Browsing by Author "Lee, Sing"
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- ItemRestrictedHow well can post-traumatic stress disorder be predicted from pre-trauma risk factors? an exploratory study in the WHO World Mental Health Surveys(2014) Kessler, Ronald C; Rose, Sherri; Koenen, Karestan C; Karam, Elie G; Stang, Paul E; Stein, Dan J; Heeringa, Steven G; Hill, Eric D; Liberzon, Israel; McLaughlin, Katie A; McLean, Samuel A; Pennell, Beth E; Petukhova, Maria; Rosellini, Anthony J; Ruscio, Ayelet M; Shahly, Victoria; Shalev, Arieh Y; Silove, Derrick; Zaslavsky, Alan M; Angermeyer, Matthias C; Bromet, Evelyn J; de Almeida, José Miguel Caldas; de Girolamo, Giovanni; de Jonge, Peter; Demyttenaere, Koen; Florescu, Silvia E; Gureje, Oye; Haro, Josep Maria; Hinkov, Hristo; Kawakami, Norito; Kovess-Masfety, Viviane; Lee, Sing; Medina-Mora, Maria Elena; Murphy, Samuel D; Navarro-Mateu, Fernando; Piazza, Marina; Posada-Villa, Jose; Scott, Kate; Torres, Yolanda; Viana, Maria CarmenPost-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice.
- ItemOpen AccessThe cross-national epidemiology of social anxiety disorder: Data from the World Mental Health Survey Initiative(BioMed Central, 2017-07-31) Stein, Dan J; Lim, Carmen C W; Roest, Annelieke M; de Jonge, Peter; Aguilar-Gaxiola, Sergio; Al-Hamzawi, Ali; Alonso, Jordi; Benjet, Corina; Bromet, Evelyn J; Bruffaerts, Ronny; de Girolamo, Giovanni; Florescu, Silvia; Gureje, Oye; Haro, Josep M; Harris, Meredith G; He, Yanling; Hinkov, Hristo; Horiguchi, Itsuko; Hu, Chiyi; Karam, Aimee; Karam, Elie G; Lee, Sing; Lepine, Jean-Pierre; Navarro-Mateu, Fernando; Pennell, Beth-Ellen; Piazza, Marina; Posada-Villa, Jose; ten Have, Margreet; Torres, Yolanda; Viana, Maria C; Wojtyniak, Bogdan; Xavier, Miguel; Kessler, Ronald C; Scott, Kate MBackground: There is evidence that social anxiety disorder (SAD) is a prevalent and disabling disorder. However, most of the available data on the epidemiology of this condition originate from high income countries in the West. The World Mental Health (WMH) Survey Initiative provides an opportunity to investigate the prevalence, course, impairment, socio-demographic correlates, comorbidity, and treatment of this condition across a range of high, middle, and low income countries in different geographic regions of the world, and to address the question of whether differences in SAD merely reflect differences in threshold for diagnosis. Methods: Data from 28 community surveys in the WMH Survey Initiative, with 142,405 respondents, were analyzed. We assessed the 30-day, 12-month, and lifetime prevalence of SAD, age of onset, and severity of role impairment associated with SAD, across countries. In addition, we investigated socio-demographic correlates of SAD, comorbidity of SAD with other mental disorders, and treatment of SAD in the combined sample. Cross-tabulations were used to calculate prevalence, impairment, comorbidity, and treatment. Survival analysis was used to estimate age of onset, and logistic regression and survival analyses were used to examine socio-demographic correlates. Results: SAD 30-day, 12-month, and lifetime prevalence estimates are 1.3, 2.4, and 4.0% across all countries. SAD prevalence rates are lowest in low/lower-middle income countries and in the African and Eastern Mediterranean regions, and highest in high income countries and in the Americas and the Western Pacific regions. Age of onset is early across the globe, and persistence is highest in upper-middle income countries, Africa, and the Eastern Mediterranean. There are some differences in domains of severe role impairment by country income level and geographic region, but there are no significant differences across different income level and geographic region in the proportion of respondents with any severe role impairment. Also, across countries SAD is associated with specific socio-demographic features (younger age, female gender, unmarried status, lower education, and lower income) and with similar patterns of comorbidity. Treatment rates for those with any impairment are lowest in low/lower-middle income countries and highest in high income countries. Conclusions: While differences in SAD prevalence across countries are apparent, we found a number of consistent patterns across the globe, including early age of onset, persistence, impairment in multiple domains, as well as characteristic sociodemographic correlates and associated psychiatric comorbidities. In addition, while there are some differences in the patterns of impairment associated with SAD across the globe, key similarities suggest that the threshold for diagnosis is similar regardless of country income levels or geographic location. Taken together, these cross-national data emphasize the international clinical and public health significance of SAD.