Post-traumatic stress disorder prevalence

Post-traumatic stress disorder (PTSD) is a severe condition with a lifetime prevalence of about 12.5% in women and 6.2% in men (Pigott, 1999). About one in four individuals exposed to trauma develop the syndrome. Drug treatments are still being developed, mostly using antidepressants. Few systematic data are available on the pharmacoeconomics of the condition. 

The development of mild forms of anxiety and neuroveg-etative and/or cognitive responses to stress may represent an adaptive evolutionary step against environmentally (external) or self-triggered (internal) threats, but maladaptive reactions have also emerged in human evolution. Thus, anxiety disorders are maladaptive conditions in which disproportionate responses to stress, or even self-evoked responses, are displayed. Anxiety disorders are one of the most frequent psychiatric illnesses, and have a lifetime prevalence of 15- 20% [1, 89]. The most common presentations are generalized anxiety disorder, with a lifetime prevalence rate of close to 5% [1, 89] social anxiety disorder, with very variable lifetime prevalence rates ranging from 2 to 14% [90] panic disorder, with rates from 2 to 4% [1,89] and post-traumatic stress disorder (PTSD), with a prevalence rate close to 8%. Specific phobias, acute stress and obsessive-compulsive behavior are other clinical presentations of anxiety disorders. 

In a 2000 report, Schnurr et al. (2000) reported on the prevalence of current post-traumatic stress disorder (PTSD) associated with participation in these secret military tests of mustard gas exposure. Using the registry established by the... 

The mood and anxiety disorders in their various permutations constitute a major source of personal suffering and impaired ability to engage in productive Avork and interpersonal relationships. Between 5 and 9% of women and between 2 and 3% of men meet the diagnostic criteria for major depression at any time 10-25% of all women suffer major depression sometime in their lives, while 5-10% of men will develop major depressive disorder (American Psychiatric Association, 1994). The anxiety disorders obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), panic disorder, and generalized anxiety disorder (GAD) show lifetime prevalence rates of approximately 2.5%, 7%, 2.5%, and 5% respectively. Between 3 and 13% of individuals in community samples are regarded to meet the diagnostic criteria for social phobia. Mood and anxiety disorders are common comorbidities (American Psychiatric Association, 1994) and the most common antidepressant medications including the serotonin reuptake inhibitors, the mixed serotonin-catecholamine reuptake inhibitors, the tricyclic antidepressants, and the monoamine oxidase inhibitors, are all effective treatments for anxiety and panic attacks. 

Besides the paucity of historic data, another difficnlty associated with mental health studies of disaster victims is the lack of standardization of criteria used for case definitions of mental health disorders following mass trauma, such as post-traumatic stress disorder (PTSD) (6,7). Diagnostic criteria for PTSD, as noted in the fourth edition of the diagnostic and statistical manual (DSM-IV), should go beyond specified combinations of symptoms to include requirements for symptom duration and the patient s ability to function (6,7). Specifically, for a PTSD diagnosis, the patient must have symptoms for more than 1 month, and the symptoms must cause clinically significant distress or impair the patient s ability to function (6,7). In addition, the symptoms must occur after the traumatic event and could not have existed before the event. Unfortunately, many studies have used questionnaires that fail to distinguish new symptoms following traumatic events from previous prevalent symptoms such as sleeplessness that many people have at various times (6). The consequence is that many studies tend to inflate the prevalence of PTSD. 

Since its introduction as a formal diagnosis in 1980, post-traumatic stress disorder (PTSD) has been shown to have a lifetime prevalence of about 8% in the USA, with a much higher prevalence in countries affected by civil war, genocide, forced migration, and terrorism. Furthermore, evidence continues to accumulate indicating that, in addition to its public health significance as a prevalent psychiatric disorder, PTSD is a risk factor for many medical illnesses. 

Cross-situational anxiety differs from the situation-specific anxiety described in the previous chapter, in that it involves multiple anxieties and worries that affect performance across a wide range of work and non-work-related situations and tasks. Examples of cross-situational anxiety include disorders such as uncued panic attacks, agoraphobia, generalized social phobia and generalized anxiety disorder (American Psychiatric Association [APA] 2000). The treatment of panic attacks and phobias was discussed in the previous chapter. This chapter thus focuses on the formulation and treatment of generalized anxiety disorder (GAD). GAD warrants specific attention since it requires quite a different CBT treatment approach from the other forms of anxiety already mentioned. Two other anxiety syndromes which have been found to be particularly prevalent among health workers, namely post-traumatic stress disorder (PTSD) and health anxiety, are also discussed in this chapter. 

There are two other work-related anxiety syndromes which have been found to be particularly prevalent among health workers. These are post-traumatic stress disorder and health anxiety. The rest of this chapter looks at the cognitive behavioural treatment of these two anxiety syndromes. 

The literature on civilian terrorist attacks reveals a number of reports of very high rates of Post Traumatic Stress Disorder (PTSD) after such attacks. In a study in France, Abenhaim, Dab, and Salmi (1992) followed 254 survivors of terrorist attacks over a period of five years. These authors report that even years after the attacks, the severely injured had a 30.7 percent prevalence of PTSD, and uninjured victims had a 10.5 percent... 

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