prevalence and prognosis of stress disorders: a review of the epidemiologic literature

Jaimie L Gradus1–4 1National Center for PTSD, VA Boston Healthcare System, 2Department of Psychiatry, Boston University School of Medicine, 3Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; 4Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Abstract: Given the ubiquity of traumatic events, it is not surprising that posttraumatic stress disorder (PTSD) – a common diagnosis following one of these experiences – is characterized as conferring a large burden for individuals and society. Although there is recognition of the importance of PTSD diagnoses throughout psychiatry, the literature on other diagnoses one may receive following a stressful or traumatic event is scant. This review summarizes the literature on stress disorders (classified according to the International Classification of Diseases, 10th Edition [ICD-10]), including acute stress reaction, PTSD, adjustment disorder and unspecified stress reactions. This review focuses on the literature related to common psychiatric and somatic consequences of these disorders. The prevalence and incidence of each disorder are described. A review of epidemiologic studies on comorbid mental health conditions, including depression, anxiety and substance abuse, is included, as well as a review of epidemiologic studies on somatic outcomes, including cancer, cardiovascular disease and gastrointestinal disorders. Finally, the current literature on all-cause mortality and suicide following stress disorder diagnoses is reviewed. Stress disorders are a critical public health issue with potentially deleterious outcomes that have a significant impact on those living with these disorders, the health care system and society. It is only through an awareness of the impact of stress disorders that appropriate resources can be allocated to prevention and treatment. Future research should expand the work done to date beyond the examination of PTSD, so that the field may obtain a more complete picture of the impact all stress disorders have on the many people living with these diagnoses. Keywords: trauma- and stressor-related disorders, stress disorders, traumatic, prognosis