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Subthreshold Posttraumatic Stress Disorder in the World Health Organization World Mental Health Surveys
Open accessAbstract
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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“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
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“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
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“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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Zhou, Y., Peng, S., Luo, H., Zhao, J., Chen, S., Yanyu, L., Li, Y., & Xu, Z. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117505
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Metadata
- 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
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-02
- Volume
- 77
- Issue
- 4
- Pages
- 375-384
- ISSN
- 0006-3223 (ISSN-L)
- 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
- 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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