Cited by 536Posttraumatic Stress Disorder ResearchChild Abuse and TraumaMigration, Health and Trauma

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A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations: Intentional and Non-Intentional Traumatic Events

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Santiago, Patcho N., Ursano, Robert J., Gray, Christine L., Pynoos, Robert S., Spiegel, David, Lewis-Fernandez, Roberto, Friedman, Matthew J., Fullerton, Carol S.·2013·PLoS ONE

DOI 10.1371/journal.pone.0059236PMC PMC3623968

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Abstract

OBJECTIVE: We conducted a systematic review of the literature to explore the longitudinal course of PTSD in DSM-5-defined trauma exposed populations to identify the course of illness and recovery for individuals and populations experiencing PTSD. METHODS: We reviewed the published literature from January 1, 1998 to December 31, 2010 for longitudinal studies of directly exposed trauma populations in order to: (1) review rates of PTSD in the first year after a traumatic event; (2) examine potential types of proposed DSM-5 direct trauma exposure (intentional and non-intentional); and (3) identify the clinical course of PTSD (early onset, later onset, chronicity, remission, and resilience). Of the 2537 identified articles, 58 articles representing 35 unique subject populations met the proposed DSM-5 criteria for experiencing a traumatic event, and assessed PTSD at two or more time points within 12 months of the traumatic event. RESULTS: The mean prevalence of PTSD across all studies decreases from 28.8% (range =3.1-87.5%) at 1 month to 17.0% (range =0.6-43.8%) at 12 months. However, when traumatic events are classified into intentional and non-intentional, the median prevalences trend down for the non-intentional trauma exposed populations, while the median prevalences in the intentional trauma category steadily increase from 11.8% to 23.3%. Across five studies with sufficient data, 37.1% of those exposed to intentional trauma develop PTSD. Among those with PTSD, about one third (34.8%) remit after 3 months. Nearly 40% of those with PTSD (39.1%) have a chronic course, and only a very small fraction (3.5%) of new PTSD cases appears after three months. CONCLUSIONS: Understanding the trajectories of PTSD over time, and how it may vary by type of traumatic event (intentional vs. non-intentional) will assist public health planning and treatment.

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Reduced heart rate variability and expressive suppression interact to prospectively predict COVID-19 pandemic-related post-traumatic stress symptoms
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COVID‐19‐related posttraumatic stress disorder in adults with lived experience of psychiatric disorder
Lewis, C., Lewis, K. S., Roberts, A., Evison, C., Edwards, B. M., John, A. M., Lloyd, K. R., Pearce, H. A., Poole, R., Richards, N. A., et al. (2022) · Depression and Anxiety · doi:10.1002/da.23262 · Cited by 11
Detection of Microstructural Medial Prefrontal Cortex Changes Using Magnetic Resonance Imaging Texture Analysis in a Post-Traumatic Stress Disorder Rat Model
Zheng, S., Wang, H., Han, F., Chu, J., Zhang, F., Zhang, X., Shi, Y., & Zhang, L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.805851 · Cited by 8
“10%, X2 = S(1,0)InvDfMom, X3 = S(0,1)DifEntrp, X4 = S(1,−1)Entropy, X5 = S(2,0)InvDfMom, X6 = S(2,0)SumAverg, X7 = S(3,0)AngScMom, X8 = S(3,3)Correlat, X9 = S(3,3)DifVarnc, X10 = S(4,0)Contrast, X11 = S(4,0)InvDfMom, X12 = S(4,0)DifVarnc, X13 = S(0,4)DifEntrp, X14 = S(4,4)AngScMom, X15 = S(4,-4)SumEntrp, X16 = S(5,0)C…”
Background
The nosographic structure of posttraumatic stress symptoms across trauma types: An exploratory network analysis approach
Ferreira, F., Gysi, D. M., Castro, D., & Ferreira, T. B. (2022) · Journal of Traumatic Stress · doi:10.1002/jts.22818 · Cited by 7
Cost-effectiveness of ‘screen-and-treat’ interventions for post-traumatic stress disorder following major incidents
Hogan, N., Knapp, M. R. J., McDaid, D., Davies, M., & Brewin, C. R. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-049472 · Cited by 10
“None.”
Method
Exploring the potential moderating role of self-compassion on the relationships between event centrality and post-assault psychological outcomes.
Hamrick, L. A., & Owens, G. P. (2020) · Journal of Clinical Psychology · doi:10.1002/jclp.23018 · Cited by 7
“…of symptoms, others may experience chronic distress in the form of psychopathology, or, less commonly, delayed distress, wherein there is minimal stress reaction at the time of the event but symptoms arise months or even years later (see Bryant, 2017 for review; also see Santiago et al., 2013).”
Background
Effects of exposure to workplace terrorism on subsequent doctor certified sickness absence, and the modifying role of psychological and social work factors: a combined survey and register study
Berthelsen, M., Hansen, M. B., Nissen, A., Nielsen, M. B., Knardahl, S., & Heir, T. (2020) · BMC Public Health · doi:10.1186/s12889-020-08465-3 · Cited by 15
Treating War-Related Moral Injury and Loss with Adaptive Disclosure: A Case Study
Laifer, A. L., Amidon, A. D., Lang, A. J., & Litz, B. T. (2015) · Springer eBooks · doi:10.1007/978-3-319-22985-0_23 · Cited by 7
Effectiveness in routine care: trauma-focused treatment for PTSD
Krüger-Gottschalk, A., Kuck, S., Dyer, A., Alpers, G. W., Pittig, A., Nexhmedin Morina, B., & Ehring, T. W. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2452680 · Cited by 6
“…(Kessler et al., 2005; Koenen et al., 2017) associated with high comorbidity (particularly with depression, substance use and anxiety disorders; Galatzer-Levy et al., 2013), low quality of life (Pagotto et al., 2015) and a high risk of chronicity (Santiago et al., 2013; Zlotnick et al., 2004).”
‘That still haunts me a little bit’: Decision-makers and information providers' experiences of recurring flood events
Johnson, D. E., Harrison, S. J., Cattoën, C., Luttrell, J., & Blackett, P. (2025) · International Journal of Disaster Risk Reduction · doi:10.1016/j.ijdrr.2025.105216 · Cited by 6
Assessing the efficacy of the problem management plus (PM+) in improving the mental health of conflict-exposed individuals
Luzano, J. G. C., & Mordeno, I. G. (2023) · Current Psychology · doi:10.1007/s12144-023-05326-1 · Cited by 7
Cerebral cortical thinning in brain regions involved in emotional regulation relates to persistent symptoms in subjects with posttraumatic stress disorder
Lee, H., Oh, S., Ha, E., Joo, Y., Suh, C., Kim, Y., Jeong, H. S., Lyoo, I. K., Yoon, S. J., & Hong, H. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115345 · Cited by 7
Dimensional structure of one-year post-COVID-19 neuropsychiatric and somatic sequelae and association with role impairment
Leung, O., Chiu, N. K. H., Wong, S. Y., Cuijpers, P., Alonso, J., Chan, P. K., Lui, G., Wong, E. L. Y., Bruffaerts, R., Yip, B., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-39209-z · Cited by 6
Daily reciprocal relations between emotion dysregulation and non‐suicidal self‐injury among individuals with a history of sexual assault: The influence of posttraumatic stress symptoms
Raudales, A. M., Yang, M., Schatten, H. T., Armey, M. F., & Weiss, N. H. (2022) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12927 · Cited by 9
A longitudinal study of post-traumatic stress, depressive, and anxiety symptoms trajectories in subjects with bipolar disorder during the COVID-19 pandemic
Carmassi, C., Cordone, A., Bertelloni, C., Cappelli, A., Pedrinelli, V., Sampogna, G., Massimetti, G., Dell'Oste, V., & Dell'Osso, L. (2022) · European psychiatry · doi:10.1192/j.eurpsy.2021.2247 · Cited by 6
“The interplay among enhanced trauma sensitivity, the persisting trauma exposure, and the intrinsic heterogeneity of longitudinal psychopathological trajectories after a traumatic event [41,42], makes the scenario highly complex.”
Background
Coping with the Impact of Systemic Racism, Inequity, School and Community Violence Among High School Students Who are Suspended or Expelled
Sanders, J. E. (2022) · Journal of Interpersonal Violence · doi:10.1177/08862605211056724 · Cited by 12
Associations Between Traumatic Stress, Brain Volumes and Post-traumatic Stress Disorder Symptoms in Children: Data from the ABCD Study
Bustamante, D., Amstadter, A. B., Pritikin, J. N., Brick, T. R., & Neale, M. C. (2021) · Behavior Genetics · doi:10.1007/s10519-021-10092-6 · Cited by 6
“However, meeting PTSD diagnosis after experiencing TEs is less common (Breslau 2009; Perkonigg et al. 2000; Santiago et al. 2013), and the risk varies depending on the type of trauma.”
Prior Psychiatric Disorder and Post-Traumatic Stress, Depressive and Anxiety Disorder after Traumatic Brain Injury with Glasgow Coma Scale Score 13–15: A TRACK-TBI Study
Eagle, S. R., Nelson, L. D., Giacino, J. T., McCrea, M., Barber, J. K., Temkin, N. R., Yue, J. K., Okonkwo, D. O., Manley, G. T., Stein, M. B., et al. (2025) · Neurotrauma Reports · doi:10.1177/2689288x251383348 · Cited by 1
“18,19 Context of injury should be considered more frequently as a predictor of post-TBI psychiatric issues and in future studies.”
Psychophysiological reactions during the trauma-film paradigm and their predictive value for intrusions
Beutler, S., & Croy, I. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2281753 · Cited by 4
“Events evoking such distress are more likely to be distinguished by certain event characteristics, such as sexual violence, or by recurrence (Kessler et al., 2017; Kilpatrick et al., 2013; Maercker et al., 2018; Santiago et al., 2013).”
Background
Trajectories of distress and recovery, secondary stressors and social cure processes in people who used the resilience hub after the Manchester Arena bombing
Stancombe, J., Williams, R., Drury, J., Hussey, L. J., Gittins, M., Barrett, A., French, P., & Chitsabesan, P. (2023) · BJPsych Open · doi:10.1192/bjo.2023.527 · Cited by 10
Sensory modulation and trauma-related symptoms during rocket attacks
Charny, S., Cao, G., Gafter, L., Bar‐Shalita, T., & Lahav, Y. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2213110 · Cited by 6
“Moreover, although most individuals are resilient and spontaneously recover after the trauma ends (Bonanno, 2004; Galea et al., 2003; Santiago et al., 2013), peritraumatic distress appears to be the most powerful predictor of subsequent post-traumatic stress disorder (PTSD; Ozer et al., 2003;…”
Background
The effect of the COVID-19 pandemic on health-care workers
Billings, J. (2022) · Lancet psychiatry · doi:10.1016/s2215-0366(22)00410-2 · Cited by 5
One Year Later: Family Members of Patients with COVID-19 Experience Persistent Symptoms of Posttraumatic Stress Disorder
Ambler, M., Rhoads, S., Peterson, R., Jin, Y., Armstrong, P., Collier, P., Cruse, M., Csikesz, N., Hua, M., Engelberg, R., et al. (2022) · Annals of the American Thoracic Society · doi:10.1513/annalsats.202209-793oc · Cited by 5
Eye movement desensitisation and reprocessing: part 1 – theory, procedure and use in PTSD
Udo, I. I., Javinsky, T.-R., & Awani, T. (2022) · BJPsych Advances · doi:10.1192/bja.2022.32 · Cited by 8
“A later study (Kessler 1995) put the prevalence at 7.8% for the general American population, whereas a more recent systematic review (Santiago 2013) found an estimated prevalence of 28.8% (range 3.1 – 87.5”
Influential
Prevalence and predictors of post-traumatic stress symptoms in 2200 hospitalised and non-hospitalised injured New Zealanders
Ameratunga, S. N., Samaranayaka, A., Wyeth, E., Davie, G. S., Lilley, R., Wilson, S. J., Kokaua, J., & Derrett, S. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211060747 · Cited by 5
“Other predictors of PTSD identified in previous research focusing on hospitalised patients such as poor expectations of recovery, tobacco use, heavy drinking and assault (Brewin et al., 2000; Davydow et al., 2009; DiGangi et al., 2013; Gradus, 2017; Ozer et al., 2003; Russo et al., 2013; Santiago et al., 2013) were si…”
Background
The effect of concreteness training on peri-traumatic processing and intrusive memories following an analogue trauma
Guzey, M., Funk, J., Kustermann, J., & Ehring, T. W. (2021) · Behaviour Research and Therapy · doi:10.1016/j.brat.2021.103970 · Cited by 7
Longitudinal transitions in patterns of PTSD symptoms and psychological distress among South Korean adults with traumatic experiences.
Jung, H., Lee, D.-H., & Lee, D. (2021) · Stress and Health · doi:10.1002/smi.3046 · Cited by 5
Emotional recovery after ocular trauma: is there more than meets the eye?
Lester, E. G., Armstrong, G. W., & Vranceanu, A.-M. (2021) · Eye · doi:10.1038/s41433-020-01389-7 · Cited by 5
The clinical course of trauma-related disorders and personality disorders: study protocol of two-year follow-up based on structured interviews
Swart, S., Wildschut, M., Draijer, N., Langeland, W., & Smit, J. (2017) · BMC Psychiatry · doi:10.1186/s12888-017-1339-6 · Cited by 5
“studies between 1998 and 2010 have followed participants for more than a year [5].”
Background
The Fragrant Power of Collective Fear
Harb, R., & Taulor, J. R. (2015) · PLoS ONE · doi:10.1371/journal.pone.0123908 · Cited by 5
“This knowledge is clinically relevant and can shed light on variability of PTSD prevalence, severity, or resilience in trauma victims [9,10].”
Background
Acute stress disorder and post traumatic stress disorder in individuals suffering from burn injury
Sharp, S., & Meyer, W. J. (2012) · Springer eBooks · doi:10.1007/978-3-7091-0315-9_1 · Cited by 4
The psychometric properties of the International Trauma Questionnaire – Child and Adolescent version in Turkish culture
Çimen, F., & Seçer, İ. (2025) · European Journal of Psychotraumatology · doi:10.1080/20008066.2025.2590402 · Cited by 4
Post-traumatic stress disorder, depression, anxiety, and their predictors among internally displaced persons in a conflict-affected area of Metekel Zone, Northwest Ethiopia: structural equation modeling
Bekeko, S. D., Mekonnen, F. A., & Teklu, R. E. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1544289 · Cited by 5
Psychological resilience and post-traumatic stress disorder: a systematic review and meta-analysis of the effects of intentional and unintentional trauma before the COVID-19 pandemic
Camargo, A., Casiraghi, L., Vargas, R., & Trujillo, M. (2025) · Middle East Current Psychiatry · doi:10.1186/s43045-025-00528-8 · Cited by 4
“The overall public health burden of PTSD is greater in individuals exposed to intentional traumatic events, and the prevalence of PTSD decreases more rapidly after unintentional traumatic events [8].”
Influential
Integrating peer support across the continuum of trauma care: Trauma survivor, caregiver and healthcare provider perspectives and recommendations.
Wasilewski, M., Reis, L., Vijayakumar, A., Leighton, J., Hitzig, S., Simpson, R., Mayo, A., Leslie, G. C., Vogt, K., McFarlan, A., et al. (2025) · Injury · doi:10.1016/j.injury.2025.112258 · Cited by 4
Peer support experiences and needs across the continuum of trauma care: A qualitative study of traumatic injury survivor, caregiver, and provider perspectives.
Wasilewski, M., Reis, L., Vijayakumar, A., Leighton, J., Hitzig, S., Simpson, R., Mayo, A., Leslie, G. C., Vogt, K., McFarlan, A., et al. (2025) · Injury · doi:10.1016/j.injury.2025.112259 · Cited by 4
A 12-Year Longitudinal Case Report: Integrating Schema Therapy and Prolonged Exposure in Delayed-Onset PTSD Following the Great East Japan Earthquake
Hori, A., Ando, E., Ozaki, A., Murakami, M., Tsubokura, M., & Oshima, F. (2025) · Case Reports in Psychiatry · doi:10.1155/crps/9195824 · Cited by 4
“Building on this, Santiago et al. [2] systematically reviewed PTSD prevalence and trajectories across various trauma-exposed populations, the results of which highlighted the heterogeneity of PTSD courses even within speci ﬁ c trauma types.”
Effectiveness, efficacy, acceptability, and feasibility of trauma‐informed depression, anxiety, and substance use prevention programs for young people aged 12–25 years: A mixed‐methods systematic review
Bailey, S., Newton, N. C., Perry, Y., Grummitt, L. R., Tiko, R., Baams, L., & Barrett, E. L. (2024) · Journal of Adolescence · doi:10.1002/jad.12407 · Cited by 5
Factors associated with mental health outcomes in a Muslim community following the Christchurch terrorist attack
Bell, C., Sulaiman-Hill, R., Tanveer, S., Porter, R., Dean, S., Schluter, P., Beaglehole, B., & Boden, J. (2024) · BJPsych Open · doi:10.1192/bjo.2024.774 · Cited by 4
The role of cortisol in development and treatment of PTSD among service members: A narrative review.
Buccellato, K., & Peterson, A. L. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.107152 · Cited by 4
Screening and Treatment of Posttraumatic Stress Disorder in Wildfire Evacuees: A Cost-Utility Analysis
Lebenbaum, M., & Hassan, S. (2024) · MDM Policy & Practice · doi:10.1177/23814683241260423 · Cited by 4
“Given that the main parameters (i.e., prevalence of PTSD, treatment effects) were derived from sytematic reviews and meta-analyses, 8,14 utilities were derived from the general population of individuals with PTSD, 25 and the screening and treatment program was the same as that implemented in…”
Method
The Factors Affecting Longitudinal Course of Posttraumatic Stress Disorder Symptoms in Sexual Assault Victims
Lee, J. H., Shin, J., Chae, S., Chun, J., Choi, J.-W., Lee, J., Park, T. W., Kim, K. M., Kim, K., & Kim, J.-W. (2023) · Psychiatry Investigation · doi:10.30773/pi.2023.0077 · Cited by 4
“13 Self-blame and depression were identified as predictors in another study of factors predicting the level of symptoms after 6 months in patients with sexual trauma-related PTSD. 22 With regard to anxiety related to PTSD, it was reported that secondary anxiety disorder after trauma could affect PTSD remission.”
BackgroundInfluential
Post-traumatic stress disorder symptoms and quality of life among older patients with cancer during the COVID-19 pandemic
Cherifi, F., Gernier, F., Jardin, F., Lefèvre‐Arbogast, S., Bastien, E., Lequesne, J., Rigal, O., Quilan, F., Clarisse, B., Grellard, J., et al. (2023) · Journal of Geriatric Oncology · doi:10.1016/j.jgo.2023.101634 · Cited by 5
Early intervention in post‐traumatic stress disorder without exposure to trauma memories using internet‐delivered cognitive therapy: A pilot case series
Thew, G. R., Wild, J., & Ehlers, A. (2023) · British Journal of Clinical Psychology · doi:10.1111/bjc.12419 · Cited by 4
“Onset of such symptoms usually occurs soon after the trauma; A systematic review of studies of trauma-exposed individuals found that on average, 25.4% of people met PTSD criteria at 1 month following the trauma (Santiago et al., 2013).”
BackgroundInfluential
Factors influencing participation in psychosocial programming among orthopaedic trauma patients with PTSD.
Furdock, R., Feldman, B., Sinkler, M., Connelly, M., Hoffa, M., Simpson, M., Hendrickson, S., & Vallier, H. (2022) · Injury · doi:10.1016/j.injury.2022.09.045 · Cited by 4
The impact of anger and self‐concealment on post‐traumatic stress and psychiatric comorbid symptoms in Chinese prisoners: A longitudinal study
Chung, M. C., Chen, Z. S., & Han, B. X. (2022) · Criminal Behaviour and Mental Health · doi:10.1002/cbm.2257 · Cited by 4

Authors: Santiago, P. N., Ursano, R. J., Gray, C. L., Pynoos, R. S., Spiegel, D., Lewis-Fernandez, R., Friedman, M. J., & Fullerton, C. S.
Affiliations: Uniformed Services University of the Health Sciences (US)
University of California, Los Angeles (US)
Stanford Medicine (US)
United States Department of Veterans Affairs (US)
Corresponding author: Santiago, Patcho N.
ORCID: Santiago, Patcho N.
Ursano, Robert J.
Gray, Christine L.
Pynoos, Robert S.
Spiegel, David
Friedman, Matthew J.
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2013-04-11
Volume: 8
Issue: 4
Pages: e59236
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0059236
PMC: PMC3623968
OpenAlex: W2035901807
Cited by: 536
References: 35
Citations by year: 2026: 34 · 2025: 50 · 2024: 50 · 2023: 41 · 2022: 50 · 2021: 51 · 2020: 53 · 2019: 44 · 2018: 35 · 2017: 43 · 2016: 35 · 2015: 27 · 2014: 15 · 2013: 6
FWCI: 4.08
Type: journal article
Language: en
Open access: gold
doi.org
Licence: public-domain
creativecommons.org/publicdomain/zero/1.0/ (unspecified)
Locations: PLoS ONE (publishedVersion, public-domain)
Europe PMC (PubMed Central) (publishedVersion, other-oa)
PubMed Central (publishedVersion, public-domain)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
eScholarship (California Digital Library) (submittedVersion)
eScholarship (California Digital Library) (submittedVersion, public-domain)
Columbia Academic Commons (Columbia University)
Topics: Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
Keywords: post-traumatic stress disorder, PTSD prevalence, PTSD trajectories, chronic PTSD, PTSD remission, resilience
MeSH terms: Epilepsy, Post-Traumatic, Humans, Longitudinal Studies, Time Factors, Wounds and Injuries, Prevalence, Diagnostic and Statistical Manual of Mental Disorders, PubMed

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A Systematic Review of PTSD Prevalence and Trajectories in DSM-5 Defined Trauma Exposed Populations: Intentional and Non-Intentional Traumatic Events

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