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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
Open accessAbstract
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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“Differences in trajectories were observed for different types of trauma: whereas PTSD prevalence decreased over time for non-violent traumas (20.1% at month 1 and 14.0% at month 12), the median prevalence increased from 11.8% at month 1 to 23.3% at month 12 for violent traumas.”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Santiago et al., 2013
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“a past review of mixed traumas which indicated that the prevalence of PTSD stabilizes after three months exposure (Santiago et al., 2013).”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Santiago et al., 2013
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“they reported decreases in the median prevalence of PTSD between 1 month (28.8%) and 3 months (17.8%) post-trauma, followed by a stabilization in prevalence through 12 months (17.0%; Santiago et al., 2013).”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Santiago et al., 2013
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“First, although the Santiago and Hiller reviews found that large reductions in PTSD symptomatology occurred between 1 and 3 months post-trauma, neither statistically determined if there was a time point at which the average rate of recovery slowed (Hiller et al., 2016; Santiago et al., 2013).”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Santiago et al., 2013
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“in the first month post-trauma, PTSD prevalence was 74.58% following sexual assault in the current analysis. In prior meta-analyses, one-month PTSD prevalence was 28.8% following mixed trauma exposure (Santiago et al., 2013) and 21.3% following childhood trauma (Hiller et al., 2016).”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Santiago et al., 2013
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“PTSD prevalence at the twelfth month post-trauma was 41.5% following sexual assault in this study, as compared to prior meta-analyses, which found 17.0% following mixed trauma exposure (Santiago et al., 2013) and 10.9% following childhood trauma (Hiller et al., 2016).”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Santiago et al., 2013
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“there is evidence that the course of PTSD differs by trauma type (Santiago et al., 2013).”
From PTSD in the Year Following Sexual Assault: A Meta-Analysis of Prospective Studies (2023) · cites this paper as Santiago et al., 2013
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Citations
Cites
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Method
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InfluentialOlorunlambe, W., & Jud, A. (2026) · Transcultural Psychiatry · doi:10.1177/13634615261436997 · Cited by 2
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Trauma- and violence-informed care for the 2SLGBTQIA+ population: A concept analysis.
Baker, L. M., Jackson, K. T., & Elliott, R. A. (2026) · Nursing Outlook · doi:10.1016/j.outlook.2026.102786
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Shorter Oxford Textbook of Psychiatry
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“Moreover, the trajectory of PTSD is influenced by trauma type, with intimate partner violence (IPV) representing one of the most prevalent and severe exposures [23-25].”
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Traumatic Birth and Chronology of Losses
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“22,23 However, research has revealed an interesting finding that individuals who experience violent injuries exhibit a greater predisposition to develop depression than PTSD, both at baseline and an eight-month period following the injury.”
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“The model was further simplified to ignore the risk of relapse because gains from CBT tend to be maintained following a single trauma (Brewin et al., 2010a; Santiago et al., 2013).”
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InfluentialBehavioural Neurology of Personality Disorders: A Bi-dimensional Model
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“Formulé autrement, ce sont donc de 80 à 90% des sujets qui ne vont pas développer de TSPT (Kessler et al., 1995, 2005; Olaya et al., 2015; Santiago et al., 2013).”
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“%) of new PTSD cases appeared after three months (Peleg & Shalev, 2006; Santiago et al., 2013).”
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“Compared to less than a 25% of developing PTSD after a traumatic event (Breslau, Davis, Andreski, & Peterson, 1991; Kessler et al, 1995; Santiago et al, 2013), these statistics of post-traumatic growth are very hopeful.”
BackgroundAcute Stress Disorder and Post-traumatic Stress Disorder in Individuals Suffering from Burn Injury
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Smith, E., & Habel, U. (2018) · Springer eBooks · doi:10.1007/978-3-662-54980-3_31
Winham, K. M. (2015) · ThinkIR: The University of Louisville's Institutional Repository (University of Louisville) · doi:10.18297/etd/2081
“…the recent publication of the DSM-5, little research has yet to examine its factor structure other than to compare criteria and prevalence of PTSD with the new diagnostic criteria (Carmassi et al., 2013; Elhai et al., 2012; Friedman et al., 2011; Kilpatrick et al., 2013; Santiago et al., 2013).”
BackgroundFord, J. D., Grasso, D. J., Elhai, J. D., & Courtois, C. A. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-801288-8.00004-2
Development of a Scale to Measure Victim Reliance on a Perpetrator
Griffith, E. L. (2021) · doi:10.12794/metadc1833522
Metadata
- 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
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-04-11
- Volume
- 8
- Issue
- 4
- Pages
- e59236
- ISSN
- 1932-6203 (ISSN-L)
- 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
- 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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