of individuals who have the disorder at a given point in time. Period prevalence is the proportion of individuals who have the disorder over specific time periods. Lifetime prevalence is the proportion of individuals who have ever had the disorder. Lifetime morbid risk also includes those who had the disorder but were deceased at the time of the survey.

What is the evidence for the prevalence of PTSD in epidemic or pandemic survivors?

Moderate to high quality evidence finds the overall prevalence of PTSD within 12 months of an infectious disease pandemic is around 22.6%. Rates were highest in frontline healthcare workers, during COVID-19 (rather than during severe acute respiratory syndrome, Middle East respiratory syndrome, Ebola, or H1N1), and in individuals exposed to quarantine (home or hotel).

Moderate quality finds the rates of PTSD were higher in coronavirus patients with a history of physical illness, functional impairment, pain, and in those experiencing a lack of control.

December 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 risk of PTSD in people exposed to physical illness and injury?

Moderate quality evidence found the prevalence of PTSD following a coronavirus infection was around 29-32%. Rates of PTSD were highest in female patients, in infected healthcare workers, in patients with a previous physical illness, and in patients with avascular necrosis. They were highest in patients with functional impairment, pain, and a sense of lack of control. Rates were highest when measured during coronavirus outbreaks, in patients with MERS rather than SARS, and in studies using the Impact of Event scale to measure PTSD.

A medium-sized increase in PTSD was found in people with a traumatic brain injury (TBI) than in people with no TBI. Rates were higher in military than civilian samples, in samples with more males than females, in samples exposed to a blast rather than a motor vehicle accident, in samples from the USA, and in samples with a TBI rather than another physical injury. Shorter post-trauma amnesia and more memory of the traumatic event were associated with increased risk of PTSD following a TBI.

The prevalence of PTSD after a fall in the elderly was 27.5%. This represents a small increased risk in PTSD compared to older people with no fall history. The prevalence of PTSD after any acute orthopaedic trauma was around 26.6%. Rates were higher in females, and higher in patients with lower versus higher extremity fractures.

The prevalence of PTSD symptoms in critical illness survivors was between 25% and 44% up to 6 months post-ICU, and between 17% and 34% by 12 months. ICU risk factors for PTSD symptoms included benzodiazepine administration and post-ICU memories of frightening ICU experiences.

The prevalence of PTSD in people with chronic pain was around 9.7%. PTSD prevalence was higher in people with chronic widespread pain and headache, and lower in people with back pain. Prevalence was higher in studies using self-reported PTSD symptoms than in studies using clinical interviews to assess PTSD.

The prevalence of PTSD in people with cancer was around 11%. This represents a small increase in the risk of PTSD in people with cancer compared to people without cancer. Rates of PTSD were higher in studies using self-report instruments than clinical assessments, in samples with brain cancer, in samples undergoing chemotherapy, in Middle Eastern samples, in samples with prior trauma, in younger samples, and in samples with a longer time since cancer diagnosis.

The prevalence of PTSD in children after an injury was around 20.5%. Rates were highest in girls, in older children and in children injured in hurricanes. A large effect of more PTSD symptoms was found in parents of chronically ill 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 parents with more social support.

Risk factors associated with PTSD following a burn injury include (in descending order of effect); more life threat perception, intrusion symptoms, pain, low socioeconomic status, alcohol use disorders, increased age, avoidance symptoms, dissociation, negative emotions or distress, acute stress symptoms, having previous psychiatric disorders, substance use disorders, need for psychological treatment, being injured by an explosion, more body surface area affected, more anxiety and depression, longer hospitalisation stay, having low openness, being female, having more surgeries, low narcissism, and feeling responsible for the burn injury. Risk factors associated with PTSD symptoms after a spinal cord injury include (in descending order of effect); depressed mood, poor cognition, distress, anxiety, pain, history of previous trauma, being female, having less time since the trauma, and having a higher education.

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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