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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“These prevalences are similar to previously published rates across different types of traumatic events [14,15,21,22].”
Result
60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981–2001
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Self-citation
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“Psychiatric epidemiology studies consistently report a lifetime prevalence of PTSD of approximately 8% [15,16,17], however, post-disaster rates of PTSD vary widely [27,28,29], and are similar to those found here.”
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“[10,11], again finding substantial variability across different populations, traumatic events and community contexts.”
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“Studies using DSM-IV criteria have followed subjects to examine the epidemiology of PTSD after disasters [3,4,5,6], other traumatic events [7,8,9], and military deployment”
Method
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“Studies using DSM-IV criteria have followed subjects to examine the epidemiology of PTSD after disasters [3,4,5,6], other traumatic events [7,8,9], and military deployment”
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M Matthieu, 2006, Treatment of human-caused trauma: attrition in the adult outcomes research, J Interpers Violence, 21, 1654, 10.1177/0886260506294243 · DOI

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Ardino, V. (2017) · MALTRATTAMENTO E ABUSO ALL INFANZIA · doi:10.3280/mal2017-002003 · Cited by 3
Motivational Interviewing for Victims of Armed Community Violence: A Nonexperimental Pilot Feasibility Study
Nanney, J. T., Conrad, E. J., Reuther, E., Wamser-Nanney, R., McCloskey, M., & Constans, J. I. (2017) · Psychology of Violence · doi:10.1037/vio0000103 · Cited by 2
“PTSD was not included as an outcome in this uncontrolled study given the expected natural remission in PTS symptoms in the immediate months following trauma (Santiago et al., 2013).”
Sick Leave and Disability Across Three Decades After a Major Disaster
Holgersen, K. H., Klöckner, C. A., Bøe, H. J., & Holen, A. (2016) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000500 · Cited by 4
“Studies that have looked into the effects of traumatization a few years after an adverse stressor tend to find that most survivors return to their previous health status (Bonanno et al., 2010; Santiago et al., 2013).”
Background
Akute und posttraumatische Belastungsstörung
Kapfhammer, H. (2017) · Springer eBooks · doi:10.1007/978-3-662-49295-6_71 · Cited by 11
Dreaming and Sleep Disorder
Pagel, J. F., & Pandi-Perumal, S. R. (2017) · Springer eBooks · doi:10.1007/978-1-4939-6578-6_14 · Cited by 1
Posttraumatic Stress Disorder Screening in the US Military and VA Populations
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Parent and Child PTSD and Parent Depression in Relation to Parenting Stress Among Trauma-Exposed Children
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“Children and adults exposed to traumatic events are at-risk for developing posttraumatic stress disorder (PTSD; McLaughlin et al. 2013; Santiago et al. 2013), an impairing disorder characterized by intrusive symptoms, persistent avoidance of reminders, negative changes in cognition and mood, arousal symptoms, and dist…”
Background
Do traumatic events have more impact on the development of dental anxiety than negative, non‐traumatic events?
de Jongh, A., van Eeden, A., van Houtem, C. V., & van Wijk, A. (2017) · European Journal of Oral Sciences · doi:10.1111/eos.12348 · Cited by 1
Post-traumatic stress disorder in Australia: Results from the 2020–2022 National Study of Mental Health and Wellbeing
Kroeger, C. M., Jones, S. C., Rowe, A., Grummitt, L. R., O’Dean, S., Rowlinson, K., Barrett, E. L., Chapman, C., & Mills, K. L. (2026) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674261450374 · Cited by 1
“While many individuals recover, a substantial proportion experience chronic or recurring symptoms (Santiago et al., 2013).”
Sexual orientation differences in trauma exposure and posttraumatic stress symptoms among adults in treatment for obsessive–compulsive disorder
Bezahler, A., Kirk, N. P. V., Feinstein, B. A., Falkenstein, M. J., & Kuckertz, J. M. (2026) · Journal of Traumatic Stress · doi:10.1002/jts.70082 · Cited by 1
“Given that interpersonal trauma is more likely to result in PTSD than noninterpersonal trauma (Santiago et al., 2013), we ran an ANOVA to examine whether baseline PTSS differed between individuals who endorsed different types of life-time trauma exposure at baseline (only interpersonal, only…”
Associations between residential segregation, ambient air pollution, and hippocampal features in recent trauma survivors
Liang, S. S., Roeckner, A. R., Ely, T. D., Lebois, L. A. M., van Rooij, S. J. H., Bruce, S. E., Jovanović, T., House, S. L., Beaudoin, F. L., An, X., et al. (2026) · Translational Psychiatry · doi:10.1038/s41398-026-04083-6 · Cited by 2
“Among the 90% of Americans who will experience a traumatic event (TE) in their lifetimes, approximately 20% will subsequently develop posttraumatic stress disorder (PTSD) [1, 2].”
Traumatic life experiences during critical periods lead to diverse developmental trajectories
Morelli, G., Visintin, G., Gelli, E., Serani, A., Bartolucci, M., Uccella, S., D’APRUZZO, M., Preiti, D., Chellali, M. M., Cucinelli, A., et al. (2026) · Cell Reports Medicine · doi:10.1016/j.xcrm.2026.102798
“22–25 Here, we investigated whether the timing of stress exposure (independent of its type) serves as a significant factor connecting experienced trauma with subsequent adult specific behavioral traits or neuropsychiatric outcomes.”
Alcohol Misuse, Posttraumatic Stress Symptoms, and Recovery After Musculoskeletal Injury: Implications for Effective Orthopaedic Care
Bakhshaie, J., Zvolensky, M. J., Vujanovic, A. A., Ditre, J. W., & Ring, D. (2026) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-25-00641 · Cited by 1
Investigating the Use of Large Language Models for the Detection of Trauma-Related Symptoms: An Exploratory Study Using Trauma Narratives.
Marengo, D., Hoeboer, C., & Olff, M. (2026) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2026.103151 · Cited by 1
“Evidence from a systematic review by Santiago et al. (2013) shows that PTSD prevalence and symptom trajectories vary depending on whether the traumatic event was intentional (e.g., assault) or non-intentional (e. g., accidents, disasters).”
Musculoskeletal Clinicians’ Perspectives on Integrated Digital Personalized Feedback Interventions to Address Risky Alcohol use and PTSD after Musculoskeletal Injury
Bakhshaie, J., Ramtin, S., Greenberg, J., Aneja, A., Ly, T. V., Vujanovic, A. A., Ring, D., & Zvolensky, M. J. (2026) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-026-10137-0 · Cited by 1
“Nearly half of hospitalized trauma patients have detectable blood alcohol at the time of injury, and up to 40% experience PTSD symptoms during recovery (Nedder et al., 2024; Nguyen et al., 2022; Santiago et al., 2013).”
Prospective predictors of posttraumatic stress symptoms following two "armed and dangerous person" campus lockdowns.
Friedman, J. B., Halverson, T., Juel, E. K., Myers, N. S., Inozu, M., & Abramowitz, J. S. (2025) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2025.103105 · Cited by 1
Adverse childhood experiences, exposure to the World Trade Center attacks, and chronic symptoms of depression, PTSD, and unhealthy drinking
Parcesepe, A., Sanborn, J., Sisti, J., & Metzler, J. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120671 · Cited by 1
Where Are the Emergency Responders? Spontaneous Volunteers in a Terrorist Attack
Fiskvik, J., Holen, S., Antonsen, S., & Bye, R. (2025) · Journal of Contingencies and Crisis Management · doi:10.1111/1468-5973.70065 · Cited by 1
PTSD therapy with fMRI-decoded neurofeedback bypassing conscious exposure: a randomized, double-blind, placebo-controlled studyPreprint
Chiba, T., Ide, K., Taylor, J. E., Cortese, A., Kubo, T., Nishida, K., Boku, S., Toda, H., Shirakawa, M. N., Amano, K., et al. (2025) · medRxiv · doi:10.1101/2025.07.07.25330779 · Cited by 1
“Females generally have twice as great a risk of developing PTSD as males 34 , and victims of intentional trauma such as male violence show worse prognosis than those of non-intentional trauma, such as natural disasters 35–37 .”
High incidence of trauma-related psychopathology in Lebanese expatriates after the Beirut explosion
Rached, G., Fiani, D., Slim, M., Dib, S.-M., Chabbouh, A., Daou, M. A. Z., & Torbey, S. (2025) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2025.100578 · Cited by 2
Trajectories of post-traumatic stress disorder symptoms and subsequent risk of long COVID in the World Trade Center Health Registry
Sisti, J. S., Packard, S. E., Yung, J., & Metzler, J. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119814 · Cited by 2
Mental health impact of a large-scale industrial fire on exposed residents in France: the post fire 76 health survey
Perrine, A.-L., Pédrono, G., Morel, P., Empereur‐Bissonnet, P., Richard, J., Golliot, F., Zeghnoun, A., Blanchard, M., Saoudi, A., Lay, E. L., et al. (2025) · Archives of Public Health · doi:10.1186/s13690-025-01602-7 · Cited by 1
“…with psychological disorders after disasters, including exposure intensity [6, 7], proximity to the event [4], intentionality of the event [8], socio-demographic characteristics and socioeconomic status [4, 6], social support [9], personality traits [10], resilience [9], and history of…”
Combat exposure, social support, and posttraumatic stress: a longitudinal test of the stress-buffering hypothesis among veterans of the wars in Afghanistan and Iraq
Bridges‐Curry, Z., Meckes, S. J., Fountain, C., Wagner, H. R., Calhoun, P. S., Kimbrel, N. A., Rowland, J. A., Dedert, E. A., Ponzini, G. T., & Workgroup, V. M.-A. M. (2025) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-025-02864-w · Cited by 2
“The disorder is often chronic, with up to 40 percent of those with PTSD experiencing unremitting symptoms [5].”
Designing and developing a prescription digital therapeutic for at-home heart rate variability biofeedback to support and enhance patient outcomes in post-traumatic stress disorder treatment
Macy, R., Somanji, F., & Sverdlov, O. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1503361 · Cited by 1
Trajectories and comorbid symptom networks of posttraumatic stress symptoms in frontline rescuers: A longitudinal study
Cheng, P., Wang, L., Zhou, Y., Ma, W., Zhao, G., & Li, W. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.125 · Cited by 1
What Is the Role of Affective Cognition in Trauma and Posttraumatic-Stress-Disorder-Related Drinking? A Systematic Review
Zaso, M. J., Troidl, I. R., & Read, J. P. (2024) · Clinical Psychological Science · doi:10.1177/21677026231215341 · Cited by 2
Initiation of multiple-session psychological care in civilians exposed to the November 2015 Paris terrorist attacks
Pirard, P., Motreff, Y., Stene, L. E., Rabet, G., Vuillermoz, C., Vandentorren, S., Baubet, T., & Messiah, A. (2023) · Archives of Public Health · doi:10.1186/s13690-023-01206-z · Cited by 6
“However, events considered as intentional (like terrorist attacks) are associated with greater persistence of PTSD symptoms than when the event is unintentional [54].”
Background
Impact of the 7/14/2016 Nice terrorist attack on pediatric emergency department visits thanks to syndromic surveillance: a descriptive study
Fernandez, A., Meurice, L., Franke, F., Vuillermoz, C., Gindt, M., Askenazy, F., & Vandentorren, S. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1248993 · Cited by 1
Novel Application of Skills for Psychological Recovery as an Early Intervention for Posttraumatic Stress Disorder, Depression, and Alcohol Misuse in Survivors of Recent Sexual Assault: A Case Series
Tilstra-Ferrell, E. L., Rheingold, A. A., Mai, K., & Hahn, C. (2023) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2023.05.003 · Cited by 1
Types of Traumatic Experiences in Drug Overdose-Related Deaths: An Exploratory Latent Class AnalysisPreprint
Hong, J. H., deDios, C., Badawi, J. C., Tonkin, S. S., Schmitz, J. M., Walss-Bass, C., & Meyer, T. (2023) · medRxiv · doi:10.1101/2023.04.30.23289256 · Cited by 1
“, assault, war) are more likely to develop PTSD, with symptoms less likely to remit (Santiago et al., 2013).”
Background
“After the rains” – A qualitative study exploring flood-related experiences, community response, coping mechanisms, and strategies from Kerala
Mathew, G., Varghese, A., Kumar, S. C. S., & Chacko, A. (2023) · Journal of Datta Meghe Institute of Medical Sciences University · doi:10.4103/jdmimsu.jdmimsu_314_22 · Cited by 1
Worldviews about the self mediate the impact of immature and mature defense styles on posttraumatic symptoms in bereaved parents
Ferrajão, P. C. (2021) · Death Studies · doi:10.1080/07481187.2021.1975176 · Cited by 1
“Previous research documented that about one-third of people exposed to a traumatic event remitted from post-traumatic stress disorder (PTSD) without specific treatment and most studies indicate that a range of 4–8months is the recommended time point for the purpose of examining the course of illness for PTSD (Santiago…”
Background
Examining reciprocal influence between posttraumatic stress and depressive symptoms among natural disaster survivors
Shigemoto, Y. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.07.056 · Cited by 2
Chronic pain among the hospitalized patients after the 22 July 2011 terror attacks in Oslo and at Utøya Island
Wisløff‐Aase, K., Raeder, J. C., Månum, G., Løvstad, M., Schanke, A., Dyb, G. A., Ekeberg, Ø., & Stanghelle, J. K. (2019) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.13373 · Cited by 2
Centrafrique et Bénin : Le trouble stress post traumatique chez les migrants Centrafricains à Cotonou : prévalence, facteurs associés et comorbidités psychiatriques
Tabo, A., Awohouedji, D. M., Gondia, G. M. D., Yimgoua, M. N. N., Kette, G. C., Kanékatoua, S., Klikpo, E., Djidonou, A., Gansou, G. M., Ezin-Houngbe, J., et al. (2019) · Psy Cause · doi:10.3917/psca.078.0017 · Cited by 1
Medical Marijuana and the Treatment of Post Traumatic Stress Disorder: A Survey of Michigan Psychiatrists’ Opinions
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Trauma‐ and Stressor‐Related Disorders: Posttraumatic Stress Disorder, Acute Stress Disorder, and Adjustment Disorder
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The First, First Responder
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Obsessive-Compulsive Disorders in New Fathers: Feeling Out of Control
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Paternal Postnatal Psychiatric Illnesses
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Challenge of Developing a Validated Animal Model of PTSD – Focus on Juvenile Stress Model
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The role of endocannabinoid function in posttraumatic stress disorder
Gabbay, F. H., Choi, K. H., Wynn, G. H., & Ursano, R. J. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-417041-4.00011-4 · Cited by 1
Self-citation
11-M Victims 3 Years After Madrid Terrorist Attacks: Looking for Health Beyond Trauma
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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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