Comorbidity of PTSD in anxiety and depressive disorders: Prevalence and shared risk factors

Spinhoven, Philip; Penninx, Brenda W.; van Hemert, Albert M.; de Rooij, Mark; Elzinga, Bernet M.

doi:10.1016/j.chiabu.2014.01.017

Cited by 305Posttraumatic Stress Disorder ResearchChild Abuse and TraumaPsychoanalysis and Psychopathology Research

Comorbidity of PTSD in anxiety and depressive disorders: Prevalence and shared risk factors

Spinhoven, Philip, Penninx, Brenda W., van Hemert, Albert M., de Rooij, Mark, Elzinga, Bernet M.·2014·Child Abuse & Neglect

DOI 10.1016/j.chiabu.2014.01.017

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Abstract

The present study aims to assess comorbidity of posttraumatic stress disorder (PTSD) in anxiety and depressive disorders and to determine whether childhood trauma types and other putative independent risk factors for comorbid PTSD are unique to PTSD or shared with anxiety and depressive disorders. The sample of 2402 adults aged 18-65 included healthy controls, persons with a prior history of affective disorders, and persons with a current affective disorder. These individuals were assessed at baseline (T0) and 2 (T2) and 4 years (T4) later. At each wave, DSM-IV-TR based anxiety and depressive disorder, neuroticism, extraversion, and symptom severity were assessed. Childhood trauma was measured at T0 with an interview and at T4 with a questionnaire, and PTSD was measured with a standardized interview at T4. Prevalence of 5-year recency PTSD among anxiety and depressive disorders was 9.2%, and comorbidity, in particular with major depression, was high (84.4%). Comorbidity was associated with female gender, all types of childhood trauma, neuroticism, (low) extraversion, and symptom severity. Multivariable significant risk factors (i.e., female gender and child sexual and physical abuse) were shared among anxiety and depressive disorders. Our results support a shared vulnerability model for comorbidity of anxiety and depressive disorders with PTSD. Routine assessment of PTSD in patients with anxiety and depressive disorders seems warranted.

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Traumatic experiences are highly prevalent in mood and anxiety disorders; in a recent sample of 2000 persons with mood and anxiety disorders, 91.2% reported having experienced a potentially traumatic or bothersome life event.
“Finally, traumatic experiences are highly prevalent in mood and anxiety disorders, where in a recent sample of 2000 persons with mood and anxiety disorders, 91.2% of reported having experienced a potentially traumatic or bothersome life event (Spinhoven et al., 2014).”
From A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions (2016) · cites this paper as Spinhoven et al., 2014
The overlap between symptoms of depression and PTSD may partly explain the significant association between PTSD symptom scores and depression scores reported in this study.
“This overlap may partly explain the significant association between PTSD symptom scores and depression scores reported in this study (Flory and Yehuda, 2015;Spinhoven et al., 2014;Greene et al., 2016).”
From Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape (2022) · cites this paper as Spinhoven et al., 2014

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Trait rumination predicts onset of Post-Traumatic Stress Disorder through trauma-related cognitive appraisals: A 4-year longitudinal study
Spinhoven, P., Penninx, B. W., Krempeniou, A., van Hemert, A. M., & Elzinga, B. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.06.004 · Cited by 84 · see citing works
Prevalence and predictors of posttraumatic stress disorder, depression and anxiety among hospitalized patients with coronavirus disease 2019 in China
Chen, Y., Huang, X. M., Zhang, C., An, Y., Liang, Y., Yang, Y., & Liu, Z. (2021) · BMC Psychiatry · doi:10.1186/s12888-021-03076-7 · Cited by 75 · see citing works
“Evidence has shown that when PTSD and other psychiatric disorders co-occur in populations who have experienced trauma, a combined stress model with shared vulnerabilities and similar risk factors might be involved [18].”
Background
Brain‐derived neurotropic factor polymorphisms, traumatic stress, mild traumatic brain injury, and combat exposure contribute to postdeployment traumatic stress
Dretsch, M. N., Williams, K., Emmerich, T., Crynen, G. C., Ait‐Ghezala, G., Chaytow, H., Mathura, V. S., Crawford, F., & Iverson, G. L. (2015) · Brain and Behavior · doi:10.1002/brb3.392 · Cited by 72 · see citing works
“Service members who have a premilitary or predeployment history of traumatic events (Youngner et al. 2012), mental health problems (Spinhoven et al. 2014; Stander et al. 2014), and lower psychological resilience (Zerach et al. 2013) are at increased risk for having a traumatic stress condition such…”
Background
Long-term psychological outcomes of flood survivors of hard-hit areas of the 1998 Dongting Lake flood in China: Prevalence and risk factors
Dai, W., Kaminga, A. C., Tan, H., Wang, J., Lai, Z., Wu, X., & Liu, A. (2017) · PLoS ONE · doi:10.1371/journal.pone.0171557 · Cited by 67 · see citing works
Animal models of post-traumatic stress disorder and novel treatment targets
Aspesi, D., & Pinna, G. (2019) · Behavioural Pharmacology · doi:10.1097/fbp.0000000000000467 · Cited by 65 · see citing works
Rate and correlates of post-traumatic stress disorder (PTSD) following the Beirut blast and the economic crisis among Lebanese University students: a cross-sectional study
Zouki, C.-J. E., Chahine, A., Mhanna, M., Obeïd, S., & Hallit, S. R. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04180-y · Cited by 61 · see citing works
“Depression, anxiety, and phobic avoidance severity levels were all higher among patients suffering from Post-Traumatic Stress [13, 14].”
Background
Glutamate Neurotoxicity and Destruction of the Blood–Brain Barrier: Key Pathways for the Development of Neuropsychiatric Consequences of TBI and Their Potential Treatment Strategies
Gruenbaum, B. F., Zlotnik, A. A., Fleidervish, I. A., Frenkel, A., & Boyko, M. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23179628 · Cited by 60 · see citing works
“The relationship between depression, anxiety, dementia, aggression, and glutamate [12–14] is well studied and documented in the scientific literature [3,15,16].”
Background
An initial review of residual symptoms after empirically supported trauma-focused cognitive behavioral psychological treatment
Larsen, S. E., Bellmore, A., Gobin, R. L., Holens, P., Lawrence, K. A., & Pacella-LaBarbara, M. L. (2019) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2019.01.008 · Cited by 57 · see citing works
Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention
Du, J., Diao, H., Zhou, X., Zhang, C., Chen, Y., Gao, Y. F., & Wang, Y. (2022) · Medical Review · doi:10.1515/mr-2022-0012 · Cited by 62 · see citing works
“Many physiological symptoms of PTSD in the DSM-5 overlap with other psychiatric diseases, such as major depressive disorder, substance use disorders, and other anxiety disorders [12, 58, 59].”
Predictors of recovery from post-traumatic stress disorder after the dongting lake flood in China: a 13–14 year follow-up study
Dai, W., Wang, J., Kaminga, A. C., Chen, L., Tan, H., Lai, Z., Deng, J., & Liu, A. (2016) · BMC Psychiatry · doi:10.1186/s12888-016-1097-x · Cited by 56 · see citing works
“Some studies have reported that females have a higher risk for PTSD symptoms [40] [41] [42] , while other research has shown that males are more likely to develop PTSD symptoms after traumatic events [43] .”
Result
The Underlying Role of Negative Affect in the Association between PTSD, Major Depressive Disorder, and Generalized Anxiety Disorder
Byllesby, B. M., Charak, R., Durham, T. A., Wang, X., & Elhai, J. D. (2016) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-016-9555-9 · Cited by 55 · see citing works
Neuroinflammatory genes associated with post-traumatic stress disorder
Zass, L. J., Hart, S. A., Seedat, S., Hemmings, S. M. J., & Malan‐Müller, S. (2016) · Psychiatric Genetics · doi:10.1097/ypg.0000000000000143 · Cited by 52 · see citing works
“Comorbidity in post-traumatic stress disorder PTSD often co-occurs with other psychiatric and general medical conditions (Brady et al., 2000; Rojas et al., 2014; Spinhoven et al., 2014), such as depression (Kessler et al.”
Background
Metabolite profiling in posttraumatic stress disorder
Karabatsiakis, A., Hamuni, G., Wilker, S., Kolassa, S., Renu, D., Kadereit, S., Schauer, M., Hennessy, T., & Kolassa, I. (2015) · Journal of Molecular Psychiatry · doi:10.1186/s40303-015-0007-3 · Cited by 52 · see citing works
“Since there is a high co-morbidity between PTSD and depression in the aftermath of traumatic stress [34], we also tested the association between the identified metabolites and depressive symptomatology (HAM-D).”
Validation of ICD-11 PTSD and DSO using the International Trauma Questionnaire in five clinical samples recruited in Denmark
Vang, M. L., Dokkedahl, S. B., Løkkegaard, S. S., Jakobsen, A. V., Møller, L., Auning-Hansen, M. A., & Elklit, A. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1894806 · Cited by 53 · see citing works
Posttraumatic stress disorder under ongoing threat: a review of neurobiological and neuroendocrine findings
Fragkaki, I., Thomaes, K., & Sijbrandij, M. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.30915 · Cited by 54 · see citing works
Attachment to Pets Moderates Transitions in Latent Patterns of Mental Health Following the Onset of the COVID-19 Pandemic: Results of a Survey of U.S. Adults
McDonald, S. E., O’Connor, K. E., Matijczak, A., Tomlinson, C. A., Applebaum, J. W., Murphy, J. L., & Zsembik, B. A. (2021) · Animals · doi:10.3390/ani11030895 · Cited by 50 · see citing works
Post‐traumatic stress and psychological health following infidelity in unmarried young adults
Roos, L. G., O'Connor, V., Canevello, A., & Bennett, J. M. (2019) · Stress and Health · doi:10.1002/smi.2880 · Cited by 49 · see citing works
Understanding the Relationship between Trauma Exposure and Depression among Adolescents after Earthquake: The Roles of Fear and Resilience
Zhou, X., Wu, X., & An, Y. (2016) · Frontiers in Psychology · doi:10.3389/fpsyg.2016.02044 · Cited by 48 · see citing works
“Many negative psychological reactions can occur after trauma experience (e.g., Armour et al., 2014; Spinhoven et al., 2014), with depression and post-traumatic stress disorders (PTSD) representing two common and critically important negative psychological outcomes (e.”
Background
Dissociative symptoms are associated with reduced neuropsychological performance in patients with recurrent depression and a history of trauma exposure
Parlar, M., Frewen, P. A., Oremus, C., Lanius, R. A., & McKinnon, M. C. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.29061 · Cited by 56 · see citing works
Cannabinoids as therapeutics for PTSD
Sbarski, B., & Akirav, I. (2020) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2020.107551 · Cited by 47 · see citing works
Depression in post-traumatic stress disorder
Radell, M. L., Hamza, E. A., & Moustafa, A. A. (2020) · Reviews in the Neurosciences · doi:10.1515/revneuro-2020-0006 · Cited by 47 · see citing works
“In addition, even after controlling for symptom severity, the experience of childhood sexual and physical abuse were also significant predictors of comorbidity, and their effect was independent of that of gender (Spinhoven et al. 2014).”
BackgroundResultInfluential
Posttraumatic stress disorder in opioid agonist therapy: A review.
Ecker, A. H., & Hundt, N. E. (2017) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000312 · Cited by 45 · see citing works
The impact of severe pediatric epilepsy on experienced stress and psychopathology in parents
Jakobsen, A. V., Møller, R. S., Nikanorova, M., & Elklit, A. (2020) · Epilepsy & Behavior · doi:10.1016/j.yebeh.2020.107538 · Cited by 45 · see citing works
Comorbidity of post-traumatic stress disorder and anxiety in flood survivors
Dai, W., Kaminga, A. C., Tan, H., Wang, J., Lai, Z., Wu, X. Y., Yuan, X., Deng, J., & Liu, A. (2017) · Medicine · doi:10.1097/md.0000000000007994 · Cited by 44 · see citing works
Post-traumatic Stress Disorder: Focus on Neuroinflammation
Li, J., Tong, L., Schock, B. C., & Ji, L.-L. (2023) · Molecular Neurobiology · doi:10.1007/s12035-023-03320-z · Cited by 44 · see citing works
How our Dreams Changed During the COVID-19 Pandemic: Effects and Correlates of Dream Recall Frequency - a Multinational Study on 19,355 Adults
Fränkl, E., Scarpelli, S., Nadorff, M. R., Bjorvatn, B., Bolstad, C. J., Chan, N. Y., Chung, F. F., Dauvilliers, Y. A., Espie, C. A., Inoue, Y., et al. (2021) · Nature and Science of Sleep · doi:10.2147/nss.s324142 · Cited by 42 · see citing works
Potential pleiotropic beneficial effects of adjuvant melatonergic treatment in posttraumatic stress disorder
Agorastos, A., & Linthorst, A. C. E. (2016) · Journal of Pineal Research · doi:10.1111/jpi.12330 · Cited by 41 · see citing works
“Depression and anxiety disorders are highly comorbid psychiatric conditions in PTSD patients, which may share common risk factors and pathophysiological background [410, 411].”
Background
Dementia and Cognitive Impairment Among U.S. Veterans With a History of MDD or PTSD: A Retrospective Cohort Study Based on Sex and Race
Bhattarai, J., Oehlert, M. E., Multon, K. D., & Sumerall, S. W. (2018) · Journal of Aging and Health · doi:10.1177/0898264318781131 · Cited by 40 · see citing works
No robust differences in fear conditioning between patients with fear-related disorders and healthy controls
Pöhlchen, D., Leuchs, L., Binder, F. P., Blaskovich, B., Nantawisarakul, T., Topalidis, P. I., Brückl, T. M., Norrholm, S. D., Jovanović, T., Binder, E. B., et al. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103610 · Cited by 37 · see citing works
A new perspective on PTSD symptoms after traumatic vs stressful life events and the role of gender
van den Berg, L. J. M., Tollenaar, M. S., Spinhoven, P., Penninx, B. W. J. H., & Elzinga, B. M. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1380470 · Cited by 39 · see citing works
“8%) and in the total NESDA sample (6.7%; Boschloo et al., 2011; Manthey et al., 2012; Spinhoven et al., 2014), and therefore we expect little impact on our results.”
BackgroundResultInfluential
The absurdity of the latent disease model in mental health: 10,130,814 ways to have a DSM-5-TR psychological disorder
Borgogna, N. C., Owen, T., & Aita, S. L. (2023) · Journal of Mental Health · doi:10.1080/09638237.2023.2278107 · Cited by 37 · see citing works
“Studies documenting similar findings are prevalent within the literature for most latent classifications (see Hunt et al., 2020; O’Brien & Vincent, 2003; Spinhoven et al., 2014 for immediate examples).”
Inflammation-related microRNAs are involved in stressful life events exposure and in trauma-focused psychotherapy in treatment-resistant depressed patients
Maffioletti, E., Bocchio‐Chiavetto, L., Perusi, G., Silva, R. C., Sacco, C., Bazzanella, R., Zampieri, E., Bortolomasi, M., Gennarelli, M., & Minelli, A. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1987655 · Cited by 37 · see citing works
The Wistar Kyoto Rat: A Model of Depression Traits
Redei, E. E., Udell, M. E., Woods, L. C. S., & Chen, H. (2022) · Current Neuropharmacology · doi:10.2174/1570159x21666221129120902 · Cited by 35 · see citing works
“[163, 164].”
Post-traumatic Stress Disorder, Depression, Anxiety Symptoms and Help Seeking in Psychiatric Staff: Trouble de stress post-traumatique, dépression, symptômes d’anxiété et recherche d’aide chez le personnel psychiatrique
Seto, M. C., Rodrigues, N. C., Ham, E., Kirsh, B. H., & Hilton, N. Z. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720916356 · Cited by 35 · see citing works
“There is substantial evidence that PTSD can be comorbid with other mental health problems, especially mood and anxiety disorders, based on meta-analyses of community and psychiatric samples.(11,12,13) We are unaware of any published research that has examined psychiatric comorbidity among psychiatric workers with PTSD…”
Background
Early Aftermath of February 6 Earthquakes in Turkey: PTSD, PTG, and Resilience
Bilge, Y., Emiral, E., & Demirci, H. (2024) · Journal of Loss and Trauma · doi:10.1080/15325024.2023.2254216 · Cited by 32 · see citing works
“Additionally, considering that depression and anxiety are risk factors for PTSD (Spinhoven et al., 2014), individuals with high anxiety alone, similar to intolerance to uncertainty, may be more likely to develop PTSD.”
Background
Comorbidity in post-traumatic stress disorder: A population-based study from the two largest cities in Brazil
Longo, M. S. C., Vilete, L. M. P., Figueira, I. L. D. V., Quintana, M. I., Mello, M. F., Bressan, R. A., Mari, J. D. J., Ribeiro, W. S., Andreoli, S. B., & Coutinho, E. S. F. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.051 · Cited by 32 · see citing works
The association between post-traumatic stress disorder (PTSD) and cognitive impairment: A systematic review of neuroimaging findings
Junior, D. A. D. A., Sair, H. I., Peters, M. E., Carvalho, A. F., Yedavalli, V. S., Sólnes, L. B., & Luna, L. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.06.016 · Cited by 34 · see citing works
The Role and Clinical Correlates of Complex Post-traumatic Stress Disorder in People With Psychosis
Panayi, P., Berry, K., Sellwood, W., Campodonico, C., Bentall, R. P., & Varese, F. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.791996 · Cited by 30 · see citing works
Anxiety and Compulsive Sexual Behavior Disorder: A Systematic Review
Weinandy, J. T. G., Lee, B. N., Hoagland, K. C., Grubbs, J. B., & Bőthe, B. (2022) · The Journal of Sex Research · doi:10.1080/00224499.2022.2066616 · Cited by 32 · see citing works
Potential causal association between gut microbiome and posttraumatic stress disorder
He, Q., Wang, W., Xu, D., Xiong, Y., Tao, C., You, C., Ma, L., & Ma, J. (2024) · Translational Psychiatry · doi:10.1038/s41398-024-02765-7 · Cited by 30 · see citing works
“This chronic condition severely compromises psychological functioning, often leading to additional comorbidities such as depression and anxiety [3, 4].”
Efficacy of digital mental health interventions for PTSD symptoms: A systematic review of meta-analyses
Tng, G. Y. Q., Koh, J., Soh, X. C., Majeed, N. M., & Hartanto, A. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.04.074 · Cited by 31 · see citing works
Systematic review of machine learning in PTSD studies for automated diagnosis evaluation
Wu, Y., Mao, K., Dennett, L., Zhang, Y., & Chen, J. (2023) · npj Mental Health Research · doi:10.1038/s44184-023-00035-w · Cited by 30 · see citing works
“The impact of comorbidities like MDD and anxiety disorders on classi ﬁ er performance is often not addressed 70 .”
Risk and protective factors affecting the symptom trajectory of posttraumatic stress disorder post-rape
Nöthling, J., Abrahams, N., Jewkes, R., Mhlongo, S., Lombard, C., Hemmings, S. M. J., & Seedat, S. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.032 · Cited by 28 · see citing works
Mental health symptoms and the reintegration difficulty of military couples following deployment: A longitudinal application of the relational turbulence model
Knobloch, L. K., Knobloch-Fedders, L. M., & Yorgason, J. B. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22734 · Cited by 28 · see citing works
Increased Substance Use among Nurses during the COVID-19 Pandemic
Arble, E. P., Manning, D., Arnetz, B. B., & Arnetz, J. E. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20032674 · Cited by 26 · see citing works
“Importantly, the experiences of anxiety, trauma, and secondary trauma share a good deal of conceptual and clinical overlap, with some research suggesting the existence of a shared vulnerability model across the experiences [54].”
Background
Predictors of remission from PTSD symptoms after sexual and non-sexual trauma in the community: A mediated survival-analytic approach
Müller, M., Ajdacic‐Gross, V., Rodgers, S., Kleim, B., Seifritz, E., Vetter, S., Egger, S., Wulf Rössler, A., Castelao, E., Preisig, M., et al. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.11.068 · Cited by 25 · see citing works
“According to other research, childhood sexual abuse in particular was found to increase the risk for depression, which, due to a shared risk factor profile with PTSD, increases the likelihood of comorbid PTSD (Spinhoven et al., 2014).”
PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak
Carmassi, C., Pedrinelli, V., Dell’Oste, V., Bertelloni, C. A., Grossi, C., Gesi, C., Cerveri, G., & Dell’Osso, L. (2021) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017902117010242 · Cited by 25 · see citing works
Coverage of child maltreatment in abnormal psychology textbooks: Reviewing the adequacy of the content.
Wilgus, S. J., Packer, M., Lile-King, R., Miller-Perrin, C., & Brand, B. L. (2016) · Psychological Trauma · doi:10.1037/tra0000049 · Cited by 6 · see citing works
The latent structure of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD in a general population sample from USA: A factor mixture modelling approach
Redican, E., Cloître, M., Hyland, P., McBride, O., Karatzias, T., Murphy, J., & Shevlin, M. E. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102497 · Cited by 27 · see citing works
Neurobiological Alterations in Females With PTSD: A Systematic Review
Eder-Moreau, E., Zhu, X., Fisch, C. T., Bergman, M., Neria, Y., & Helpman, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.862476 · Cited by 24 · see citing works
A translational approach to the genetics of anxiety disorders
McGregor, N. W., Dimatelis, J. J., van Zyl, P. J., Hemmings, S. M. J., Kinnear, C. J., Russell, V. A., Stein, D. J., & Löchner, C. (2017) · Behavioural Brain Research · doi:10.1016/j.bbr.2017.12.030 · Cited by 24 · see citing works
Neural and behavioural correlates of autobiographical memory retrieval in patients with major depressive disorder and a history of trauma exposure
Parlar, M. E., Densmore, M., Hall, G. B., Lanius, R. A., & McKinnon, M. C. (2017) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2017.07.004 · Cited by 22 · see citing works
Neuroinflammation is a susceptibility factor in developing a PTSD-like phenotype
Shanazz, K., Nalloor, R. I., Lucas, R., & Vazdarjanova, A. I. (2023) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2023.1112837 · Cited by 22 · see citing works
Comorbidity Patterns of Psychiatric Conditions in Canadian Armed Forces Personnel
Richardson, J. D., Thompson, A., King, L., Ketcheson, F., Shnaider, P., Armour, C., Cyr, K. S., Sareen, J., Elhai, J. D., & Zamorski, M. A. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743718816057 · Cited by 22 · see citing works
The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression
Garabiles, M. R., Lao, C. K., Wang, S., & Hall, B. J. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1765544 · Cited by 21 · see citing works
Epidemiology of DSM-5 PTSD and ICD-11 PTSD and complex PTSD in the Netherlands
Hoeboer, C. M., Nava, F., Haagen, J. F. G., Broekman, B. F. P., van der Gaag, R. J., & Olff, M. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2024.102963 · Cited by 21 · see citing works
The shared and specific relationships between exposure to potentially traumatic events and transdiagnostic dimensions of psychopathology
Sunderland, M., Carragher, N., Chapman, C., Mills, K. L., Teesson, M., Lockwood, E., Forbes, D., & Slade, T. N. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.02.001 · Cited by 21 · see citing works
Trajectory of post-traumatic stress and depression among children and adolescents following single-incident trauma
Zhang, J., Meiser‐Stedman, R., Jones, B. L., Smith, P. A., Dalgleish, T., Boyle, A. A., Edwards, A., Subramanyam, D., Dixon, C., Sinclaire-Harding, L., et al. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2037906 · Cited by 20 · see citing works
Relation between patterns of intrinsic network connectivity, cognitive functioning, and symptom presentation in trauma‐exposed patients with major depressive disorder
Parlar, M. E., Densmore, M., Hall, G. B., Frewen, P., Lanius, R. A., & McKinnon, M. C. (2017) · Brain and Behavior · doi:10.1002/brb3.664 · Cited by 20 · see citing works
PTSD and Burnout are Related to Lifetime Mood Spectrum in Emergency Healthcare Operator
Carmassi, C., Bertelloni, C. A., Avella, M. T., Cremone, I. M., Massimetti, E., Corsi, M., & Dell’Osso, L. (2020) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017902016010165 · Cited by 19 · see citing works
“The relationship between post-traumatic stress reactions and depression is considered complex, with overlapping symptomatology, mutual influence, and very high comorbidity rates [16, 19, 24, 52].”
Background
A pilot study adapting and validating the Harvard Trauma Questionnaire (HTQ) and PTSD checklist-5 (PCL-5) with Indian women from slums reporting gender-based violence
Patel, A., Newman, E., & Richardson, J. (2022) · BMC Women s Health · doi:10.1186/s12905-022-01595-3 · Cited by 19 · see citing works
“, idioms of distress and the embedded PCL-5 by examining their relationships with known correlates such as depression, anxiety, and somatic problems [25, 35, 59, 60].”
Background
Buprenorphine: prospective novel therapy for depression and PTSD
Madison, C. A., & Eitan, S. (2020) · Psychological Medicine · doi:10.1017/s0033291720000525 · Cited by 19 · see citing works
Combat‐Related Posttraumatic Stress Disorder and Comorbid Major Depression in U.S. Veterans: The Role of Deployment Cycle Adversity and Social Support
Goetter, E. M., Hoeppner, S. S., Khan, A. J., Charney, M. E., Wieman, S. T., Venners, M. R., Avallone, K. M., Rauch, S. A. M., & Simon, N. M. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22496 · Cited by 17 · see citing works
Enhancing Prolonged Exposure therapy for PTSD using physiological biomarker-driven technology
Back, S. E., Acierno, R. E., Saraiya, T. C., Harley, B., Wangelin, B. C., Jarnecke, A. M., McTeague, L. M., Brown, D. G., Ana, E. J. S., Rothbaum, A. O., et al. (2022) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2022.100940 · Cited by 18 · see citing works
PTSD symptom profiles among Louisiana women affected by the 2010 Deepwater Horizon Oil Spill: A latent profile analysis
Nugent, N. R., Gaston, S. A., Perry, J. F., Rung, A. L., Trapido, E. J., & Peters, E. S. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.03.018 · Cited by 18 · see citing works
Internalizing Symptoms Among Youth in Foster Care: Prevalence and Associations with Exposure to Maltreatment
Moussavi, Y., Wergeland, G. J., Bøe, T., Haugland, B. S. M., Larsen, M., & Lehmann, S. (2021) · Child Psychiatry & Human Development · doi:10.1007/s10578-020-01118-x · Cited by 17 · see citing works
#4645Boricuas: Twitter reactions to the estimates of deaths by Hurricane María in Puerto Rico
García‐Ramírez, G., Bogen, K. W., Rodríguez‐Guzmán, V. M., Nugent, N. R., & Orchowski, L. M. (2020) · Journal of Community Psychology · doi:10.1002/jcop.22295 · Cited by 17 · see citing works
Vesicular monoamine transporter 2 mediates fear behavior in mice
Branco, R. C., Burkett, J. P., Black, C. A., Winokur, E. J., Ellsworth, W., Dhamsania, R. K., Lohr, K. M., Schroeder, J. P., Weinshenker, D., Jovanović, T., et al. (2020) · Genes Brain & Behavior · doi:10.1111/gbb.12634 · Cited by 16 · see citing works
Long-term PTSD prevalence and associated adverse psychological, functional, and economic outcomes: a 12–15 year follow-up of adults with suspected serious injury
Karchoud, J. F., Haagsma, J. A., Karaban, I., Hoeboer, C. M., van de Schoot, R., Olff, M., & van Zuiden, M. (2024) · European Journal of Psychotraumatology · doi:10.1080/20008066.2024.2401285 · Cited by 18 · see citing works
“There are studies reporting gender differences in psychological comorbidity in people with PTSD (i.e. Brady et al., 2000; Kessler et al., 2013 higher in men; i.e. Spinhoven et al., 2014 higher in women), however, it remains uninvestigated whether this applies to the long-term as well.”
Background
Pass it on? The neural responses to rejection in the context of a family study on maltreatment
van den Berg, L. J. M., Tollenaar, M. S., Pittner, K., Block, L. C.-D., Buisman, R. S. M., van IJzendoorn, M. H., & Elzinga, B. M. (2018) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsy035 · Cited by 16 · see citing works
“Child physical and emotional abuse and neglect are associated with increased risk for long-lasting behavioral, physical and mental health problems (e.g. Heim et al., 2010; Spinhoven et al., 2010; Twardosz and Lutzker, 2010; McCrory et al., 2011a; Norman et al., 2012; Spinhoven et al., 2014).”
Background
Increased persistence of avoidance behaviour and social deficits with L.rhamnosus JB-1 or selective serotonin reuptake inhibitor treatment following social defeat
Liu, Y., Steinhausen, K., Bharwani, A., Mian, M. F., Neufeld, K. M., & Forsythe, P. (2020) · Scientific Reports · doi:10.1038/s41598-020-69968-y · Cited by 16 · see citing works
A framework for estimating the United States depression burden attributable to indoor fine particulate matter exposure
Taylor, W. L., Schuldt, S., Delorit, J. D., Chini, C. M., Postolache, T. T., Lowry, C. A., Brenner, L. A., & Hoisington, A. J. (2020) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2020.143858 · Cited by 16 · see citing works
“5 composition and toxicity (Stanek et al., 2011), and that magnitude of exposure is the sole predictor for health effects.”
Background
A randomized controlled trial of supervised remotely-delivered attention bias modification for posttraumatic stress disorder
Alon, Y., Azriel, O., Pine, D. S., & Bar-Haim, Y. (2022) · Psychological Medicine · doi:10.1017/s003329172200023x · Cited by 16 · see citing works
“PTSD is highly comorbid with major depression (Hankin, Spiro, Miller, & Kazis, 1999; Norris, Murphy, Baker, & Perilla, 2004; Spinhoven, Penninx, van Hemert, de Rooij, & Elzinga, 2014).”
The Impact of Psychedelic Drugs on Anxiety and Depression in Advanced Cancer or other Life-threatening Disease
Sicignano, D. J., Caroti, K. S., Hernández, A. V., & White, C. M. (2023) · American Journal of Clinical Oncology · doi:10.1097/coc.0000000000000998 · Cited by 15 · see citing works
Self-Disgust Is Associated With Loneliness, Mental Health Difficulties, and Eye-Gaze Avoidance in War Veterans With PTSD
Ypsilanti, A., Gettings, R., Lazuras, L., Robson, A., Powell, P. A., & Overton, P. G. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.559883 · Cited by 15 · see citing works
“, 1998), anxiety (Spinhoven et al., 2014), suicidality (Kramer et al.”
Psychological challenges and related factors of ordinary residents after “7.20” heavy rainstorm disaster in Zhengzhou: a cross-sectional survey and study
Wang, Z., Jiang, B., Wang, X., Wang, D., & Xue, H. (2023) · BMC Psychology · doi:10.1186/s40359-023-01038-0 · Cited by 14 · see citing works
“This finding was consistent with many previous studies [10, 44, 45], which found that females were more susceptible to certain psychiatric disorders after traumatic events, even during non-disastrous events, the proportion of females with various psychological problems was also larger than that of males [46].”
Result
Childhood maltreatment and internalizing/externalizing disorders in trauma-exposed adolescents: Does posttraumatic stress disorder (PTSD) severity have a mediating role?
van den Heuvel, L. L., Assim, A., Koning, M., Nöthling, J., & Seedat, S. (2023) · Development and Psychopathology · doi:10.1017/s0954579423001414 · Cited by 17 · see citing works
“Multiple studies have demonstrated that PTSD is often comorbid with other internalizing disorders, such as depression and anxiety disorders (Brady et al., 2000; Kilpatrick et al., 2003; Spinhoven et al., 2014).”
Is a Criterion A trauma necessary to elicit posttraumatic stress symptoms?
Howard, J., Lorenzo‐Luaces, L., Lind, C. M., Lakhan, P., & Rutter, L. A. (2023) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2023.12.008 · Cited by 14 · see citing works
Genetic Model to Study the Co-Morbid Phenotypes of Increased Alcohol Intake and Prior Stress-Induced Enhanced Fear Memory
Lim, P. H., Shi, G., Wang, T., Jenz, S. T., Mulligan, M. K., Redei, E. E., & Chen, H. (2018) · Frontiers in Genetics · doi:10.3389/fgene.2018.00566 · Cited by 14 · see citing works
Comorbid posttraumatic stress disorder and major depressive disorder are associated with asthma morbidity among World Trade Center workers
Wisnivesky, J. P., Markowitz, S. B., James, S., Stone, K., Dickens, B., Busse, P. J., Crowley, L. E., Federman, A. D., Katz, C. L., & Gonzalez, A. (2020) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2020.10.007 · Cited by 14 · see citing works
Depression in a youth population-based sample from Brazil: Prevalence and symptom structure
Manfro, P. H., da Silva, C. T. B., Anselmi, L., Barros, F. C., Eaton, W. W., Gonçalves, H., Murray, J., Oliveira, I. O., Tovo‐Rodrigues, L., Wehrmeister, F. C., et al. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.073 · Cited by 14 · see citing works

Relationship of posttraumatic stress symptoms with depression, anxiety, childhood trauma and personality characteristics
Aldemir, S., Dalbudak, E., & Topcu, M. (2021) · Psychiatry and Clinical Psychopharmacology
Childhood trauma and comorbid mood and anxiety disorders in adult patients with post-traumatic stress disorder
Morgan, J. E., Calderon, S., Lebow, M., Iosifescu, D. V., Charney, D. S., & Feder, A. (2012) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v3i0.19567
PTSD, social anxiety disorder, and trauma: An examination of the influence of trauma type on comorbidity using a nationally representative sample
McMillan, K. A., & Asmundson, G. J. G. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.10.036 · Cited by 31 · see citing works
Comorbid anxiety disorders in civilians seeking treatment for posttraumatic stress disorder
Zayfert, C., Becker, C. B., Unger, D. L., & Shearer, D. K. (2002) · Journal of Traumatic Stress · doi:10.1023/a:1014379127240 · Cited by 59 · see citing works
Chapter 3Post-Traumatic Stress Disorder and Other Psychiatric Conditions
Coughlin, S. S. (2013) · American Public Health Association eBooks · doi:10.2105/9780875530161ch03

Authors: Spinhoven, P., Penninx, B. W., van Hemert, A. M., de Rooij, M., & Elzinga, B. M.
Affiliations: Leiden University (NL)
University Medical Center Groningen (NL)
Corresponding author: Spinhoven, Philip
ORCID: Spinhoven, Philip
Penninx, Brenda W.
Elzinga, Bernet M.
Venue: Child Abuse & Neglect
Publisher: Elsevier BV
Published: 2014-08
Volume: 38
Issue: 8
Pages: 1320-1330
ISSN: 0145-2134 (ISSN-L)
DOI: 10.1016/j.chiabu.2014.01.017
OpenAlex: W2137565796
Cited by: 305
References: 57
Citations by year: 2026: 21 · 2025: 51 · 2024: 28 · 2023: 38 · 2022: 28 · 2021: 27 · 2020: 30 · 2019: 15 · 2018: 16 · 2017: 22 · 2016: 15 · 2015: 11 · 2014: 2 · 2013: 1
FWCI: 19.67
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Child Abuse & Neglect (publishedVersion)
PubMed (publishedVersion)
Pure Amsterdam UMC (publishedVersion)
Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
Data Archiving and Networked Services (DANS) (submittedVersion)
Leiden Repository (Leiden University) (submittedVersion)
VU Research Portal (submittedVersion)
University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
Keywords: post-traumatic stress disorder, PTSD comorbidity, anxiety disorders, depressive disorders, major depressive disorder, childhood trauma, child sexual abuse, child physical abuse, shared risk factors, neuroticism, extraversion, symptom severity, gender differences, prevalence
MeSH terms: Adolescent, Adult, Aged, Child Abuse, Depressive Disorder, Female, Humans, Male, Middle Aged, Netherlands, Psychiatric Status Rating Scales, Risk Factors, Stress Disorders, Post-Traumatic, Cohort Studies, Comorbidity, Prevalence, Logistic Models, Diagnostic and Statistical Manual of Mental Disorders, Young Adult

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Comorbidity of PTSD in anxiety and depressive disorders: Prevalence and shared risk factors

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