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.

What is the evidence for the prevalence of PTSD in medical patients?

Moderate quality evidence finds the overall prevalence of PTSD in primary care settings (first-contact medical care centres) is around 12.5%. In critical illness survivors, the prevalence of PTSD diagnosis is 20% between discharge from ICU and over 12 months post-discharge. Rates were highest within the first 3 months post-discharge. The prevalence of PTSD symptoms in critical illness survivors is between 25% and 44% up to 6 months post-ICU. Rates vary depending on the Impact of Event Scale score cut-off threshold. By 12 months, rates were between 17% and 34%.

The prevalence of PTSD diagnosis following a coronavirus infection was around 29-32%. Coronavirus infections include the severe acute respiratory syndrome (SARS), the Middle East respiratory syndrome (MERS), and the coronavirus disease 2019 (COVID-19). Rates of PTSD were higher in females than in males following a coronavirus infection. Rates were highest in healthcare workers, in people with a previous physical illness, and in people with avascular necrosis. They were also highest in those with functional impairment, pain, and a sense of lack of control.

The prevalence of PTSD after a traumatic brain injury (TBI) is around 24%. Rates were highest in samples with more males. They were highest in samples with TBI rather than another physical injury, and in military samples exposed to a blast rather than civilians exposed to a motor vehicle accident. They were also highest in studies from the USA. There were no differences in rates of PTSD between people with a mild or moderate/severe TBI.

The prevalence of PTSD after acute orthopaedic trauma is around 26.6%. The prevalence of both PTSD and depression is around 16.8%. Rates were higher in females than males with orthopaedic trauma. They were also higher in patients with lower extremity fractures (including pelvic) than upper extremity fractures.

In people with cancer, the current prevalence of PTSD is around 5-6% and lifetime prevalence is around 12-15%. After an acute coronary event, the prevalence of PTSD is around 12%, with rates higher in studies using a screening instrument than a clinical diagnostic interview to assess PTSD. Within one year after a stroke or transient ischemic attack, the prevalence is around 23% and around 11% after one year. After a caesarean section, prevalence is around 10.7%, with rates higher after an emergency caesarean than after an elective caesarean. The prevalence of PTSD in HIV-positive women is around 30%, with rates proposed to be lower in HIV-positive men.

Prevalence of PTSD symptoms after a burn injury ranged from 3.3% to 35.1% at 1 month, 2.2% to 40% at 3 to 6 months, 9% to 45.2% within the year post-injury, and 6.7% to 25.4% more than 2 years later.

The prevalence of PTSD in people with chronic pain is around 9.7%. PTSD prevalence was highest in people with chronic widespread pain and headache, and lowest 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 after an injury in children is around 20.52%. Rates were highest in girls, in older children, and in children injured in hurricanes.

August 2021

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Traumatic brain injury (TBI) is an alteration in brain function, or other brain pathology, caused by an external force. Brain injury can have severe consequences on physical, cognitive, and affective functioning and may lead to long-lasting limitations. Both civilian and military patients with TBI can develop PTSD, even when a person cannot recall the details of the traumatic event.

What is the evidence for traumatic brain injury and PTSD?

Moderate quality evidence found the prevalence of PTSD after a TBI was around 24%. Rates were higher in males than females, in samples with TBI than other physical injuries, in military samples exposed to a blast than civilians exposed to a motor vehicle accident, and in studies from the USA than other countries. There have been no differences found in the rates of PTSD in people with a mild versus moderate-severe TBI.

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 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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It is well established that traumatic brain injury increases the risk for a wide range of neuropsychiatric disturbances, however, there is little consensus on whether it is a risk factor for bipolar disorder.

What is the evidence for traumatic brain injury as a risk factor for bipolar disorder?

Moderate quality evidence suggests a small effect of increased risk of bipolar disorder in people with a prior traumatic brain injury.

October 2021

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