Subthreshold Posttraumatic Stress Disorder in the World Health Organization World Mental Health Surveys

McLaughlin, Katie A.; Koenen, Karestan C.; Friedman, Matthew J.; Ruscio, Ayelet Meron; Karam, Elie G.; Shahly, Victoria; Stein, Dan J.; Hill, Eric D.; Petukhova, Maria; Alonso, Jordi; Andrade, Laura Helena; Angermeyer, Matthias C.; Borges, Guilherme; de Girolamo, Giovanni; de Graaf, Ron; Demyttenaere, Koen; Florescu, Silvia E.; Mladenova, Maya; Posada-Villa, Jose; Scott, Kate M.; Takeshima, Tadashi; Kessler, Ronald C.

doi:10.1016/j.biopsych.2014.03.028

Cited by 277Posttraumatic Stress Disorder ResearchMigration, Health and TraumaChild Abuse and Trauma

Subthreshold Posttraumatic Stress Disorder in the World Health Organization World Mental Health Surveys

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McLaughlin, Katie A., Koenen, Karestan C., Friedman, Matthew J., Ruscio, Ayelet Meron, Karam, Elie G., Shahly, Victoria, Stein, Dan J., Hill, Eric D. +14 more·2015·Biological Psychiatry

DOI 10.1016/j.biopsych.2014.03.028PMC PMC4194258

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Abstract

Background Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition.Methods The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions.Results Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones.Conclusions Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.

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During the COVID-19 pandemic, the prevalence of self-reported modest-to-severe posttraumatic stress symptoms in the global general population ranged from 7% to 53.8%, compared with a world average of 3.9%-7.8% prior to the pandemic.
“The prevalence of self-reported modest-to-severe posttraumatic stress symptoms in the global general population ranged from 7 % to 53.8 % during the pandemic (Xiong et al., 2020; Krishnamoorthy et al., 2020), compared to the world average of 3.9 %–7.8 % prior to the pandemic (McLaughlin et al., 2015; Koenen et al., 2017).”
From Efficacy and mechanisms of mobile application-delivered Acceptance and Commitment Therapy for posttraumatic stress disorder in China: Study protocol for a randomized controlled trial (2022) · cites this paper as McLaughlin et al., 2015
The Results section (Prevalence of PTSD symptom profiles; page unavailable) provides a pre-pandemic, cross-national PTSD estimate, but reports 3.0% meeting the study’s approximation of DSM-5 PTSD and an additional 4.6% meeting at least one subthreshold definition—not the claimed 3.9%–7.8%. The Methods (Samples; page unavailable) cover trauma-exposed respondents in 13 countries, so these estimates are not presented as a world average for the general population. The pandemic range is attributed to other citations, not this paper. (LLM, conf=0.84)
Experimental — accuracy not yet measured
In a WHO World Mental Health Survey of 23,936 trauma-exposed people across 13 countries, 6.6% evidenced clinical or subclinical PTSD symptoms consistent with DSM-V criteria.
“In a survey of 23,936 people with trauma exposure conducted by the World Health Organization World Mental Health Surveys across 13 countries, 6.6% evidenced clinical or subclinical PTSD symptoms consistent with DSM-V criteria (McLaughlin et al., 2014).”
From Maladaptive autonomic regulation in PTSD accelerates physiological aging (2015) · cites this paper as McLaughlin et al., 2014
Subthreshold PTSD is more prevalent in the community than full PTSD.
“While this condition does not fulfill the diagnosis of PTSD, it is found to be more prevalent in the community [4].”
From Effects of mindfulness-based cognitive therapy for Chinese adults with PTSD symptoms: protocol for a randomised controlled trial (2024) · cites this paper as [4]

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Factors associated with PTSD and partial PTSD among first responders following the Paris terror attacks in November 2015
Motreff, Y., Baubet, T., Pirard, P., Rabet, G., Petitclerc, M., Stene, L. E., Vuillermoz, C., Chauvin, P., & Vandentorren, S. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.11.018 · Cited by 97 · see citing works
Psychological Interventions for Post-traumatic Stress Symptoms in Psychosis: A Systematic Review of Outcomes
Swan, S., Keen, N., Reynolds, N., & Onwumere, J. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00341 · Cited by 83 · see citing works
“Approximately 3% of the general adult population is estimated to have PTSD and an additional 3.6% are thought to experience PTS symptoms which do not meet full diagnostic criteria for a diagnosis of PTSD i.e., sub-threshold (McLaughlin et al., 2015).”
BackgroundInfluential
PTSD, cyberbullying and peer violence: prevalence and correlates among adolescent emergency department patients
Ranney, M. L., Patena, J. V., Nugent, N. R., Spirito, A., Boyer, E. W., Zatzick, D., & Cunningham, R. M. (2015) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2015.12.002 · Cited by 78 · see citing works
“However, prior studies have shown that meeting partial criteria for PTSD also correlates with longterm impairment, suicidality and other comorbid disorders [112,113].”
Background
Rates of Subthreshold PTSD Among U.S. Military Veterans and Service Members: A Literature Review
Bergman, H. E., Przeworski, A., & Feeny, N. C. (2016) · Military Psychology · doi:10.1037/mil0000154 · Cited by 75 · see citing works
Mental Disorders Around the World
Scott, K. M., de Jonge, P., Stein, D. J., & Kessler, R. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316336168 · Cited by 75 · see citing works
Self-citation
Treatment-refractory posttraumatic stress disorder (TRPTSD): a review and framework for the future
Koek, R. J., Schwartz, H. N., Scully, S., Langevin, J., Spangler, S. L., Korotinsky, A., Jou, K., & Leuchter, A. F. (2016) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2016.01.015 · Cited by 70 · see citing works
“The lifetime prevalence of PTSD in the US is 6.8% (Kessler et al., 2005).”
BackgroundInfluential
Time course of symptoms in posttraumatic stress disorder with delayed expression: A systematic review
Bonde, J. P., Jensen, J. H., Smid, G. E., Flachs, E. M., Elklit, A., Mors, O. N., & Videbech, P. (2021) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.13372 · Cited by 68 · see citing works
High burden of subthreshold DSM ‐5 post‐traumatic stress disorder in U.S. military veterans
Mota, N. P., Tsai, J., Sareen, J., Marx, B. P., Wisco, B. E., Harpaz‐Rotem, I., Southwick, S. M., Krystal, J. H., & Pietrzak, R. H. (2016) · World Psychiatry · doi:10.1002/wps.20313 · Cited by 65 · see citing works
Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women
Pearson, C. R., Kaysen, D. L., Huh, D., & Bedard‐Gilligan, M. A. (2019) · AIDS and Behavior · doi:10.1007/s10461-018-02382-8 · Cited by 60 · see citing works
Mothers and fathers of children with epilepsy: gender differences in post-traumatic stress symptoms and correlations with mood spectrum symptoms
Carmassi, C., Corsi, M., Bertelloni, C. A., Carpita, B., Gesi, C., Pedrinelli, V., Massimetti, G., Peroni, D. G., Bonuccelli, A., Orsini, A. A., et al. (2018) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s158249 · Cited by 60 · see citing works
“were also considered by means of the fulfillment of three of the four or two of the four B–E symptomatological criteria, respectively.(27) The SCID was administered by psychiatrists trained and certified in the use of the study.”
Examining the effectiveness of an intensive, 2‐week treatment program for military personnel and veterans with PTSD: Results of a pilot, open‐label, prospective cohort trial
Bryan, C. J., Leifker, F. R., Rozek, D. C., Bryan, A. O., Reynolds, M. L., Oakey‐Frost, N., & Roberge, E. M. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22651 · Cited by 56 · see citing works
Pharmacological treatments for adults with post-traumatic stress disorder: A network meta-analysis of comparative efficacy and acceptability
Costa, G. D. M., Zanatta, F. B., Ziegelmann, P. K., Barros, A. J. S., & Mello, C. F. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.07.046 · Cited by 53 · see citing works
Single-cell transcriptomic and chromatin dynamics of the human brain in PTSD
Hwang, A., Škarica, M., Xu, S., Coudriet, J. M., Lee, C.-Y., Lin, L., Terwilliger, R. Z., Sliby, A., Wang, J., Nguyen, T. P., et al. (2025) · Nature · doi:10.1038/s41586-025-09083-y · Cited by 57 · see citing works
Self-citation
Mindfulness-Related Traits Partially Mediate the Association Between Lifetime and Childhood Trauma Exposure and PTSD and Dissociative Symptoms in a Community Sample Assessed Online
Boughner, E., Thornley, E., Kharlas, D., & Frewen, P. (2016) · Mindfulness · doi:10.1007/s12671-016-0502-3 · Cited by 51 · see citing works
Childhood sexual abuse and posttraumatic stress disorder among pregnant and postpartum women: review of the literature
Wosu, A. C., Gelaye, B., & Williams, M. A. (2014) · Archives of Women s Mental Health · doi:10.1007/s00737-014-0482-z · Cited by 49 · see citing works
“While the majority of trauma survivors do not meet the diagnostic criteria for PTSD, many still experience symptoms that may interfere with daily functioning (Pietrzak et al. 2011; McLaughlin et al. 2014).”
Background
The Development of Trauma and Resilience Competencies for Nursing Education
Wheeler, K., & Phillips, K. E. (2019) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390319878779 · Cited by 49 · see citing works
“PTSD symptoms in the absence of the full disorder, or subthreshold PTSD, can still result in significant functional impairments and a greater incidence of other psychiatric disorders such as major depression, social anxiety, alcohol, and drug use (McLaughlin et al., 2015; Mota et al., 2016).”
Background
Posttraumatic stress disorder and accelerated aging: PTSD and leukocyte telomere length in a sample of civilian women
Roberts, A. L., Koenen, K. C., Chen, Q., Gilsanz, P., Mason, S. M., Prescott, J., Ratanatharathorn, A. D., Rimm, E. B., Sumner, J. A., Winning, A., et al. (2017) · Depression and Anxiety · doi:10.1002/da.22620 · Cited by 48 · see citing works
Self-citation
A Network Analysis of Post-traumatic Stress Disorder Symptoms and Correlates During the COVID-19 Pandemic
Jiang, W., Ren, Z., Yu, L., Tan, Y., & Shi, C. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.568037 · Cited by 57 · see citing works
An App a Day Keeps the Doctor Away: Guided Education and Training via Smartphones in Subthreshold Post Traumatic Stress Disorder
Roy, M. J., Costanzo, M. E., Highland, K. B., Olsen, C., Clayborne, D., & Law, W. (2017) · Cyberpsychology, Behavior, and Social Networking · doi:10.1089/cyber.2017.0221 · Cited by 43 · see citing works
Electroacupuncture Pretreatment Ameliorates PTSD-Like Behaviors in Rats by Enhancing Hippocampal Neurogenesis via the Keap1/Nrf2 Antioxidant Signaling Pathway
Zhou, C.-H., Xue, F., Xue, S.-S., Sang, H., Liu, L., Wang, Y., Cai, M., Zhang, Z.-J., Tan, Q.-R., Wang, H.-N., et al. (2019) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2019.00275 · Cited by 41 · see citing works
Biological correlates of complex posttraumatic stress disorder—state of research and future directions
Marinova, Z., & Maercker, A. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.25913 · Cited by 42 · see citing works
“Functional impairment degree and comorbidity rates in partial PTSD have been found to be intermediate between those of traumatized subjects without PTSD symptoms or with full PTSD (McLaughlin et al., 2015).”
The intergenerational consequences of war: anxiety, depression, suicidality, and mental health among the children of war veterans
Forrest, W., Edwards, B., & Daraganova, G. (2018) · International Journal of Epidemiology · doi:10.1093/ije/dyy040 · Cited by 42 · see citing works
Assessment of Stress and Resiliency in Emergency Dispatchers
Steinkopf, B. L., Reddin, R. A., Black, R. A., Hasselt, V. B. V., & Couwels, J. (2018) · Journal of Police and Criminal Psychology · doi:10.1007/s11896-018-9255-3 · Cited by 40 · see citing works
“In an examination of the types of trauma that lead to PTSD and sub-threshold PTSD, McLaughlin et al. (2015) suggest that, due to the indirect nature of the critical incidents to which dispatchers are exposed, they are more likely to develop sub-threshold PTSD.”
BackgroundResultInfluential
Sexual abuse in very young children: a psychological assessment in the Amsterdam Sexual Abuse Case study
van Duin, E. M., Verlinden, E., Vrolijk‐Bosschaart, T. F., Diehle, J., Verhoeff, A. P., Brilleslijper‐Kater, S. N., & Lindauer, R. (2018) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1503524 · Cited by 38 · see citing works
“We defined subthreshold PTSD as the presence of symptoms from two of the three clusters and parental reports of child functional impairment (Gigengack et al., 2015; McLaughlin et al., 2015).”
Background
Post-traumatic stress and major depressive disorders in parent caregivers of children with a chronic disorder
Carmassi, C., Corsi, M., Bertelloni, C. A., Pedrinelli, V., Massimetti, G., Peroni, D. G., Bonuccelli, A., Orsini, A. A., & Dell’Osso, L. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.02.062 · Cited by 38 · see citing works
A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash–related Injury
Pacella‐LaBarbara, M. L., Suffoletto, B. P., Kuhn, E. R., Germain, A., Jaramillo, S., Repine, M. J., & Callaway, C. W. (2020) · Academic Emergency Medicine · doi:10.1111/acem.14000 · Cited by 39 · see citing works
Acceptance and commitment therapy as a nonpathologizing intervention approach for survivors of trauma
McLean, C., & Follette, V. M. (2016) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2016.1103111 · Cited by 34 · see citing works
“Although individuals who have experienced traumatic events will not necessarily meet diagnostic criteria for PTSD, many survivors report significant levels of psychological distress (McLaughlin et al., 2015; Zlotnick, Franklin, & Zimmerman, 2002).”
Background
Stress and Its Impact on the Transcriptome
Girgenti, M. J., Pothula, S., & Newton, S. S. (2020) · Biological Psychiatry · doi:10.1016/j.biopsych.2020.12.011 · Cited by 35 · see citing works
The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults
Johnson, J. C. S., Byrne, G. J., & Pelecanos, A. M. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-03834-1 · Cited by 36 · see citing works
“Other SPS criteria are also contentious, such as for subthreshold posttraumatic stress [7, 34, 35], personality [13], and generalized anxiety [10, 36].”
Background
Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys
Stein, D. J., Kazdin, A. E., Munthali, R. J., Hwang, I. H., Harris, M., Alonso, J., Andrade, L. H., Bruffaerts, R., Cardoso, G., Chardoul, S., et al. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-04605-2 · Cited by 34 · see citing works
“While more severe PTSD symptoms may be associated with more disability, previous findings from WMHS have emphasized the graded relationship between PTSD severity and clinical outcomes [43].”
BackgroundSelf-citation
Post-traumatic stress and cancer: Findings from a cross-sectional nationally representative sample
Kaster, T. S., Sommer, J. L., Mota, N. P., Sareen, J., & El-Gabalawy, R. M. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.04.004 · Cited by 34 · see citing works
PTSD symptoms among health workers and public service providers during the COVID-19 outbreak
Johnson, S. U., Ebrahimi, O. V., & Hoffart, A. (2020) · doi:10.31234/osf.io/w8c6p · Cited by 273 · see citing works
An empirical investigation of definitions of subthreshold posttraumatic stress disorder
Klein, A. B., Schnurr, P. P., Bovin, M. J., Friedman, M. J., Keane, T. M., & Marx, B. P. (2023) · Journal of Traumatic Stress · doi:10.1002/jts.22987 · Cited by 34 · see citing works
“…that required individuals to meet Criterion B and/or Criterion C were not meaningfully different from those that did not with regard to most psychological and functional outcomes, which is consistent with previous findings (Brancu et al., 2016; Kim et al., 2020; McLaughlin et al., 2015).”
InfluentialSelf-citation
A Prospective Investigation of the Impact of Distinct Posttraumatic (PTSD) Symptom Clusters on Suicidal Ideation
Panagioti, M., Angelakis, I., Tarrier, N., & Gooding, P. A. (2017) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9829-2 · Cited by 33 · see citing works
A diagnostic questionnaire for childbirth related posttraumatic stress disorder: a validation study
Arora, I. H., Woscoboinik, G. G., Mokhtar, S., Quagliarini, B., Bartal, A., Jagodnik, K. M., Barry, R. L., Edlow, A. G., Orr, S. P., & Dekel, S. (2024) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2023.11.1229 · Cited by 32 · see citing works
Comparing three diagnostic algorithms of posttraumatic stress in young children exposed to accidental trauma: an exploratory study
Gigengack, M. R., van Meijel, E. P. M., Alisic, E., & Lindauer, R. (2015) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-015-0046-7 · Cited by 32 · see citing works
“Our definition of subthreshold PTSD is supported by a study on definitions of subthreshold PTSD according to the DSM-5 PTSD algorithm [21].”
BackgroundMethodInfluential
The ties that bind: Ingroup ties are linked with diminished inflammatory immune responses and fewer mental health symptoms through less rumination
Ysseldyk, R., McQuaid, R. J., McInnis, O., Anisman, H., & Matheson, K. (2018) · PLoS ONE · doi:10.1371/journal.pone.0195237 · Cited by 20 · see citing works
Effectiveness of cognitive behavioral conjoint therapy for posttraumatic stress disorder (PTSD) in a U.S. Veterans Affairs PTSD clinic
Pukay‐Martin, N. D., Fredman, S. J., Martin, C. E., Le, Y., Haney, A. M., Sullivan, C., Monson, C. M., & Chard, K. M. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22781 · Cited by 32 · see citing works
Mindfulness and Metta-based Trauma Therapy (MMTT): Initial Development and Proof-of-Concept of an Internet Resource
Frewen, P., Rogers, N., Flodrowski, L., & Lanius, R. A. (2015) · Mindfulness · doi:10.1007/s12671-015-0402-y · Cited by 30 · see citing works
Association Between Positive Results on the Primary Care–Posttraumatic Stress Disorder Screen and Suicide Mortality Among US Veterans
Cooper, S. A., Szymanski, B. R., Bohnert, K. M., Sripada, R. K., & McCarthy, J. F. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.15707 · Cited by 29 · see citing works
Classification and descriptive psychopathology of post-traumatic stress disorder and other stressor-related disorders
Kilpatrick, D. G., Friedman, M. J., & Gilmore, A. K. (2020) · doi:10.1093/med/9780198713005.003.0078 · Cited by 29 · see citing works
Self-citation
Development of a novel, integrated cognitive-behavioral therapy for co-occurring posttraumatic stress and substance use disorders: A pilot randomized clinical trial
Vujanovic, A. A., Smith, L. J., Green, C. E., Lane, S. D., & Schmitz, J. M. (2017) · Contemporary Clinical Trials · doi:10.1016/j.cct.2017.12.013 · Cited by 29 · see citing works
Network analysis of posttraumatic stress and eating disorder symptoms in a community sample of adults exposed to childhood abuse
Liebman, R. E., Becker, K. R., Smith, K. E., Cao, L., Keshishian, A. C., Crosby, R. D., Eddy, K. T., & Thomas, J. J. (2021) · Journal of Traumatic Stress · doi:10.1002/jts.22644 · Cited by 27 · see citing works
The prevalence and clinical impairment of subthreshold PTSD using DSM‐5 criteria in a national sample of Korean firefighters
Kim, J. I., Oh, S., Park, H., Min, B., & Kim, J. (2020) · Depression and Anxiety · doi:10.1002/da.22998 · Cited by 28 · see citing works
“About 18% of the respondents in our study, whereas 4.6% of the WHO World Mental Health Survey respondents and 69.4% of veterans in Franklin's study, met at least one definition of probable subthreshold PTSD (Franklin et al., 2018; McLaughlin et al., 2015).”
BackgroundMethodResultInfluential
Posttraumatic stress and medication adherence in pediatric transplant recipients
Duncan, S. E., Danziger‐Isakov, L. A., Armstrong, B., Williams, N. M., Odim, J. N. K., Shemesh, E., Sweet, S. C., & Annunziato, R. A. (2021) · American Journal of Transplantation · doi:10.1111/ajt.16896 · Cited by 26 · see citing works
Ketamine attenuates the PTSD-like effect via regulation of glutamatergic signaling in the nucleus accumbens of mice
Asim, M., Hao, B., Waris, A., Liang, Y.-M., & Wang, X.-G. (2022) · Molecular and Cellular Neuroscience · doi:10.1016/j.mcn.2022.103723 · Cited by 24 · see citing works
Resting Heart Rate Variability: Exploring Associations With Symptom Severity in Adults With Substance Use Disorders and Posttraumatic Stress
D’Souza, J. M., Wardle, M. C., Green, C. E., Lane, S. D., Schmitz, J. M., & Vujanovic, A. A. (2018) · Journal of Dual Diagnosis · doi:10.1080/15504263.2018.1526431 · Cited by 25 · see citing works
“…with subthreshold PTSD symptoms based on the following: (1) comparable rates of distress and impairment in full versus subthreshold PTSD (McLaughlin et al., 2015; Pietrzak et al., 2011) and (2) high rates of subthreshold PTSD in substance use disorder populations (Najavits et al., 2003;…”
Background
A plea for symptom-based research in psychiatry
Schmidt, U. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27660 · Cited by 23 · see citing works
“The concept of partial/subthreshold PTSD was established in the 1990s (Bryant, 1996; McLaughlin et al., 2015; Schützwohl & Maercker, 1999).”
Background
Post-traumatic stress disorder risk and witnessing team members in acute psychological stress during combat
Adler, A. B., Svetlitzky, V., & Gutierrez, I. A. (2020) · BJPsych Open · doi:10.1192/bjo.2020.81 · Cited by 24 · see citing works
Aspects of posttraumatic stress disorder in long-term testicular cancer survivors: cross-sectional and longitudinal findings
Dahl, A. A., Østby-Deglum, M., Oldenburg, J., Bremnes, R. M., Dahl, O., Klepp, O., Wist, E., & Fosså, S. D. (2016) · Journal of Cancer Survivorship · doi:10.1007/s11764-016-0529-4 · Cited by 24 · see citing works
Examining PTSD treatment choice among individuals with subthreshold PTSD
Bergman, H. E., Kline, A. C., Feeny, N. C., & Zoellner, L. A. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.07.010 · Cited by 23 · see citing works
Emotional Dysregulation and Post-Traumatic Stress Symptoms: Which Interaction in Adolescents and Young Adults? A Systematic Review
Conti, L., Fantasia, S., Violi, M., Dell’Oste, V., Pedrinelli, V., & Carmassi, C. (2023) · Brain Sciences · doi:10.3390/brainsci13121730 · Cited by 23 · see citing works
“At the same time, fear, worry, intrusive thoughts, and avoidance, essential diagnostic elements in the assessment of PTSD, are considered in the theoretical description of the mechanism of emotion regulation, suggesting an interplay between this latter and even subthreshold forms of PTSD [20,21].”
Background
Threat-induced anxiety during goal pursuit disrupts amygdala–prefrontal cortex connectivity in posttraumatic stress disorder
Sun, D., Gold, A. L., Swanson, C. A., Haswell, C. C., Brown, V. M., Stjepanović, D., Workgroup, V. M.-A. M., Beckham, J. C., Brancu, M., Calhoun, P. S., et al. (2020) · Translational Psychiatry · doi:10.1038/s41398-020-0739-4 · Cited by 23 · see citing works
PTSD and Suicidal Behaviors Amongst L'Aquila 2009 Earthquake Young Survivors
Carmassi, C., Bertelloni, C. A., Dell’Oste, V., Luperini, C., Marazziti, D., Rossi, R., & Dell’Osso, L. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.590753 · Cited by 23 · see citing works
“To assess the presence of partial PTSD, we adopted the criteria proposed by previous studies corresponding to the endorsement of two or three symptom clusters (27, 36).”
BackgroundMethod
Parenting behaviors of mothers with posttraumatic stress: The roles of cortisol reactivity and negative emotion.
Franz, M. R., Kumar, S. A., Brock, R. L., Calvi, J. L., & DiLillo, D. (2021) · Journal of Family Psychology · doi:10.1037/fam0000865 · Cited by 24 · see citing works
Post-Traumatic Stress Disorder Trajectories the Year after COVID-19 Hospitalization
Serra, R., Borrazzo, C., Vassalini, P., Nicolantonio, C. D., Koukopoulos, A. E., Tosato, C., Cherubini, F., Alessandri, F., Ceccarelli, G., Mastroianni, C. M., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19148452 · Cited by 23 · see citing works
“A PCL-5 total >30 can also be used in order to indicate the presence of a clinically relevant PTSD symptomatology [28].”
Method
Circulating PACAP levels are associated with increased amygdala-default mode network resting-state connectivity in posttraumatic stress disorder
Clancy, K. J., Devignes, Q., Kumar, P., May, V., Hammack, S. E., Akman, E., Casteen, E. J., Pernia, C. D., Jobson, S. A., Lewis, M. W., et al. (2023) · Neuropsychopharmacology · doi:10.1038/s41386-023-01593-5 · Cited by 22 · see citing works
DSM-5 criteria for PTSD in parents of pediatric patients with epilepsy: What are the changes with respect to DSM-IV-TR?
Carmassi, C., Corsi, M., Gesi, C., Bertelloni, C. A., Faggioni, F., Calderani, E., Massimetti, G., Saggese, G., Bonuccelli, A., Orsini, A. A., et al. (2017) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2017.02.025 · Cited by 23 · see citing works
Sexual Assault Severity and Depressive Symptoms as Longitudinal Predictors of the Quality of Women's Sexual Experiences
Neilson, E. C., Norris, J., Bryan, A. E. B., & Stappenbeck, C. A. (2016) · Journal of Sex & Marital Therapy · doi:10.1080/0092623x.2016.1208127 · Cited by 23 · see citing works
Efficacy and acceptability of mobile application-delivered acceptance and commitment therapy for posttraumatic stress disorder in China: A randomized controlled trial
Zhao, C., Zhao, Z., Levin, M. E., Lai, L., Shi, C., Hu, J., Chen, W., & Ren, Z. (2023) · Behaviour Research and Therapy · doi:10.1016/j.brat.2023.104440 · Cited by 22 · see citing works
PTSD as a mediator of the relationship between trauma and psychotic experiences
Strelchuk, D., Hammerton, G., Wiles, N., Croft, J., Turner, K. M., Heron, J., & Zammit, S. (2020) · Psychological Medicine · doi:10.1017/s0033291720004821 · Cited by 22 · see citing works
Improving access to evidence‐based interventions for trauma‐exposed adults in low‐ and middle‐income countries
Kaminer, D., Booysen, D. D., Ellis, K., Kristensen, C. H., Patel, A., Robjant, K., & Sardana, S. M. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23031 · Cited by 21 · see citing works
Post-traumatic stress spectrum symptoms in parents of children affected by epilepsy: Gender differences
Carmassi, C., Corsi, M., Bertelloni, C. A., Pedrinelli, V., Massimetti, G., Peroni, D. G., Bonuccelli, A., Orsini, A. A., & Dell’Osso, L. (2020) · Seizure · doi:10.1016/j.seizure.2020.06.021 · Cited by 22 · see citing works
Effectiveness of a school-based, lay counselor-delivered cognitive behavioral therapy for Chinese children with posttraumatic stress symptoms: a randomized controlled trial
Li, J., Li, J., Zhang, W., Wang, G., & Qu, Z. (2023) · The Lancet Regional Health - Western Pacific · doi:10.1016/j.lanwpc.2023.100699 · Cited by 24 · see citing works
The impact of trauma core dimensions on anxiety and depression: a latent regression model through the Post-Traumatic Symptom Questionnaire (PTSQ)
Rossi, A. A., Panzeri, A., Fernández, I., Invernizzi, R., Taccini, F., & Mannarini, S. (2024) · Scientific Reports · doi:10.1038/s41598-024-72274-6 · Cited by 24 · see citing works
Assessing posttraumatic stress related impairment and well-being: The Posttraumatic Stress Related Functioning Inventory (PRFI)
McCaslin, S. E., Maguen, S., Metzler, T. J., Bosch, J. O., Neylan, T. C., & Marmar, C. R. (2015) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2015.10.016 · Cited by 22 · see citing works
Largest genome-wide association study for PTSD identifies genetic risk loci in European and African ancestries and implicates novel biological pathwaysPreprint
Nievergelt, C. M., Maihofer, A. X., Klengel, T., Atkinson, E. G., Chen, C., Choi, K. W., Coleman, J. R. I., Dalvie, S., Duncan, L. E., Logue, M. W., et al. (2018) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/458562 · Cited by 24 · see citing works
“Extensive epidemiologic work has shown that subthreshold PTSD is highly prevalent and debilitating.(72,73) In our analysis, persons with subthreshold PTSD are classified as controls, which would likely reduce our power to find genetic associations.”
BackgroundSelf-citation
Using a Brief Mental Imagery Competing Task to Reduce the Number of Intrusive Memories: Exploratory Case Series With Trauma-Exposed Women
Þórarinsdóttir, K., Holmes, E. A., Hardarson, J., Stephenssen, E. S., Jonasdottir, M. H., Kanstrup, M., Singh, L., Hauksdóttir, A., Halldorsdottir, T., Guðmundsdóttir, B., et al. (2022) · JMIR Formative Research · doi:10.2196/37382 · Cited by 17 · see citing works
“Posttraumatic stress symptoms, even when subthreshold for a diagnosis of PTSD, can be associated with substantial distress, functional impairment, and comorbidity [5].”
Background
Mental health informed physical activity for first responders and their support partner: a protocol for a stepped-wedge evaluation of an online, codesigned intervention
McKeon, G., Steel, Z., Wells, R., Newby, J. M., Hadži-Pavlović, D., Vancampfort, D., & Rosenbaum, S. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-030668 · Cited by 18 · see citing works
“The long-term impact of traumatic stress on mental health has been identified as one of the major determinants of impairment and disability across the globe.(8) Adverse consequences of PTSD include impairments in psychosocial functioning,(9) substance abuse,(10) comorbid mental disorders(9) and an increase risk of sui…”
Background
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Watts, J. R., Lazzareschi, N. R., Liu, Y., & O’Sullivan, D. (2022) · Journal of Counseling & Development · doi:10.1002/jcad.12455 · Cited by 19 · see citing works
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“McLaughlin et al. (2015) concluded that no clear definition of subclinical PTSD exists, and proposed that complying with at least two of any of the DSM-5 criteria B to E identifies the group with the highest negative outcome.”
BackgroundMethodResultInfluential
Susceptibility to others' emotions moderates immediate self-reported and biological stress responses to witnessing trauma
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“Exposure to traumatic events is associated with a higher risk for various mental disorders such as posttraumatic stress disorder (Karam et al., 2014; McLaughlin et al., 2015), anxiety disorders (Asselmann, Wittchen, Lieb, Perkonigg, & Beesdo-Baum, 2017), depressive disorders (Suliman et al., 2009)…”
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Central amygdala angiotensin type 1 receptor (Agtr1) expressing neurons contribute to fear extinction
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Dawson, R. L., Calear, A. L., McCallum, S. M., McKenna, S., Nixon, R. D. V., & O’Kearney, R. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22596 · Cited by 17 · see citing works
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Subthreshold posttraumatic stress disorder: A meta-analytic review of DSM–IV prevalence and a proposed DSM–5 approach to measurement.
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Authors: McLaughlin, K. A., Koenen, K. C., Friedman, M. J., Ruscio, A. M., Karam, E. G., Shahly, V., Stein, D. J., Hill, E. D., Petukhova, M., Alonso, J., Andrade, L. H., Angermeyer, M. C., Borges, G., de Girolamo, G., de Graaf, R., Demyttenaere, K., Florescu, S. E., Mladenova, M., Posada-Villa, J., Scott, K. M., Takeshima, T., & Kessler, R. C.
Affiliations: University of Washington (US)
Columbia University (US)
United States Department of Veterans Affairs (US)
University of Pennsylvania (US)
University of Balamand (LB)
Harvard University (US)
University of Cape Town (ZA)
Universitat Pompeu Fabra (ES)
Universidade de São Paulo (BR)
Universidad Autónoma Metropolitana (MX)
Universitair Ziekenhuis Leuven (BE)
National School of Public Health, Management and Professional Development (RO)
New Bulgarian University (BG)
University of Otago (NZ)
National Center of Neurology and Psychiatry (JP)
Corresponding author: Kessler, Ronald C.
ORCID: McLaughlin, Katie A.
Koenen, Karestan C.
Friedman, Matthew J.
Karam, Elie G.
Stein, Dan J.
Hill, Eric D.
Petukhova, Maria
Alonso, Jordi
Andrade, Laura Helena
Borges, Guilherme
Demyttenaere, Koen
Florescu, Silvia E.
Mladenova, Maya
Scott, Kate M.
Takeshima, Tadashi
Kessler, Ronald C.
Venue: Biological Psychiatry
Publisher: Elsevier BV
Published: 2015-02
Volume: 77
Issue: 4
Pages: 375-384
ISSN: 0006-3223 (ISSN-L)
DOI: 10.1016/j.biopsych.2014.03.028
PMC: PMC4194258
OpenAlex: W2123975962
Cited by: 275
References: 42
Citations by year: 2026: 21 · 2025: 22 · 2024: 35 · 2023: 41 · 2022: 24 · 2021: 25 · 2020: 29 · 2019: 17 · 2018: 18 · 2017: 20 · 2016: 11 · 2015: 10 · 2014: 1
FWCI: 16.57
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Biological Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
RECERCAT (Consorci de Serveis Universitaris de Catalunya) (acceptedVersion, other-oa)
Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion)
Funders: National Institutes of Health (5r13mh066849-04, 5r01mh069864-04, 5r01mh070884-05, 5r01mh093612-03)
National Institute of Mental Health (R13-MH-066849, R01‐MH070884, U01-MH-60220, R01-MH093612, K01MH092526, U01MH060220, R01 MH093612-01, R01‐MH069864)
National Institute on Drug Abuse (K05DA015799, R01DA016558)
Fogarty International Center (R03TW006481)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Keywords: post-traumatic stress disorder, DSM-5 PTSD criteria, trauma exposure, PTSD comorbidity, suicidality, interpersonal violence, World Mental Health Surveys
MeSH terms: Female, Health Surveys, Humans, Male, Mental Health, Severity of Illness Index, Stress Disorders, Post-Traumatic, World Health Organization, Prevalence, Diagnostic and Statistical Manual of Mental Disorders

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Subthreshold Posttraumatic Stress Disorder in the World Health Organization World Mental Health Surveys

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