Skip to main content

Advertisement

SpringerLink
Log in

Trauma, PTSD, and complex PTSD in the Republic of Ireland: prevalence, service use, comorbidity, and risk factors

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

This study represents the first assessment of the prevalence of trauma exposure, and Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), ever conducted in the general population of the Republic of Ireland. Additionally, prevalence of past-year mental health service use, comorbidity with major depression and generalized anxiety, and risk factors associated with PTSD and CPTSD were assessed.

Methods

A nationally representative sample of non-institutionalized Irish adults (N = 1020) completed self-report measures of trauma history, trauma-related psychopathology, mental health service use, and concurrent mental health problems.

Results

Lifetime exposure to one or more traumatic events was 82.3%, and 67.8% reported experiencing two or more traumatic events. Males and females significantly differed in their frequency of exposure to eight of 16 traumatic events. The past-month prevalence for PTSD was 5.0% (95% CI 3.7%, 6.3%) and 7.7% (95% CI 6.1%, 9.4%) for CPTSD. Of those who screened positive for PTSD or CPTSD, 48.6% accessed mental health care in the past year. Comorbidity with major depression and generalized anxiety was high, especially among those with CPTSD. Several unique and shared risk factors for PTSD and CPTSD were identified.

Conclusion

Approximately one-in-eight Irish adults met diagnostic requirements for PTSD or CPTSD, and comorbidity with other disorders was high. History of interpersonal trauma and exposure to multiple types of trauma in different developmental periods were associated with CPTSD. Many individuals did not access mental health care revealing a substantial mental health treatment gap.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Benjet C, Bromet E, Karam EG et al (2016) The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psych Med 46:327–343. https://doi.org/10.1017/s0033291715001981

    Article  CAS  Google Scholar 

  2. American Psychological Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. Author, Washington DC

    Google Scholar 

  3. Koenen KC, Ratanatharathorn A, Ng L et al (2017) Posttraumatic stress disorder in the world mental health surveys. Psychol Med 47:2260–2274. https://doi.org/10.1017/s0033291717000708

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Kessler RC, Aguilar-Gaxiola Alonso J et al (2017) Trauma and PTSD in the WHO world mental health surveys. Eur J Psychotraumatol 8:1353383. https://doi.org/10.1080/20008198.2017.1353383

    Article  PubMed  PubMed Central  Google Scholar 

  5. Carr A, Dooley B, Fitzpatrick M et al (2010) Adult adjustment of survivors of institutional child abuse in Ireland. Child Abuse Negl 34:477–489. https://doi.org/10.1016/j.chiabu.2009.11.003

    Article  PubMed  Google Scholar 

  6. Organisation for economic co-operation and development (2017). Health at a glance 2017: OECD indicators. https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-2017_health_glance-2017-en. Accessed 3 Jan 2020

  7. World Health Organization (2018) The ICD-11 for mortality and morbidity statistics. https://icd.who.int/browse11/l-m/en. Accessed 27 June 2019

  8. World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. World Health Organization, Geneva

    Google Scholar 

  9. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Author, Washington DC

    Book  Google Scholar 

  10. Brewin CR, Cloitre M, Hyland P et al (2017) A review of current evidence regarding the ICD-11 proposals for diagnosing PTSD and complex PTSD. Clin Psychol Rev 58:1–15. https://doi.org/10.1016/j.cpr.2017.09.001

    Article  PubMed  Google Scholar 

  11. Brewin CR (2019) Complex post-traumatic stress disorder: a new diagnosis in ICD-11. BJPsych Adv. https://doi.org/10.1192/bja.2019.48

    Article  Google Scholar 

  12. Cloitre M, Hyland P, Bisson JI, Brewin CR, Roberts NP, Karatzias T, Shevlin M (2019) ICD-11 PTSD and complex PTSD in the United States: a population-based study. J Trauma Stress 32:833–842. https://doi.org/10.1002/jts.22454

    Article  PubMed  Google Scholar 

  13. Ben-Ezra M, Karatzias T, Hyland P et al (2018) Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as per ICD-11 proposals: a population study in Israel. Depress Anxiety 35:264–274. https://doi.org/10.1002/da.22723

    Article  PubMed  Google Scholar 

  14. Maercker A, Hecker T, Augsburger M, Kliem S (2018) ICD-11 prevalence rates of posttraumatic stress disorder and complex posttraumatic stress disorder in a German nationwide sample. J Nerv Ment Dis 206:270–276. https://doi.org/10.1097/nmd.0000000000000790

    Article  PubMed  Google Scholar 

  15. Tolin DF, Foa EB (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132:959–992. https://doi.org/10.1037/0033-2909.132.6.959

    Article  PubMed  Google Scholar 

  16. Karatzias T, Cloitre M (2019) Treating adults with complex posttraumatic stress disorder using a modular approach to treatment: rationale, evidence, and directions for future research. J Trauma Stress 32:870–876. https://doi.org/10.1002/jts.22457

    Article  PubMed  Google Scholar 

  17. Central Statistics Office (2020) Census 2016 reports. Retrieved from https://www.cso.ie/en/census/census2016reports/. Accessed 3 Jan 2020

  18. Hyland P, Shevlin M, Karatzias T, Cloitre M (2020) The International Trauma Exposure Measure (ITEM). Unpublished measure. https://www.traumameasuresglobal.com/item. Accessed 3 Jan 2020

  19. Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane TM (2013) The life events checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at https://www.ptsd.va.gov. Accessed 3 Jan 2020

  20. Ehring T, Quack D (2010) Emotion regulation difficulties in trauma survivors: the role of trauma type and PTSD symptom severity. Behav Ther 41:587–598. https://doi.org/10.1016/j.beth.2010.04.004

    Article  PubMed  Google Scholar 

  21. Hyland P, Karatzias T, Cloitre M, Shevlin M (2019) Examining the discriminant validity of complex PTSD and Borderline Personality Disorder symptoms: results from a UK community sample. J Trauma Stress 32:855–863. https://doi.org/10.1002/jts.22444

    Article  PubMed  Google Scholar 

  22. Cloitre M, Shevlin M, Brewin CR et al (2018) The International Trauma Questionnaire: development of a self-report measure of ICD-11 PTSD and complex PTSD. Acta Psychiatr Scand 138:536–546. https://doi.org/10.1111/acps.12956

    Article  CAS  PubMed  Google Scholar 

  23. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613. https://doi.org/10.1046/j.15251497.2001.016009606.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Manea L, Gilbody S, McMillan D (2015) A diagnostic metaanalysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry 37:67–75. https://doi.org/10.1016/j.genhosppsych.2014.09.009

    Article  PubMed  Google Scholar 

  25. Spitzer RL, Kroenke K, Williams JB, Lowe B (2006) A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 166:1092–1097. https://doi.org/10.1001/archinte.166.10.1092

    Article  Google Scholar 

  26. Kertz S, Bigda-Peyton J, Bjorgvinsson T (2013) Validity of the generalized anxiety disorder-7 scale in an acute psychiatric sample. Clin Psychol Psychother 20:456–464. https://doi.org/10.1002/cpp.1802

    Article  PubMed  Google Scholar 

  27. de Vries GJ, Olff M (2009) The lifetime prevalence of traumatic events and posttraumatic stress disorder in the Netherlands. J Trauma Stress 22:259–267. https://doi.org/10.1002/jts.20429

    Article  PubMed  Google Scholar 

  28. Frans O, Rimmo PA, Aberg L, Fredrikson M (2005) Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiatr Scand 111:291–299. https://doi.org/10.1111/j.1600-0447.2004.00463.x

    Article  CAS  PubMed  Google Scholar 

  29. Hoffman YS, Diamond GM, Lipsitz JD (2011) The challenge of estimating PTSD prevalence in the context of ongoing trauma: the example of Israel during the Second Intifada. J Anxiety Disord 25:788–793. https://doi.org/10.1016/j.janxdis.2011.03.016

    Article  PubMed  Google Scholar 

  30. Bondjers K, Hyland P, Roberts NP, Bisson JI, Willebrand M, Arnberg F (2019) Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample. Eur J Psychotraumatol 10:1665617. https://doi.org/10.1080/20008198.2019.1665617

    Article  PubMed  PubMed Central  Google Scholar 

  31. Santiago PN, Ursano RJ, Gray CL et al (2013) A systematic review of PTSD prevalence and trajectories in DSM-5 defined trauma exposed populations: intentional and non-intentional traumatic events. PLoS One 8:e59236. https://doi.org/10.1371/journal.pone.0059236

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Kessler RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61:4–12 (Discussion 13–14)

    PubMed  Google Scholar 

  33. Edmondson D, von Kanel R (2017) Post-traumatic stress disorder and cardiovascular disease. Lancet Psychiatry 4:320–329. https://doi.org/10.1016/s2215-0366(16)30377-7

    Article  PubMed  PubMed Central  Google Scholar 

  34. Boscarino JA (2006) Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Ann Epidemiol 16:248–256. https://doi.org/10.1016/j.annepidem.2005.03.009

    Article  PubMed  Google Scholar 

  35. First MB, Reed GM, Hyman SE, Saxena S (2015) The development of the ICD-11 clinical descriptions and diagnostic guidelines for mental and behavioural disorders. World Psychiatry 14:82–90. https://doi.org/10.1002/wps.20189

    Article  PubMed  PubMed Central  Google Scholar 

  36. Shevlin M, Hyland P, Vallieres F et al (2018) A comparison of DSM-5 and ICD-11 PTSD prevalence, comorbidity and disability: an analysis of the Ukrainian Internally Displaced Person’s Mental Health Survey. Acta Psychiatr Scand 137:138–147. https://doi.org/10.1111/acps.12840

    Article  CAS  PubMed  Google Scholar 

  37. Hyland P, Shevlin M, Fyvie C, Karatzias T (2018) Posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in DSM-5 and ICD-11: clinical and behavioural correlates. J Trauma Stress 31:174–180. https://doi.org/10.1002/jts.22272

    Article  PubMed  Google Scholar 

  38. Rytwinski NK, Scur MD, Feeny NC, Youngstrom EA (2013) The co-occurrence of major depressive disorder among individuals with posttraumatic stress disorder: a meta-analysis. J Trauma Stress 26:299–309. https://doi.org/10.1002/jts.21814

    Article  PubMed  Google Scholar 

  39. Kotov R, Krueger RF, Watson D et al (2017) The Hierarchical Taxonomy of Psychopathology (HiTOP): a dimensional alternative to traditional nosologies. J Abnorm Psychol 126:454–477. https://doi.org/10.1037/abn0000258

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, Maynooth University, Kildare, Ireland

    Philip Hyland

  2. Trinity College, Trinity Centre for Global Health, University of Dublin, Dublin, Ireland

    Philip Hyland & Frédérique Vallières

  3. National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA

    Marylène Cloitre

  4. Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA

    Marylène Cloitre

  5. School of Social Work, Ariel University, Ariel, Israel

    Menachem Ben-Ezra

  6. School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK

    Thanos Karatzias

  7. NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK

    Thanos Karatzias

  8. Department of Psychiatry, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Miranda Olff

  9. Arq Psychotrauma Expert Group, Diemen, The Netherlands

    Miranda Olff

  10. School of Psychology, Ulster University, Derry, Northern Ireland, UK

    Jamie Murphy & Mark Shevlin

Authors
  1. Philip Hyland
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Frédérique Vallières
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marylène Cloitre
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Menachem Ben-Ezra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Thanos Karatzias
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Miranda Olff
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jamie Murphy
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mark Shevlin
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the conceptual and analytical design of this study. PH, FV, JM, and MS conducted the statistical analyses. PH and FV wrote the first draft of the manuscript. All authors contributed to writing the final version of the manuscript. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author

Correspondence to Philip Hyland.

Ethics declarations

Conflict of interest

Marylène Cloitre participated as a member of the World Health Organization Working Group on the Classification of Disorders Specifically Associated with Stress, reporting to the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders. However, the views expressed reflect the opinions of the authors and not necessarily the Working Group or Advisory Group and the content of this article does not represent WHO policy.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hyland, P., Vallières, F., Cloitre, M. et al. Trauma, PTSD, and complex PTSD in the Republic of Ireland: prevalence, service use, comorbidity, and risk factors. Soc Psychiatry Psychiatr Epidemiol 56, 649–658 (2021). https://doi.org/10.1007/s00127-020-01912-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-020-01912-x

Keywords

Search

Navigation