This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Ronald C. Kessler, PhD; Amanda Sonnega, PhD; Evelyn Bromet, PhD; Michael Hughes, PhD; Christopher B. Nelson, MPH, PhD

Arch Gen Psychiatry. 1995;52(12):1048-1060.

Abstract
Background
Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.

Methods
Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.

Results
The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.

Conclusions
Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.

Author Affiliations
From the Institute for Social Research (Drs Kessler and Sonnega) and the Department of Sociology (Dr Kessler), University of Michigan, Ann Arbor; Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook (Dr Bromet); Department of Sociology, Virginia Polytechnic Institute and State University, Blacksburg, Va (Dr Hughes); and Max Planck Institute of Psychiatry—Clinical Institute, Munich, Germany (Dr Nelson).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Posttraumatic Stress Symptoms in Children and Adolescents Referred for Child Welfare Investigation: A National Sample of In-Home and Out-of-Home Care
Kolko et al.
Child Maltreat 2010;15:48-63.
ABSTRACT  

Mental Health Consequences in Men Exposed to Sexual Abuse During the War in Croatia and Bosnia
Loncar et al.
J Interpers Violence 2010;25:191-203.
ABSTRACT  

Traumatic Events and Mental Health in the Community: a New Zealand Study
Kazantzis et al.
Int J Soc Psychiatry 2010;56:35-49.
ABSTRACT  

The Association of Immigrant- and Non-Immigrant-Specific Factors With Mental Ill Health Among Immigrants in Sweden
Tinghog et al.
Int J Soc Psychiatry 2010;56:74-93.
ABSTRACT  

Predicting Stress Related to Basic Needs and Safety in Darfur Refugee Camps: A Structural and Social Ecological Analysis
Rasmussen and Annan
Journal of Refugee Studies 2009;0:fep044v1-fep044.
ABSTRACT | FULL TEXT  

Health Care Utilization and Its Costs for Depressed Veterans With and Without Comorbid PTSD Symptoms
Chan et al.
Psychiatr. Serv. 2009;60:1612-1617.
ABSTRACT | FULL TEXT  

Child Abuse in Young, HIV-Positive Women: Linkages to Risk
Clum et al.
Qual Health Res 2009;19:1755-1768.
ABSTRACT  

Comparison of Short-Term Psychological Outcomes of Respiratory Failure Treated by Either Invasive or Non-Invasive Ventilation
Shaw et al.
Psychosomatics 2009;50:586-591.
ABSTRACT | FULL TEXT  

Interactive Effect of Stressful Life Events and the Serotonin Transporter 5-HTTLPR Genotype on Posttraumatic Stress Disorder Diagnosis in 2 Independent Populations
Xie et al.
Arch Gen Psychiatry 2009;66:1201-1209.
ABSTRACT | FULL TEXT  

Posttraumatic Stress Disorder and Health-Related Quality of Life in Patients With Coronary Heart Disease: Findings From the Heart and Soul Study
Cohen et al.
Arch Gen Psychiatry 2009;66:1214-1220.
ABSTRACT | FULL TEXT  

Relationship Between Type of Trauma Exposure and Posttraumatic Stress Disorder Among Urban Children and Adolescents
Luthra et al.
J Interpers Violence 2009;24:1919-1927.
ABSTRACT  

Trauma, Posttraumatic Stress Disorder, and Physical Illness: Findings from the General Population
Spitzer et al.
Psychosom. Med. 2009;71:1012-1017.
ABSTRACT | FULL TEXT  

Posttraumatic Stress Disorder: The Role of Medial Prefrontal Cortex and Amygdala
Koenigs and Grafman
Neuroscientist 2009;15:540-548.
ABSTRACT  

From the Margins to the Center: Ethnic Minority Women and the Mental Health Effects of Sexual Assault
Bryant-Davis et al.
Trauma Violence Abuse 2009;10:330-357.
ABSTRACT  

Commentary: Trauma and Female Inmates: Why Is Witnessing More Traumatic?
Hackett
J Am Acad Psychiatry Law 2009;37:310-315.
ABSTRACT | FULL TEXT  

Reports of Community Violence Exposure, Traumatic Loss, Posttraumatic Stress Disorder, and Complicated Grief Among Guatemalan Aid Workers
Putman et al.
Traumatology 2009;15:40-47.
ABSTRACT  

Trends and Risk Factors for Mental Health Diagnoses Among Iraq and Afghanistan Veterans Using Department of Veterans Affairs Health Care, 2002-2008
Seal et al.
AJPH 2009;99:1651-1658.
ABSTRACT | FULL TEXT  

A Dynamic Model for Posttraumatic Stress Disorder Among U.S. Troops in Operation Iraqi Freedom
Atkinson et al.
Management Science 2009;55:1454-1468.
ABSTRACT  

Probable Posttraumatic Stress Disorder and Disability in Cambodia: Associations With Perceived Justice, Desire for Revenge, and Attitudes Toward the Khmer Rouge Trials
Sonis et al.
JAMA 2009;302:527-536.
ABSTRACT | FULL TEXT  

The Personality Assessment Inventory in the Evaluation of Multiple Channel Exposure Therapy
Petrac and Bedwell
Clinical Case Studies 2009;8:326-339.
ABSTRACT  

Impact of childhood exposure to a natural disaster on adult mental health: 20-year longitudinal follow-up study
McFarlane and Van Hooff
Br. J. Psychiatry 2009;195:142-148.
ABSTRACT | FULL TEXT  

The Physical and Mental Health of Australian Vietnam Veterans 3 Decades After the War and Its Relation to Military Service, Combat, and Post-Traumatic Stress Disorder
O'Toole et al.
Am J Epidemiol 2009;170:318-330.
ABSTRACT | FULL TEXT  

The Epidemiology of Trauma, PTSD, and Other Posttrauma Disorders
Breslau
Trauma Violence Abuse 2009;10:198-210.
ABSTRACT  

Pathways Linking Intimate Partner Violence and Posttraumatic Disorder
Dutton
Trauma Violence Abuse 2009;10:211-224.
ABSTRACT  

Psychotherapies for Trauma and Substance Abuse in Women: Review and Policy Implications
Najavits
Trauma Violence Abuse 2009;10:290-298.
ABSTRACT  

Substance use disorders and psychological trauma
Shora et al.
The Psychiatrist 2009;33:257-260.
ABSTRACT | FULL TEXT  

Medication Adherence and Its Effect on Relapse Among Patients Discharged from a Veterans Affairs Posttraumatic Stress Disorder Treatment Program
Lockwood et al.
The Annals of Pharmacotherapy 2009;43:1227-1232.
ABSTRACT | FULL TEXT  

Trauma Training, Trauma Practices, and Secondary Traumatic Stress Among Substance Abuse Counselors
Bride et al.
Traumatology 2009;15:96-105.
ABSTRACT  

Predictors of Acute Stress Symptoms in Rape Victims
Elklit et al.
Traumatology 2009;15:38-45.
ABSTRACT  

Trauma Victim: Yes or No?: Why It May Be Difficult to Answer Questions Regarding Violence, Sexual Abuse, and Other Traumatic Events
Thoresen and Overlien
Violence Against Women 2009;15:699-719.
ABSTRACT  

The dangers of inflation: memories of trauma and post-traumatic stress disorder
Greenberg and Wessely
Br. J. Psychiatry 2009;194:479-480.
ABSTRACT | FULL TEXT  

Evaluation of Lifetime Trauma Exposure and Physical Health in Women With Posttraumatic Stress Disorder or Major Depressive Disorder
Dennis et al.
Violence Against Women 2009;15:618-627.
ABSTRACT  

Posttraumatic Stress Disorder: From Phenomenology to Clinical Practice
Benedek and Ursano
Focus 2009;7:160-175.
ABSTRACT | FULL TEXT  

Performance in Practice: Clinical Tools to Improve the Care of Patients with Posttraumatic Stress Disorder
Duffy et al.
Focus 2009;7:186-203.
ABSTRACT | FULL TEXT  

Bibliography for PTSD and Disaster Psychiatry
Focus 2009;7:214-216.
FULL TEXT  

Posttraumatic Stress Disorder: A State-of-the-Science Review
Nemeroff et al.
Focus 2009;7:254-273.
ABSTRACT | FULL TEXT  

Psychiatric Diagnosis as a Risk Marker for Victimization in a National Sample of Children
Cuevas et al.
J Interpers Violence 2009;24:636-652.
ABSTRACT  

Gender differences in the association between childhood abuse and psychosis
Fisher et al.
Br. J. Psychiatry 2009;194:319-325.
ABSTRACT | FULL TEXT  

Modification of the Association Between Serotonin Transporter Genotype and Risk of Posttraumatic Stress Disorder in Adults by County-Level Social Environment
Koenen et al.
Am J Epidemiol 2009;169:704-711.
ABSTRACT | FULL TEXT  

Post-Traumatic Stress in Asylum Seekers and Refugees From Chechnya, Afghanistan, and West Africa: Gender Differences in Symptomatology and Coping
Renner and Salem
Int J Soc Psychiatry 2009;55:99-108.
ABSTRACT  

Disillusionment, Faith, and Cultural Traumatization on a Northern Plains Reservation
Jervis and AI-SUPERPFP Team
Traumatology 2009;15:11-22.
ABSTRACT  

Systematic Review and Meta-Analysis of Multiple-Session Early Interventions Following Traumatic Events
Roberts et al.
Am. J. Psychiatry 2009;166:293-301.
ABSTRACT | FULL TEXT  

Resource Loss and Naturalistic Reduction of PTSD Among Inner-City Women
Walter and Hobfoll
J Interpers Violence 2009;24:482-498.
ABSTRACT  

Substance Use and PTSD Symptoms Impact the Likelihood of Rape and Revictimization in College Women
Messman-Moore et al.
J Interpers Violence 2009;24:499-521.
ABSTRACT  

Psychiatric Comorbidities and Schizophrenia
Buckley et al.
Schizophr Bull 2009;35:383-402.
ABSTRACT | FULL TEXT  

Telehealth-Based Exposure Therapy for Motor Vehicle Accident-Related Posttraumatic Stress Disorder
Hassija and Gray
Clinical Case Studies 2009;8:84-94.
ABSTRACT  

The Aftermath of Combat-Related PTSD: Toward an Understanding of Transgenerational Trauma
Pearrow and Cosgrove
Communication Disorders Quarterly 2009;30:77-82.
ABSTRACT  

Psychiatric symptoms in Ground Zero ironworkers in the aftermath of 9/11: prevalence and predictors
Katz et al.
The Psychiatrist 2009;33:49-52.
ABSTRACT | FULL TEXT  

Toward Validation of the Diagnosis of Posttraumatic Stress Disorder
North et al.
Am. J. Psychiatry 2009;166:34-41.
ABSTRACT | FULL TEXT  

Chapter 9 Anxiety and stress-related disorders
Semple and Smyth
Oxford Handbook of Psychiatry 2009;2:med-9780199239467-chapter-med-9780199239467-chapter.
FULL TEXT  

Service Utilization and Help Seeking in a National Sample of Female Rape Victims
Amstadter et al.
Psychiatr. Serv. 2008;59:1450-1457.
ABSTRACT | FULL TEXT  

Exploratory and Confirmatory Factor Analyses of the Structured Interview for Disorders of Extreme Stress
Scoboria et al.
Assessment 2008;15:404-425.
ABSTRACT  

Complicated Grief and its Relationship to Mental Health and Well-Being Among Bosnian Refugees After Resettlement in the United States: Implications for Practice, Policy, and Research
Craig et al.
Traumatology 2008;14:103-115.
ABSTRACT  

Trauma, Resilience, and Recovery in a High-Risk African-American Population
Alim et al.
Am. J. Psychiatry 2008;165:1566-1575.
ABSTRACT | FULL TEXT  

Posttraumatic Stress Disorder and Social Support in Female Victims of Sexual Assault: The Impact of Spousal Involvement on the Efficacy of Cognitive-Behavioral Therapy
Billette et al.
Behav Modif 2008;32:876-896.
ABSTRACT  

Acute Stress Disorder After Myocardial Infarction: Prevalence and Associated Factors
Roberge et al.
Psychosom. Med. 2008;70:1028-1034.
ABSTRACT | FULL TEXT  

Military Sexual Trauma: A Review of Prevalence and Associated Health Consequences in Veterans
Suris and Lind
Trauma Violence Abuse 2008;9:250-269.
ABSTRACT  

Breathing the Fire: Fighting to Report--and Survive--the War in Iraq
Kosaraju and Casscells
JAMA 2008;300:1595-1596.
FULL TEXT  

The Conundrum of Medically Unexplained Symptoms: Questions to Consider
McFarlane et al.
Psychosomatics 2008;49:369-377.
ABSTRACT | FULL TEXT  

Prevalence of Mental Disorder and Associated Factors in Civilian Guatemalans With Disabilities Caused By the Internal Armed Conflict
Herrera Rivera et al.
Int J Soc Psychiatry 2008;54:414-424.
ABSTRACT  

Secondary Trauma in Children of Parents with Mental Illness
Lombardo and Motta
Traumatology 2008;14:57-67.
ABSTRACT  

Reliability and Validity of the SCL-90-R PTSD Subscale
Carlozzi and Long
J Interpers Violence 2008;23:1162-1176.
ABSTRACT  

Exploring the Relationships of Women's Sexual Assault Disclosure, Social Reactions, and Problem Drinking
Ullman et al.
J Interpers Violence 2008;23:1235-1257.
ABSTRACT  

Substance Use Disorders and Clinical Management of Traumatic Brain Injury and Posttraumatic Stress Disorder
Corrigan and Cole
JAMA 2008;300:720-721.
FULL TEXT  

Major Life Changes Before and After the Onset of Chronic Daily Headache: A Population-Based Study
Scher et al.
Cephalalgia 2008;28:868-876.
ABSTRACT | FULL TEXT  

Rewriting My Autobiography: The Legal and Ethical Implications of Memory-Dampening Agents
Aoki
Bulletin of Science Technology Society 2008;28:349-359.
ABSTRACT  

Cognitive Dysfunctions Associated With PTSD: Evidence from World War II Prisoners of War
Hart et al.
J. Neuropsychiatry Clin. Neurosi. 2008;20:309-316.
ABSTRACT | FULL TEXT  

Glutamate and cortisol--a critical confluence in PTSD?
Reul and Nutt
J Psychopharmacol 2008;22:469-472.
 

A Prospective Study of PTSD and Early-Age Heart Disease Mortality Among Vietnam Veterans: Implications for Surveillance and Prevention
Boscarino
Psychosom. Med. 2008;70:668-676.
ABSTRACT | FULL TEXT  

Trauma and PTSD Among Adolescents With Severe Emotional Disorders Involved in Multiple Service Systems
Mueser and Taub
Psychiatr. Serv. 2008;59:627-634.
ABSTRACT | FULL TEXT  

Individual and Group Treatment and Self and Other Representations Predicting Posttraumatic Recovery Among Former Political Prisoners
Salo et al.
Traumatology 2008;14:45-61.
ABSTRACT  

Treatment of Acute Stress Disorder: A Randomized Controlled Trial
Bryant et al.
Arch Gen Psychiatry 2008;65:659-667.
ABSTRACT | FULL TEXT  

Trauma, Mental Health, Distrust, and Stigma Among HIV-Positive Persons: Implications for Effective Care
Whetten et al.
Psychosom. Med. 2008;70:531-538.
ABSTRACT | FULL TEXT  

Invited Commentary: How Healthy is the "Healthy Warrior"?
Toomey
Am J Epidemiol 2008;167:1277-1280.
ABSTRACT | FULL TEXT  

Post-traumatic stress disorder in serious accidental injury: 3-year follow-up study
Hepp et al.
Br. J. Psychiatry 2008;192:376-383.
ABSTRACT | FULL TEXT  

Prolonged Exposure Treatment for Posttraumatic Stress Disorder Following the 9/11 Attack With a Person Who Escaped From the Twin Towers
Kazi et al.
Clinical Case Studies 2008;7:100-117.
ABSTRACT  

A Second Look at Prior Trauma and the Posttraumatic Stress Disorder Effects of Subsequent Trauma: A Prospective Epidemiological Study
Breslau et al.
Arch Gen Psychiatry 2008;65:431-437.
ABSTRACT | FULL TEXT  

Association of FKBP5 Polymorphisms and Childhood Abuse With Risk of Posttraumatic Stress Disorder Symptoms in Adults
Binder et al.
JAMA 2008;299:1291-1305.
ABSTRACT | FULL TEXT  

Historical Trauma in American Indian/Native Alaska Communities: A Multilevel Framework for Exploring Impacts on Individuals, Families, and Communities
Evans-Campbell
J Interpers Violence 2008;23:316-338.
ABSTRACT  

Posttraumatic Stress and Aggression Among Veterans in Long-term Care
Carlson et al.
J Geriatr Psychiatry Neurol 2008;21:61-71.
ABSTRACT  

Getting a peace of the action: measures of post traumatic stress in UK military peacekeepers
Greenberg et al.
JRSM 2008;101:78-84.
ABSTRACT | FULL TEXT  

The Impact of Cumulative Maternal Trauma and Diagnosis on Parenting Behavior
Cohen et al.
Child Maltreat 2008;13:27-38.
ABSTRACT  

Reasons Underlying Treatment Preference: An Exploratory Study
Cochran et al.
J Interpers Violence 2008;23:276-291.
ABSTRACT  

The Human Capacity to Thrive in the Face of Potential Trauma
Bonanno and Mancini
Pediatrics 2008;121:369-375.
ABSTRACT | FULL TEXT  

Prevalence of Psychiatric Disorders Among Toronto Hospital Workers One to Two Years After the SARS Outbreak
Lancee et al.
Psychiatr. Serv. 2008;59:91-95.
ABSTRACT | FULL TEXT  

Longitudinal Investigation of Reciprocal Relationship Between Stress Reactions and Hardiness
Vogt et al.
Pers Soc Psychol Bull 2008;34:61-73.
ABSTRACT  

Disruption of Existing Mental Health Treatments and Failure to Initiate New Treatment After Hurricane Katrina
Wang et al.
Am. J. Psychiatry 2008;165:34-41.
ABSTRACT | FULL TEXT  

Terrorism, Acute Stress, and Cardiovascular Health: A 3-Year National Study Following the September 11th Attacks
Holman et al.
Arch Gen Psychiatry 2008;65:73-80.
ABSTRACT | FULL TEXT  

Cumulative Traumas and Psychosis: an Analysis of the National Comorbidity Survey and the British Psychiatric Morbidity Survey
Shevlin et al.
Schizophr Bull 2008;34:193-199.
ABSTRACT | FULL TEXT  

Symptoms and coping in Sri Lanka 20-21 months after the 2004 tsunami
Hollifield et al.
Br. J. Psychiatry 2008;192:39-44.
ABSTRACT | FULL TEXT  

Changes in Brain Electrical Activity After Cognitive Behavioral Therapy for Posttraumatic Stress Disorder in Patients Injured in Motor Vehicle Accidents
Rabe et al.
Psychosom. Med. 2008;70:13-19.
ABSTRACT | FULL TEXT  

Depression, Posttraumatic Stress Disorder, and Mortality
Kinder et al.
Psychosom. Med. 2008;70:20-26.
ABSTRACT | FULL TEXT