Posttraumatic Stress Disorder in Germany: Results of a Recent Nationwide Epidemiological Study
July 1, 2008
Since the most influential epidemiological studies on PTSD are from the US, lifetime prevalence rates of 5-10% are the most cited (Breslau, 2002; Kessler et al., 1995). However, a joint “European Study of the Epidemiology of Mental Disorders (ESEMeD)” from Belgium, France, Germany, Italy, the Netherlands and Spain found a lifetime prevalence of 1.4% (Alonso et al., 2004). Other countries (Mexico, Australia, Portugal) have also found lower PTSD prevalence rates to that of the US (for a review, see Maercker et al., 2008).
To explain cross-national differences in PTSD prevalence rates, one has to take into account different levels of exposure to natural catastrophes, societal propensities to violence, and war effects. Participants and survivors of World War II are widely represented in the German population. Therefore, we predicted that German elderly over the age of 60 would report high rates of war-related, potentially traumatic experiences, as well as higher PTSD rates. To our knowledge, epidemiological studies of the general population including those over the age of 60 are lacking.
To better understand the experiences of war in the elderly, we conducted a nationwide study drawing on a representative cross-section of the German population, ages 14-95 from 210 data collection sites all over Germanys urban and rural areas (Maercker et al., 2008). This representative epidemiological study (N=2426) estimated prevalence rates of traumatic life events, post-traumatic stress disorder (PTSD) and partial PTSD. A standardized interview with the trauma checklist of the Composite International Diagnostic Interview (CIDI) and a DSM-IV PTSD symptom checklist (Modified PTSD Symptom Scale) was applied.
25% of the sample reported one or more potentially traumatic events (e.g., 1.2% childhood sexual abuse, 0.8% natural catastrophes, 8.8% war events). One-month prevalence rates were 2.3% for DSM-IV PTSD and 2.7% for partial PTSD. There were no gender differences, but age-group differences: Among persons above the age of 60, prevalence of PTSD was 3.4%, whereas prevalence of PTSD was estimated to be 1.3% among persons aged 14-29 years and 1.9% among persons aged 30-59 years. Conditional probabilities of PTSD were consistent with other international PTSD studies (e.g., 38% conditional PTSD probability after childhood sexual abuse).
Prevalence rates for partial PTSD (criteria for which approximately equal international WHO (ICD-10) criteria for PTSD) were comparable to PTSD with 3.8% in the elderly, 2.4% in the middle-aged, and 1.3% in the young adults. Thus, for the first time, our representative study provides evidence of higher PTSD prevalence rates among older age-groups in the German population, which is assumed to be a related consequence of World War II. These findings may be of importance to other countries with histories of war.
Alonso, J., Angermeyer, M.C., Bernert, S., et al (2004). Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica, 109, 21-27.
Breslau, N. (2002) Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Canadian Journal of Psychiatry 47, 923-929.
Kessler, R.C., Sonnega, A., Bromet, A. et al (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 1048-1060.
Maercker, A., Forstmeier, S., Wagner, B., Glaesmer, H., Brähler, E. (2008). Posttraumatische Belastungsstörung in Deutschland. Ergebnisse einer gesamtdeutschen epidemiologischen Studie [Posttraumatic Stress Disorder in Germany: Results of a nationwide epidemiological study]. Nervenarzt, 79, 577-586.