Post-traumatic stress disorder

The role of trauma, pre-existing psychiatric disorders, and gender
  • Ulfert HapkeEmail author
  • Anja Schumann
  • Hans-Juerger Rumpf
  • Ulrich John
  • Christian Meyer



The study is aimed at investigating the influence of trauma type, pre-existing psychiatric disorders with an onset before trauma, and gender on post-traumatic stress disorder (PTSD).


Traumas, PTSD and psychiatric disorders were assessed in a representative sample of 4075 adults aged 18–64 years using the Composite International Diagnostic Interview. Pre-existing DSM-IV diagnoses of anxiety disorders, depressive disorders, somatoform disorders, alcohol abuse and dependence, nicotine dependence, gender, and the type of trauma were analysed with logistic regressions to estimate the influence of these factors on the risk for developing PTSD.


The lifetime prevalence of exposure to any trauma did not vary by gender. The conditional probability of PTSD after exposure to trauma was higher in women (11.1% SE = 1.58) than men (2.9% SE = 0.83). Univariate analyses showed that pre-existing anxiety disorders, somatoform disorders and depressive disorders significantly increase the risk of PTSD. Multivariate analyses revealed that specific types of trauma, especially rape and sexual abuse, pre-existing anxiety disorders and somatoform disorders are predictors of an increased risk of PTSD, while gender and depressive disorder were not found to be independent risk factors.


Women do not have a higher vulnerability for PTSD in general. However, especially sexually motivated violence and pre-existing anxiety disorders are the main reasons for higher prevalences of PTSD in women.

Key words

PTSD trauma psychiatric disorder gender 


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  1. 1.
    American Psychiatric Association (APA) (ed) (1995) Diagnostic and statistical manual of mental disorders (DSM-IV). APA, Washington, DCGoogle Scholar
  2. 2.
    Andrews G, Peters L (1998) The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol 33:80–88PubMedCrossRefGoogle Scholar
  3. 3.
    Behrens K (1995) Schichtung und Gewichtung – Verbesserung der regionalen Repräsentanz. In: Gabler S, Hoffmeyer-Zlotnik JHP (eds) Gewichtung in der Umfragepraxis. Westdeutscher Verlag, Wiesbaden, pp 27–41Google Scholar
  4. 4.
    Breslau N (2002) Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry 47:923–929PubMedGoogle Scholar
  5. 5.
    Breslau N (2002) Gender differences in trauma and posttraumatic stress disorder. J Gend Specif Med 5:34–40PubMedGoogle Scholar
  6. 6.
    Breslau N, Chilcoat HD, Kessler RC, Peterson EL, Lucia VC (1999) Vulnerability to assaultive violence: further specification of the sex difference in post-traumatic stress disorder. Psychol Med 29:813–821PubMedCrossRefGoogle Scholar
  7. 7.
    Breslau N, Davis GC, Andreski P, Peterson E (1991) Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiat 48:216–222PubMedGoogle Scholar
  8. 8.
    Breslau N, Davis GC, Andreski P, Peterson EL, Schultz LR (1997) Sex differences in posttraumatic stress disorder. Arch Gen Psychiat 54:1044–1048PubMedGoogle Scholar
  9. 9.
    Breslau N, Davis GC, Peterson EL, Schultz L (1997) Psychiatric sequelae of posttraumatic stress disorder in women. Arch Gen Psychiatry 54:81–87PubMedGoogle Scholar
  10. 10.
    Breslau N, Kessler RC (2001) The stressor criterion in DSM-IV posttraumatic stress disorder: an empirical investigation. Biol Psychiatry 50:699–704PubMedCrossRefGoogle Scholar
  11. 11.
    Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P (1998) Trauma and posttraumatic stress disorder in the community. Archi Gen Psychiat 55:626–632CrossRefGoogle Scholar
  12. 12.
    Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma- exposed adults. J Consult Clin Psychol 68:748–766PubMedCrossRefGoogle Scholar
  13. 13.
    Bromet E, Sonnega A, Kessler RC (1998) Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 147:353–361PubMedGoogle Scholar
  14. 14.
    Bundeskriminalamt (1997–2004) Kriminalstatistik. In: Bundeskriminalamt
  15. 15.
    Davidson JRT, Hughes D, Blazer DG, George LK (1991) Post-traumatic stress disorder in the community: an epidemiological study. Psychol Med 21:713–721sPubMedCrossRefGoogle Scholar
  16. 16.
    Ehlers A, Mayou RA, Bryant B (1998) Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol 107:508–519PubMedCrossRefGoogle Scholar
  17. 17.
    Gavranidou M, Rosner R (2003) The weaker sex? Gender and post-traumatic stress disorder. Depress Anxiety 17:130–139PubMedCrossRefGoogle Scholar
  18. 18.
    Helzer JE, Robins LN, McEvoy L (1987) Post-traumatic stress disorder in the general population. Findings of the Epidemiologic Catchment Area Survey. New Engl J Med 317:1630–1634PubMedCrossRefGoogle Scholar
  19. 19.
    Hepp U, Gamma A, Milos G, Eich D, Ajdacic-Gross V, Rossler W, Angst J, Schnyder U (2005) Prevalence of exposure to potentially traumatic events and PTSD The Zurich Cohort Study. Eur Arch Psychiatry Clin Neurosci 256:151–158PubMedCrossRefGoogle Scholar
  20. 20.
    Hosmer DW, Lemeshow S (1989) Applied logistic regression. John Wiley & Sons, New YorkGoogle Scholar
  21. 21.
    Innenministerium des Landes Schleswig-Holstein (2004) Polizeiliche Kriminalstatistik. In: Innenministerium des Landes Schleswig-Holstein
  22. 22.
    Jacobi F, Wittchen HU, Holting C, Hofler M, Pfister H, Muller N, Lieb R (2004) Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34:597–611PubMedCrossRefGoogle Scholar
  23. 23.
    Kessler RC, Abelson J, Demler O, Escobar JI, Gibbon M, Guyer ME, Howes MJ, Jin R, Vega WA, Walters EE, Wang P, Zaslavsky A, Zheng H (2004) Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). Int J Methods Psychiatr Res 13:122–139PubMedCrossRefGoogle Scholar
  24. 24.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060PubMedGoogle Scholar
  25. 25.
    Kesteren JV, Mayhew P, Nieuwbeerta P (2001) Criminal victimisation in seventeen industrialised countries – Key findings from the 2000 International Crime Victims Survey. In: WODC (Wetenschappelijk Onderzoek-en Documentatiecentrum, in English: Research and Documentation Centre), The Hague Ministry of Justice WODC Onderzoeken beleid Nr. 187Google Scholar
  26. 26.
    McFarlane AC, de Girolamo Gd (1996) The nature of traumatic stressors and the epidemiology of posttraumatic reactions. In: van der Kolk BA, McFarlane AC, Weisaeth L (eds). Traumatic stress. The effects of overwhelming experience on mind, body, and society. The Guilford Press, New York, pp 129–154Google Scholar
  27. 27.
    Meyer C, Rumpf HJ, Hapke U, John U (2000) The Composite International Diagnostic Interview: feasibility and necessity of editing and interviewer training in general population surveys. Int J Method Psych 9:32–42CrossRefGoogle Scholar
  28. 28.
    Meyer C, Rumpf H-J, Hapke U, John U (2001) Prevalence of DSM-IV psychiatric disorders including nicotine dependence in the general population: results from the northern German TACOS study. Neurol, Psychiatry Brain Res 9:75–80Google Scholar
  29. 29.
    Ozer EJ, Best SR, Lipsey TL, Weiss DS (2003) Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull 129:52–73PubMedCrossRefGoogle Scholar
  30. 30.
    Pagani M, Hogberg G, Salmaso D, Tarnell B, Sanchez-Crespo A, Soares J, Aberg-Wistedt A, Jacobsson H, Hallstrom T, Larsson SA, Sundin O (2005) Regional cerebral blood flow during auditory recall in 47 subjects exposed to assaultive and non-ssaultive trauma and developing or not posttraumatic stress disorder. Eur Arch Psychiatry Clin Neurosci 255:359–365PubMedCrossRefGoogle Scholar
  31. 31.
    Perkonigg A, Kessler RC, Storz S, Wittchen HU (2000) Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 101:46–59PubMedCrossRefGoogle Scholar
  32. 32.
    Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61:984–991PubMedCrossRefGoogle Scholar
  33. 33.
    Robins LN, Wing J, Wittchen H-U, Helzer JE, Babor TF, Burke J, Farmer A, Jablensky A, Pickens R, Regier DA, Sartorius N, Towle LH (1988) The Compisite International Diagnostic Interview: an epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiat 45:1069–1077PubMedGoogle Scholar
  34. 34.
    Stein MB, Walker JR, Forde DR (2000) Gender differences in susceptibility to posttraumatic stress disorder. Behav Res Ther 38:619–628PubMedCrossRefGoogle Scholar
  35. 35.
    Tabachnick BG, Fidell LS (2001) Using multivariate statistics. Allyn and Bacon, BostonGoogle Scholar
  36. 36.
    Wittchen H-U (1994) Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiat Res 28:57–84PubMedCrossRefGoogle Scholar
  37. 37.
    Wittchen H-U, Beloch E, Garczynski E, Holly A, Lachner G, Perkonigg A, Vodermaier A, Vossen A, Wunderlich U, Zieglgänsberger S (1995) Münchener Composite International Diagnostik Interview (M-CIDI), Version 2.2. Max-Planck-Institut für Psychiatrie, MünchenGoogle Scholar
  38. 38.
    Wittchen H-U, Burke JD, Semler G, Pfister H, Von Cranach M, Zaudig M (1989) Recall and dating of psychiatric symptoms: test–retest reliability of time-related symptom questions in a standardized psychiatric interview. Arch Gen Psychiat 46:437–443PubMedGoogle Scholar
  39. 39.
    World Health Organization (ed) (1993) Tenth revision of the international classification of diseases, chapter V (F), mental and behavioural disorders, diagnostik criteria for research. World Health OrganizationGoogle Scholar

Copyright information

© Steinkopff-Verlag 2006

Authors and Affiliations

  • Ulfert Hapke
    • 1
  • Anja Schumann
    • 1
  • Hans-Juerger Rumpf
    • 2
  • Ulrich John
    • 1
  • Christian Meyer
    • 1
  1. 1.Institute of Epidemiology and Social MedicineUniversity of GreifswaldGreifswaldGermany
  2. 2.Department of PsychiatryMedical University of LübeckGermany

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