Certain risk factors can strongly predict the risk of a person developing post-traumatic stress disorder (PTSD) after the unexpected death of a loved one, suggests a new study in Depression and Anxiety.
“Preliminary evidence suggests that unexpected death of a loved one-related PTSD could be predicted with good accuracy from data available shortly after the death, although this evidence is based on retrospective data and needs to be confirmed prospectively,” reported Lukoye Atwoli, PhD, MMed, MBChB, of Moi University School of Medicine in Eldoret, Kenya, and the University of Cape Town in South Africa, and colleagues.
“The 5% of respondents with highest predicted risk included 30.6% of all cases of unexpected death of a loved one-related PTSD. This is 6 times the proportion expected by chance,” they reported. “These findings emphasize that [unexpected death] is a major public health issue and suggest that screening assessments might be useful in identifying high-risk individuals for early interventions.”
The researchers analyzed data from 19 World Health Organization World Mental Health surveys that involved 78,023 participants, representing a 70% response rate. The surveys came from the United States, Japan, and 7 Western European countries among the high-income countries. Middle-income countries represented included Brazil, Bulgaria, Colombia, Lebanon, Peru, Romania, South Africa, and Ukraine.
Of the respondents, 30.2% of them (2813 individuals) chose from 27 listed traumatic events that the unexpected death of a loved one was the one that triggered their PTSD. The specific survey question was, “Did someone very close to you ever die unexpectedly; for example, were they killed in an auto accident, murdered, committed suicide, or had a fatal heart attack at an early age?”
The authors calculated the risk of PTSD among these respondents based on the following potential predictors: characteristics of the death and the respondents’ age, education, marital status, sex, history of prior trauma exposure, and history of prior mental disorders. An average 5.2% of respondents developed PTSD following the unexpected death of a loved one, regardless of whether they lived in high-income or middle-income countries.
Before adjustment for all sociodemographic characteristics, women had 3-times greater odds of experiencing PTSD following the unexpected death of a loved one compared with men. In addition, those who were age 35 or older when the death occurred had 2.5-times greater odds of developing PTSD than if the death had occurred when the person was aged 17 or younger. Married individuals also had more than double the odds of PTSD from such a death, and individuals who were divorced or widowed at the time of the survey had more than triple the odds. After accounting for the other sociodemographic factors, however, only gender — being female — remained a significant predictor of PTSD.
Among the strongest PTSD predictors was the respondent’s relationship to the deceased. Those who lost their spouse had 9.6-greater odds of developing PTSD compared with those who lost any other loved ones, and those who lost a son or daughter had 8.7-greater odds of PTSD. Loss of a parent doubled the odds of PTSD, and loss of anyone else who was a child quadrupled them. Although cause of death did not contribute to PTSD risk, a respondents’ belief they could have helped prevent it almost tripled the odds.
A prior history of trauma, particularly involving interpersonal violence or man-made disasters increased the odds of PTSD by 2.6 times. A history of childhood family adversities involving parental mental illness, parental alcohol abuse, or sexual abuse nearly tripled the odds of experiencing PTSD.
Further, in contrast to the new requirement in the Diagnostic and Statistical Manual of Mental disorders, Fifth Edition (DSM-5) that a person must have witnessed a death of a loved one for their symptoms to meet the criteria for PTSD, “our analysis found that specific manner of death of a loved one has little impact on the risk of subsequent DSM-IV PTSD,” the authors wrote.
Atwoli L, Stein D, King A, et al. Posttraumatic stress disorder associated with unexpected death of a loved one: cross-national findings from the world mental health surveys. Depress Anxiety. 2016;00:1-116. doi: 10.1002/da.22579