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Traumatic events and their relative PTSD burden in Northern Ireland: a consideration of the impact of the ‘Troubles’

  • Finola FerryEmail author
  • Brendan Bunting
  • Samuel Murphy
  • Siobhan O’Neill
  • Dan Stein
  • Karestan Koenen
Original Paper

Abstract

Purpose

Over a 30-year period in its recent history, daily life in Northern Ireland (NI) was characterised by civil violence, colloquially termed as the ‘Troubles’. The current report examines exposure to 29 traumatic event types and the associated conditional prevalence of post-traumatic stress disorder (PTSD) among the Northern Ireland population, with a focus on the impact of traumatic events that were characteristic of the NI ‘Troubles’.

Method

Results presented are based on analysis of data from the Northern Ireland Study of Health and Stress (NISHS). The NISHS is a representative epidemiological study of mental health among the NI adult population (N = 4,340) and part of the World Mental Health Survey Initiative.

Results

Perpetration of violence, physical assault by a spouse or partner and private events were the event types associated with the highest conditional prevalence of PTSD. Despite this elevated risk, collectively these events accounted for just 16.8 % of the overall public burden of PTSD, given their low prevalence among the general population. Events that were characteristic of civil conflict, including unexpected death of a loved one, witnessing death or a dead body or someone seriously injured and being mugged or threatened with a weapon accounted for the highest proportion of the overall public health burden of PTSD (18.6, 9.4 and 7.8 %, respectively). These findings are a feature of the higher prevalence of these events among the general population coupled with their moderate to above average risk of PTSD.

Conclusions

Despite the formal end to conflict in NI in 1999, a substantial proportion of the adult population continue to suffer the adverse mental health effects of chronic trauma exposure. Given rates of recovery of PTSD in the absence of evidence-based treatments, it is likely that the legacy of mental ill health associated with conflict, if not adequately addressed, will endure for many years.

Keywords

PTSD Mental health Trauma Conflict Northern Ireland 

Notes

Acknowledgments

The NISHS is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative which is supported by the National Institute of Mental Health (NIMH; R01 MH070884 and R01 MH093612-01), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, GlaxoSmithKline, and Bristol-Myers Squibb. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. None of the funders had any role in the design, analysis, interpretation of results, or preparation of this paper. A complete list of all within-country and cross-national WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

Ethical standard

This study was approved by the University of Ulster Research Ethics and Governance Committee. All participants in the NISHS gave written informed consent before taking part.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

References

  1. 1.
    Northern Ireland Statistics and Research Agency (NISRA) (2010). Historical Mid-Year Population Estimate Publications. Home Population by sex & single year of age. NISRA. http://www.nisra.gov.uk/demography/default.asp17.htm. Accessed 17 July 2012
  2. 2.
    Ferry FR, Bolton D, Bunting BP, O’Neill SM, Murphy SD (2010) The experience and psychological impact of ‘Troubles’ related trauma in Northern Ireland: a review. Ir J Psychol 31:95–110CrossRefGoogle Scholar
  3. 3.
    Fay MT, Morrissey M, Smyth M, Wong T (1999) The cost of the troubles study: report on the Northern Ireland survey. The experience and impact of the Troubles. INCORE, BelfastGoogle Scholar
  4. 4.
    Cairns E, Mallett J, Lewis C, Wilson R (2003) Who are the Victims? Self-assessed victimhood and the Northern Irish conflict. NIO Statistics and Research BranchGoogle Scholar
  5. 5.
    Muldoon O, Schmid K, Downes C, Kremer J, Trew K (2005) The legacy of the Troubles: experience of the Troubles, mental health and social attitudes. Queen’s University, BelfastGoogle Scholar
  6. 6.
    O’Reilly D, Stevenson M (2003) Mental health in Northern Ireland: have “the troubles” made it worse? J Epid Comm Health 57:488–492CrossRefGoogle Scholar
  7. 7.
    Kessler RC, Üstün TB (2008) The WHO world mental health Surveys: global perspectives on the epidemiology of mental disorders. Cambridge University Press, New YorkGoogle Scholar
  8. 8.
    Breslau N (2002) Epidemiological studies of posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry 47:923–929PubMedGoogle Scholar
  9. 9.
    Stein MB, Walker JR, Hazen AL, Forde DR (1998) Full and partial posttraumatic stress disorder: findings from a community survey. Arch Gen Psychiatry 55:626–632CrossRefGoogle Scholar
  10. 10.
    Breslau N, Kessler RC, Chilcoat HD, Schultz L, Davis GC, Andreski P (1998) Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 55:626–632PubMedCrossRefGoogle Scholar
  11. 11.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB, Breslau N (1999) Epidemiological risk factors for trauma and PTSD. In: Yehuda R (ed) Risk factors for posttraumatic stress disorder. American Psychiatric Press, Washington DCGoogle Scholar
  12. 12.
    Galea S, Nandi A, Vlahov D (2005) The epidemiology of post-traumatic stress disorder after disasters. Epidem Rev 27:78–91CrossRefGoogle Scholar
  13. 13.
    American Psychiatry Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington DCGoogle Scholar
  14. 14.
    Darves-Bornoz J-M, Alonso J, de Girolamo G, de Graaf R, Haro J-M, Kovess-Mastefy V et al (2008) Main traumatic events in Europe: PTSD in the European Study of the Epidemiology of Mental Disorders Survey. J Trauma Stress 21:455–462PubMedCrossRefGoogle Scholar
  15. 15.
    Bleich A, Gelkoph M, Melamed Y, Solomon Z (2006) Mental health and resiliency following 4 months of terrorism: a survey of an Israeli national representative sample. BMC Med 4:21PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Shalev AY, Tuval R, Frenkiel-Fishman S, Hadar H, Eth S (2006) Psychological responses to continuous terror: a study of two communities in Israel. Am J Psychiatry 163:667–673PubMedCrossRefGoogle Scholar
  17. 17.
    Shalev AY, Tuval-Mashiach R, Hadar H (2004) Posttraumatic stress disorder as a result of mass trauma. J Clin Psychiatry 65(Suppl 1):4–10PubMedGoogle Scholar
  18. 18.
    World Health Organization (1992) The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. WHO, GenevaGoogle Scholar
  19. 19.
    Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E et al (2004) The US national comorbdity survey replication (NCS-R): design and field procedures. Int J Methods Psychiatr Res 13:69–92PubMedCrossRefGoogle Scholar
  20. 20.
    Kish L (1965) Survey sampling. Wiley, New YorkGoogle Scholar
  21. 21.
    Kessler RC, Üstün TB (2008) The world health organization composite international diagnostic interview. In: Kessler R, Üstün T (eds) The WHO world mental health Surveys: global perspectives on the epidemiology of mental disorders. Cambridge University Press, New York, pp 58–90Google Scholar
  22. 22.
    Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New YorkGoogle Scholar
  23. 23.
    Wolter KM (1985) Introduction to variance estimation. Springer, New YorkGoogle Scholar
  24. 24.
    SUDAAN (2002) Version 8.01. Research Triangle Institute, Research Triangle Park, NCGoogle Scholar
  25. 25.
    Bunting BP, Ferry FR, Murphy SD, O’Neill SM, Bolton D (2013) Conflict-related trauma and the epidemiology of posttraumatic stress disorder in Northern Ireland: evidence from the Northern Ireland Study of Health and Stress. J Trauma Stress 26:134–141. doi: 10.1002/jts.21766 PubMedCrossRefGoogle Scholar
  26. 26.
    Frans O, Rimmo PA, Aberg L, Friedrikson M (2005) Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiatr Scand 111:291–299PubMedCrossRefGoogle Scholar
  27. 27.
    Ferry FR, Bolton D, Bunting BP, O’Neill SM, Murphy SD, Devine B (2012) Ageing, Health and Conflict. An investigation of the experience and health impact of ‘Troubles-related’ trauma among older adults in Northern Ireland. Bamford Centre for Mental Health and Wellbeing and the Northern Ireland Centre for Trauma and Transformation, LondonderryGoogle Scholar
  28. 28.
    Ferry F, Bolton D, Bunting B, Devine B, McCann S, Murphy S (2008) Trauma, health and conflict in Northern Ireland. A study of the epidemiology of trauma related disorders and qualitative investigation of the impact of trauma on the individual. Northern Ireland Centre for Trauma and Transformation and University of Ulster Psychology Research Institute, LondonderryGoogle Scholar
  29. 29.
    Northern Ireland Statistics & Research Agency (2010) Northern Ireland Omnibus Survey. The Northern Ireland Statistics & Research Agency, BelfastGoogle Scholar
  30. 30.
    Perkonigg A, Kessler RC, Storz S, Wittchen H (2000) Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 101:46–59PubMedCrossRefGoogle Scholar
  31. 31.
    Norris FH (1992) Epidemiology of trauma—frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol 60:409–418PubMedCrossRefGoogle Scholar
  32. 32.
    Breslau N, Davis GC, Andreski P, Peterson E (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry 48:216–222PubMedCrossRefGoogle Scholar
  33. 33.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52:1048–1060PubMedCrossRefGoogle Scholar
  34. 34.
    Creamer M, Burgess P, McFarlane AC (2001) Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being. Psychol Med 31:1237–1247PubMedGoogle Scholar
  35. 35.
    Tolin DF, Foa EB (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132:959–992PubMedCrossRefGoogle Scholar
  36. 36.
    Stein DJ, Williams SL, Jackson PB, Seedat S, Myer L, Herman A et al (2009) Perpetration of gross human rights violations in South Africa: association with psychiatric disorders. S Afr Med 99:390–395Google Scholar
  37. 37.
    Orcutt HK, King LA, King DW (2003) Male-perpetrated violence among Vietnam veteran couples: relationships with veteran’s early life characteristics, trauma history, and PTSD symptomatology. J Trauma Stress 16:81–390CrossRefGoogle Scholar
  38. 38.
    Sutton M (2001) Bear in mind these dead. An Index of Deaths from the Conflict in Ireland 1969–1993. Updated database of Troubles-related deaths. CAIN: Beyond the Pale Publications, http://cain.ulst.ac.uk/sutton/updates.html. Accessed 17 July 2012
  39. 39.
    Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C et al (2009) Moral injury and moral repair in war veterans: a preliminary model and intervention strategy. Clin Psychol Rev 29:695–706PubMedCrossRefGoogle Scholar
  40. 40.
    Hatch SL, Dohrenwend BO (2007) Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: a review of the research. Am J Community Psychol 40:313–332PubMedCrossRefGoogle Scholar
  41. 41.
    Smyth M, Morrissey M, Hamilton J (2001) Caring through the Troubles: Health and Social Services in Northern and West Belfast. North & West Belfast Health and Social Services TrustGoogle Scholar
  42. 42.
    Luce A, Firth-Cozens J (2002) Effects of the Omagh bombing on medical staff working in the local NHS trust: a longitudinal survey. Hosp Med 63:44–47PubMedGoogle Scholar
  43. 43.
    Luce A, Firth-Cozens J, Midgley S, Burges C (2002) After the Omagh bomb: posttraumatic stress disorder in health service staff. J Trauma Stress 15:27–30PubMedCrossRefGoogle Scholar
  44. 44.
    Stein MB, Walker JR, Forde DR (2000) Gender differences in susceptibility to posttraumatic stress disorder. Behav Res Ther 38:619–628PubMedCrossRefGoogle Scholar
  45. 45.
    Breslau N (2002) Gender differences in trauma and posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry 47:923–929PubMedGoogle Scholar
  46. 46.
    Bijl RV, Ravelli A, van Zessen G (1998) Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epid 33:587–595CrossRefGoogle Scholar
  47. 47.
    Arababzadeh-Bouchez S, Gasquet I, Kovess-Masfety V, Negres-Pages L, Lépine J-P (2008) The prevalence of mental disorders and service use in France: results from a national survey 2001–2002. In: Kessler R, Üstün T (eds) The WHO world mental health Surveys: global perspectives on the epidemiology of mental disorders. Cambridge University Press, New York, pp 305–330Google Scholar
  48. 48.
    Kessler RC, Berglund PA, Chiu WT, Demlar O, Glantz M, Lane MC et al (2008) The national comorbidity survey replication (NCS-R): the cornerstone in improving mental health and mental health care in the United States. In: Kessler R, Üstün T (eds) The WHO world mental health Surveys: global perspectives on the epidemiology of mental disorders. Cambridge University Press, New York, pp 165–210Google Scholar
  49. 49.
    Wade TJ, Pevalin DJ (2004) Marital transitions and mental health. J Health Soc Behav 45:155–170PubMedCrossRefGoogle Scholar
  50. 50.
    Broman CL, Riba ML, Trahan MR (1996) Traumatic events and marital wellbeing. J Marriage Fam 58(4):908–916CrossRefGoogle Scholar
  51. 51.
    Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC (2005) Twelve-month use of mental health services in the United States; results from the national comorbidity survey replication. Arch Gen Psychiatry 62:629–640PubMedCrossRefGoogle Scholar
  52. 52.
    Bunting BP, Murphy SD, O’Neill SM, Ferry FR (2012) Lifetime prevalence of mental disorders and delay in treatment following initial onset: evidence from the Northern Ireland Study of Health and Stress. Psychol Med 42:1727–1739PubMedCrossRefGoogle Scholar
  53. 53.
    Bunting BP, Murphy SD, O’Neill SM, Ferry FR (2012) Prevalence and treatment of 12-month DSM-IV disorders in the Northern Ireland Study of Health and Stress: an epidemiological study. Soc Psychiatry Psychiatr Epidemiol. doi: 10.1007/s00127-012-0518-5 PubMedGoogle Scholar
  54. 54.
    Breslau N, Kessler RC (2001) The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation. Biol Psychiatry 50:699–704PubMedCrossRefGoogle Scholar
  55. 55.
    Brewin CR, Laniu RA, Novac A, Schnyder U, Galea S (2009) Reformulating PTSD for DSM-V: life after Criterion A. J Trauma Stress 22:366–373PubMedCrossRefGoogle Scholar
  56. 56.
    Kilpatrick DG, Resnick HS, Acierno R (2009) Should PTSD Criterion A be Retained? J Trauma Stress 22:374–387PubMedCrossRefGoogle Scholar
  57. 57.
    Bensimon M, Horesh D, Solomon Z (in print) The utility of Criterion A under chronic national terror. Israel J Psychiatry Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Finola Ferry
    • 1
    Email author
  • Brendan Bunting
    • 2
  • Samuel Murphy
    • 2
  • Siobhan O’Neill
    • 2
  • Dan Stein
    • 3
  • Karestan Koenen
    • 4
  1. 1.MRC Trial Methodology Hub, Room MB119, Bamford Centre for Mental Health and WellbeingUniversity of UlsterLondonderryNorthern Ireland, UK
  2. 2.Bamford Centre for Mental Health and WellbeingUniversity of UlsterLondonderryNorthern Ireland, UK
  3. 3.Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  4. 4.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA

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