The associations of earlier trauma exposures and history of mental disorders with PTSD after subsequent traumas


Ronald C. Kessler, Harvard University
Sergio Aguilar-Gaxiola, Center for Reducing Health Disparities, UC Davis Health System, Sacramento, CA, USA
Jordi Alonso, Health Services Research Unit, IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Pompeu Fabra University (UPF) and CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Evelyn J. Bromet, Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, NY, USA
Oye Gureje, Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Elie G. Karam, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, St George Hospital University Medical Center, Balamand University, Beirut, Lebanon
Karestan C. Koenen, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
Sing Lee, Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
Howard Liu, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Beth-Ellen Pennell, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
Maria Vladimirovna Petukhova, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Nancy A. Sampson, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Victoria Shahly, Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
Dan J. Stein, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, Republic of South Africa
Lukoye Atwoli, Aga Khan UniversityFollow

Document Type



Internal Medicine (East Africa)


Although earlier trauma exposure is known to predict post-traumatic stress disorder (PTSD) after subsequent traumas, it is unclear if this association is limited to cases where the earlier trauma led to PTSD. Resolution of this uncertainty has important implications for research on pre-trauma vulnerability to PTSD. We examined this issue in the WHO World Mental Health (WMH) Surveys with 34,676 respondents who reported lifetime trauma exposure. One lifetime trauma was selected randomly for each respondent. DSM-IV PTSD due to that trauma was assessed. We reported in a previous paper that four earlier traumas involving interpersonal violence significantly predicted PTSD after subsequent random traumas (OR=1.3–2.5). We also assessed 14 lifetime DSM-IV mood, anxiety, disruptive behavior, and substance disorders prior to random traumas. We show in the current report that only prior anxiety disorders significantly predicted PTSD in a multivariate model (OR=1.5–4.3) and that these disorders interacted significantly with three of the earlier traumas (witnessing atrocities, physical violence victimization, rape). History of witnessing atrocities significantly predicted PTSD after subsequent random traumas only among respondents with prior PTSD (OR=5.6). Histories of physical violence victimization (OR=1.5) and rape after age 17 (OR=17.6) significantly predicted only among respondents with no history of prior anxiety disorders. Although only preliminary due to reliance on retrospective reports, these results suggest that history of anxiety disorders and history of a limited number of earlier traumas might usefully be targeted in future prospective studies as distinct foci of research on individual differences in vulnerability to PTSD after subsequent traumas.


This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Molecular psychiatry