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

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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., 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.·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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Trauma-related shame predicts daily non-medical prescription opioid use among individuals with PTSD symptoms
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Trauma Assessment in Personal Injury and Employment Discrimination Cases
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“Though definitions of subthreshold PTSD vary across studies (McLaughlin et al., 2015), our rates are similar to, or greater than, lifetime rates identified in a large nationally representative sample of U.S. adults (17.2% of women and 8.6% of men meeting threshold or subthreshold PTSD; Pietrzak et…”
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Concurrent and proximal associations among PTSD symptoms, prescription opioid use, and co-use of other substances: Results from a daily monitoring study.
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A Public Health Framework for Preventing Mental Disorders in the Context of Pandemics
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“well-studied, but it is increasingly understood to be a prevalent clinical syndrome related to various negative outcomes [12-16].”
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Functional annotation of the human PTSD methylome identifies tissue-specific epigenetic variation across subcortical brain regionsPreprint
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“For our study, we used two definitions for the sub-threshold DSM-5 PTSD (McLaughlin et al., 2015), the ‘six plus’ definition: Having at least six symptoms of PTSD, but not meeting full criteria due to failure to meet criterion specifiers and the ‘majority’ definition: meeting full threshold for 3…”
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“…for Behavioural and Cognitive Psychotherapies. meaningful distress, including subthreshold PTSD symptoms, mood and anxiety symptoms, impaired functioning, impaired interpersonal relationships, suicidality, and hopelessness (e.g. Iverson et al., 2013; Kessler et al., 2005; McLaughlin et al., 2015).”
Background
Facets of psychopathy in relation to trauma-exposure and posttraumatic stress symptomology in a sample of incarcerated male offenders
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“In some severe cases, psychiatric comorbidity can occur, (McLaughlin et al., 2015) and traumatized people start predicting dangerous future events based on their memories (Kessler et al., 2017) instead of relying on the reality as it is.”
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Le trouble de stress post-traumatique lié à l’accouchement
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“Despite failing to meet PTSD diagnostic criteria, PTSS can nonetheless induce significant distress (McLaughlin et al., 2015).”
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Leveraging interindividual variability in threat conditioning of inbred mice to model trait anxiety
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Internet-based cognitive behavioral therapy versus internet-based modified present-centered therapy for world trade center responders and survivors with posttraumatic stress disorder: rationale and design of a randomized controlled trial
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“Early intervention in people experiencing a major trauma was highly, meaningful in several cases.(42,43) The initial IES is a 15-item self-reported scale assessing subjective distress caused by Table 4 Reliability, Validity, and Relevance Analyzed by Clinical Evaluation of GHE-MSS”
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Presença de Risco de Transtorno do Estresse Pós-Traumático em Policiais Militares Feridos por Arma de Fogo
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“Já o “Parcial” é definido como o cumprimento de grande parte dos critérios diagnósticos, ou seja, tem de 50% a 75% de chance de desenvolver o TEPT (Mclaughlin et al., 2015).”
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Trauma Type and Posttraumatic Stress Symptoms in Youth
Doehrmann, A., Bibb, S. A., Kreutzer, K. A., & Gorka, S. M. (2025) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001837 · Cited by 3
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“Eligibility was determined using the four-factor DSM-5 model of PTSD symptom clusters (McLaughlin et al. 2015); individuals meeting subthreshold PTSD criteria—defined as endorsing ≥ 2 items rated ≥ 2 in each of the four symptom clusters—were included.”
Mapping DNA Methylation Signatures to Identify Epigenetic Variation Across Subcortical Regions of the Human Posttraumatic Stress Disorder Brain
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Randomized controlled trial of two internet-based written therapies for world trade center workers and survivors with persistent PTSD symptoms
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Associations between PACAP levels and psychophysiological indicators of fear and arousal in adults with posttraumatic stress symptoms
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“Participants needed to be able to provide written informed consent, be 18 – 55 years old, and meet diagnostic criteria for PTSD or subthreshold PTSD (meeting diagnostic criteria for at least two PTSD symptom) [35].”
The Cross-National Epidemiology of Mental Disorders
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“…DSM and ICD diagnostic conceptualizations and operationalizations, they have also made important contributions to psychiatric nosology by rigorously comparing different diagnostic constructs (Ruscio et al. 2007; Lee et al. 2009; Karam et al. 2010; Stein et al. 2010, 2013; McLaughlin et al. 2015).”
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“A study in 2014 conducted across 24 countries found that while 3% of participants met the diagnostic criteria of DSM-5 for PTSD, there was an additional 4.6% that met the criteria of subthreshold PTSD [4].”
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“E symptom criteria, respectively [49,50].”

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
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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