G-Stress

A global assessment of the ICD-11 stress-related disorders

Project group

PI: Dr Philip Hyland, Department of Psychology, Maynooth University, Kildare, Ireland

See Core collaborators and Collaborators below.

This project brings together traumatic stress experts from around the world including members of ISTSS, ESTSS, and DeGPT. Four of the collaborators are also part of the other Global Collaboration projects who such as the development of the Global Psychotrauma Screen (GPS), the e-pamphlets for adults who have experienced childhood trauma (Internet information on Childhood Abuse and Neglect ((iCAN)) the the CARTS project (ongoing). 

Core Collaborators

  • Prof. Menachem Ben-Ezra, School of Social Work, Ariel University, Ariel, Israel.

  • Prof. Jon Bisson, School of Medicine, Cardiff University, Cardiff, UK.

  • Prof. Chris Brewin, Clinical, Educational, and Health Psychology, University College London, London, UK.

  • Prof. Marylene Cloitre, National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, United States of America.

  • Prof. Thanos Karatzias, Edinburgh Napier University, School of Health & Social Care, Edinburgh, UK.

  • Prof. Brigitte Lueger-Schuster, Department of Applied Psychology, University of Vienna, Vienna, Austria.

  • Prof. Andreas Maercker, Department of Psychology, Division of Psychopathology, University of Zurich, Zurich, Switzerland.

  • Prof. Miranda Olff, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, and ARQ National Psychotrauma Center, Diemen, Netherlands.

  • Dr Neil Roberts, Cardiff & Vale University Health Board, Cardiff, UK and School of Medicine, Cardiff University, Cardiff, UK.

  • Prof. Mark Shevlin, School of Psychology, Ulster University, Derry, Northern Ireland.

  • Dr Frédérique Vallières Trinity Centre for Global Health, University of Dublin, Trinity College, Dublin, Republic of Ireland.

Collaborators

  • Ms. Kristina Bondjers, Uppsala University, Uppsala, Sweden.

  • Prof. Wai Tong Chien, The Chinese University of Hong Kong, Hong Kong.

  • Prof. Amy Chow, University of Hong Kong, Hong Kong.

  • Ms. Carmen Fernández-Fillol, Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Spain.

  • Andres Fresno, University of Talca, Chile.

  • Ms. Marieke van Gelderen, Arq Psychotrauma Expert Group, Centrum ’45, Netherlands.

  • Dr. Ohad Gilbar, Bar-Ilan University, Israel.

  • Dr. Sachiko Inoue, Okayama Prefectural University, Japan.

  • Dr. Evaldas Kazlauskas, Vilnius University, Lithuania.

  • Dr. Matthias Knefel, University of Vienna, Austria.

  • Dr. Grace W.K. Ho, The Hong Kong Polytechnic University, Hong Kong.

  • Dr. Eoin McElroy, University College London, UK.

  • Ms. Grainne McGinty, Maynooth University, Kildare, Ireland.

  • Carolina Salgado, University of Talca, Chile.

  • Prof. Daja Somarasundaram, University of Jaffna, India.

  • Prof. Jiangping Wang, Beijing Normal University, Beijing, China.

  • Dr. Pei-Jung (Annie) Yang, National Chengchi University, Taiwan.

Background

Approximately 70% of the world’s population have been exposed to a traumatic life event (Benjet et al., 2016, Kessler et al., 2017), and the resulting mental health problems represent a major challenge to public mental health services, globally (Sara & Lappin, 2017). In 2018, the World Health Organization (WHO) released the 11th version of the International Classification of Diseases (ICD-11), the primary diagnostic manual used by health professionals worldwide (First, Reed, Hyman, & Saxena, 2015). All United Nations member states are committed to using the ICD-11, and relevant to psychotraumatologists, ICD-11 provides novel descriptions of stress-related psychopathology compared to the ICD-10 and the DSM-5 (American Psychiatric Association, 2013).

Under the parent category of ‘Disorders Specifically Associated with Stress’, ICD-11 defines a number of stress-related disorders including ‘Posttraumatic Stress Disorder’ (PTSD) (PB40), ‘Complex PTSD’ (CPTSD) (PB41), ‘Prolonged Grief Disorder’ (PB42), and ‘Adjustment Disorder’ (PB43). The guiding principles underlying the development on these disorders were that they should (a) maximize clinical utility by including a small number of core symptoms and (b) be internationally applicable (Maercker et al., 2013). The World Mental Health Survey consortium have provided information about the prevalence of traumatic life events, and PTSD, internationally (Benjet et al., 2016; Karam et al., 2014). While valuable, these studies utilized the now outdated DSM-IV description of PTSD.

 

Aims

As ICD-11 represents the primary diagnostic manual used worldwide, and includes a new and distinct model of stress-related psychopathology, it is imperative for psychotraumatology research and practice to determine the global prevalence rates of these disorders.

Methods and Output

Members of the G-Stress Project have begun to assess the current prevalence rates of the ICD-11 stress-related disorders using nationally representative samples in countries like Israel (Hyland et al., under review; Kilkelly et al., 2019), Germany (Maercker et al., 2018), United Kingdom (Maercker et al., 2018; Cloitre et al., 2018) and United States (Cloitre et al., in press). It is clear that substantially more data is needed from nations all around the world to better understand how common these disorders are. In this project, we invite members of the ISTSS’s Global Collaboration to contribute to the ongoing work that aims to ascertain the prevalence of the ICD-11 stress-related disorders around the world. By obtaining information about the prevalence rates of the ICD-11 stress-related disorder at a global level, the ISTSS’s Global Collaboration will be able to provide the scientific community with vital information about the frequency and distribution of stress- and trauma-related events, and stress-related disorders, globally. This would allow for more effective and efficient resource planning among global health professionals. 

The following countries have already collected data:

·         United Kingdom

·         United States of America

·         Israel

·         Ghana, Kenya, and Nigeria

·         Germany

·         Ukraine

·         Lithuania

·         Ireland

See publications below, and several more are under review.

 
 

G-Stress Related Publications

 

Cross-country:

  1. Karatzias, T., Shevlin, M., Hyland, P., Ben-Ezra, M., Cloitre, M., Owkzarek, M., & McElroy, M. (2020). The network structure of ICD-11 complex post-traumatic stress disorder across different traumatic life events. World Psychiatry, 19, 400-401. DOI:10.1002/wps.20795

  2. Knefel, M., Karatzias, T., Ben-Ezra, M., Cloitre, M. Lueger-Schuster, B., & Maercker, A. (2019). The replicability of ICD-11 complex post-traumatic stress disorder symptom networks in adults. The British Journal of Psychiatry, 214, 361-368. doi: 10.1192/bjp.2018.286 

Republic of Ireland:

  1. Hyland, P., Karatzias, T., Shevlin, M., McElroy, E., Ben-Ezra, M., Cloitre, M., & Brewin, C. R. (2020). Does requiring trauma exposure affect rates of ICD-11 PTSD and complex PTSD? Implications for DSM-5. Psychological Trauma: Theory, Research, Practice, and Policy. In press.

  2. Hyland, P., Vallieres, F., Cloitre, M., Ben-Ezra, M., Karatzias, T., Olff, M., Murphy, J., & Shevlin, M. (2020). Trauma, PTSD, and Complex PTSD in the Republic of Ireland: Prevalence, comorbidity, service use, and risk factors. Social Psychiatry and Psychiatric Epidemiology. DOI: 10.1007/s00127-020-01912-x

  3. Hyland, P., Shevlin, M., McBride, O., Murphy, J., Karatzias, T., Bentall, R. P., Martinez, A., & Vallières, F. (2020). Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatrica Scandinavica. DOI: 10.1111/acps.13219

  4. Karatzias, T., Shevlin, M., Murphy, J., McBride, O., Ben-Ezra, M., Bentall, R. P., Vallières, F., & Hyland, P. (2020). Posttraumatic stress symptoms and associated comorbidity during the COVID-19 pandemic in Ireland: A Population-Based Study. Journal of Traumatic Stress, 33, 365-370. DOI: 10.1002/jts.22565

  5. Shevlin, M., Hyland, P., Ben-Ezra, M., Karatzias, T., Cloitre, M., Vallieres, F., Bachem, R., & Maercker, A. (2020). Measuring ICD-11 Adjustment Disorder: The development and initial validation of the International Adjustment Disorder Questionnaire. Acta Psychiatrica Scandinavica, 141, 265-274. DOI: 10.1111/acps.13126

 

United Kingdom:

  1. Shevlin, M., McBride, O., Murphy, J., Miller, J. G., Hartman, T. K., Levita, L., Mason, L., Martinez, A. P., McKay, R., Stocks, T. V. A., Bennett, K. M., Hyland, P., Karatzias, K., & Bentall, R. P. (2020). Anxiety, depression, traumatic stress, and COVID-19 related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open.

  2. Charak, R., Vang, M., Shevlin, M., Ben-Ezra, M., Karatzias, T., & Hyland, P. (2020). Lifetime interpersonal victimization profiles and mental health problems in a nationally representative panel of trauma-exposed adults from the United Kingdom. Journal of Traumatic Stress. https://doi.org/10.1002/jts.22527

  3. Hyland, P., Karatzias, T., Cloitre, M., & Shevlin, M. (2019). Examining the discriminant validity of Complex PTSD and Borderline Personality Disorder symptoms: Results from a UK community sample. Journal of Traumatic Stress, 32, 855-863. doi: 10.1002/jts.22444

  4. Karatzias, T., Hyland, P., Bradley, A., Cloitre, M., Roberts, N. P., Bisson, J. I., & Shevlin, M. (2019). Risk-factors and comorbidity of ICD-11 PTSD and Complex PTSD: Findings from a trauma-exposed community sample of adults in the United Kingdom. Depression and Anxiety, 36, 887-894. doi: 10.1002/da.22934

  5. Frost, R., Vang, M., Karatzias, T., Hyland, P., & Shevlin, M. (2019). The distribution of psychosis, ICD-11 PTSD and Complex PTSD symptoms among a trauma-exposed UK general population sample. Psychosis, 11, 187-198. https://doi.org/10.1080/17522439.2019.1626472

  6. Cloitre, M., Shevlin, M., Brewin, C. R., Bisson, J. I., Roberts, N. P., Maercker, A., Karatzias, T., & Hyland, P. (2018). The International Trauma Questionnaire (ITQ): Development of a self-report measure of ICD-11 PTSD and Complex PTSD. Acta Psychiatrica Scandinavica, 138, 536-546. Doi: 10.1111/acps.12956.

United States of America:

  1. Fox, R., Hyland, P., McHugh Power, J., & Coogan, A. N. (2020). Patterns of comorbidity associated with ICD-11 PTSD among older adults in the United States. Psychiatry Research, 290, 113171. https://doi.org/10.1016/j.psychres.2020.113171

  2. Fox, R., Hyland, P., McHugh Power, J., & Coogan, A. N. (2020). Posttraumatic stress disorder among older adults: A differential item functioning analysis of PTSD in ICD-11 and DSM–5. Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. https://doi.org/10.1037/tra0000596

  3. Haahr-Pedersen, I., Perera, C., Hyland, P., Vallieres, F., Murphy, D., Hansen, M., Spitz, P., Hansen, P., & Cloitre, M. (2020). Females have more complex patterns of childhood adversity: Implications for mental, social, and emotional outcomes in adulthood. European Journal of Psychotraumatology, 11(1), 1708618. https://doi.org/10.1080/20008198.2019.1708618​

  4. Cloitre, M., Hyland, P., Bisson, J. I., Brewin, C. R., Roberts, N. P., Karatzias, T., & Shevlin, M. (2019). ICD-11 PTSD and Complex PTSD in the United States: A population-based study. Journal of Traumatic Stress, 32, 833-842. doi: 10.1002/jts.22454

  5. Hyland, P., Shevlin, M., Cloitre, M., Vallieres, F., McGinty, G., Fox, R., Karatzias, T., & McHugh Power, J. (2019). Quality not quantity: Loneliness subtypes, psychological trauma, and mental health in the US adult population. Social Psychiatry and Psychiatric Epidemiology, 54, 1089-1099. doi: 10.1007/s00127-018-1597-8

  6. Shevlin, M., Hyland, P., Roberts, N., Bisson, J., Brewin, C., & Cloitre, M. (2018). A psychometric assessment of disturbances in self-organization symptom indicators for ICD-11 complex PTSD. European Journal of Psychotraumatology, 9, 1419749. doi: https://doi.org/10.1080/20008198.2017.1419749

 

Israel:

  1. Hyland, P., Karatzias, T., Shevlin, M., Cloitre, M., & Ben-Ezra, M. (2020). A longitudinal study of ICD-11 PTSD and Complex PTSD in the general population of Israel. Psychiatry Research. https://doi.org/10.1016/j.psychres.2020.112871

  2. McElroy, E., Shevlin, E., Murphy, S., Roberts, B., Bisson, J. Ben-Ezra, M., & Hyland, P. (2019). ICD-11 PTSD and Complex PTSD: Structural validation using exploratory graph analysis. World Psychiatry, 18, 236-237. doi: 10.1002/wps.20638

  3. Ben-Ezra, M., Karatzias, T., Hyland, P., Brewin, C. R., Cloitre, M., Bisson, J. I., Roberts, N. R., Lueger-Schuster, B., & Shevlin, M. (2018). Posttraumatic stress disorder (PTSD) and Complex PTSD (CPTSD) as per ICD-11 proposals: A population study in Israel. Depression and Anxiety, 35, 264-274. doi: 10.1002/da.22723

  4. Lorenz, L., Hyland, P., Maercker, A., & Ben-Ezra, M. (2018). An empirical assessment of adjustment disorder as proposed for ICD-11 in a general population sample of Israel. Journal of Anxiety Disorders, 54, 65-70. doi: 10.1016/j.janxdis.2018.01.007​​

Nigeria, Kenya, Ghana

  1. Palgi, Y., Karatzias, T., Hyland, P., Shevlin, M., & Ben-Ezra, M. (in press). Can subjective perceptions of trauma differentiate between ICD-11 PTSD and Complex PTSD? A Cross–cultural comparison of three African countries. Psychological Trauma: Theory, Research, Practice, and Policy.

  2. Ben-Ezra, M., Hyland, P., Karatzias, T., Maercker, A., Hamama-Raz, Y., Lavenda, O., Mahat-Shamir, M., & Shevlin, M. (2020). A cross-country psychiatric screening of ICD-11 disorders specifically associated with stress in Kenya, Nigeria and Ghana. European Journal of Psychotraumatology, 11(1), 1720972. https://doi.org/10.1080/20008198.2020.1720972

  3. Owczarek, M., Ben-Ezra, M., Karatzias, T., Hyland, P., Vallieres, F., & Shevlin, M. (2020). Testing the factor structure of the International Trauma Questionnaire (ITQ) in African community samples from Kenya, Ghana and Nigeria. Journal of Trauma and Loss, 25, 348-363. https://doi.org/10.1080/15325024.2019.1689718

 

Ukraine:

  1. McElroy, E., Shevlin, E., Murphy, S., Roberts, B., Bisson, J. Ben-Ezra, M., & Hyland, P. (2019). ICD-11 PTSD and Complex PTSD: Structural validation using exploratory graph analysis. World Psychiatry, 18, 236-237. doi: 10.1002/wps.20638

  2. Shevlin, M., Hyland, P., Vallieres, F., Bisson, J., Makhashvili, N., Javakhishvili, Kharchenk, N., Shpiker, M., & Roberts, B. (2018). A comparison of DSM-5 and ICD-11 Posttraumatic Stress Disorder rates and comorbidity: An analysis of the Ukrainian Internally Displaced Person’s Mental Health Survey. Acta Psychiatrica Scandinavica, 137, 138-147. doi: 10.1111/acps.12840

Lithuania:

  1. Kazlauskas, E., Zelviene, P., Daniunaite, I., Hyland, P., Kvedaraite, M., Shevlin, M., & Cloitre, M. (2020). The structure of ICD-11 PTSD and Complex PTSD in adolescents exposed to potentially traumatic experiences. Journal of Affective Disorders, 265, 169-174. DOI: 10.1016/j.jad.2020.01.061

  2. Kazlauskas, E., Gegieckaite, G., Hyland, P., Zelviene, P., & Cloitre M. (2018). The structure of the ICD-11 PTSD and Complex PTSD in a Lithuanian clinical sample. European Journal of Psychotraumatology, 9, 1414559. doi: https://doi.org/10.1080/20008198.2017.1419749

Germany:

  1. Maercker, A., Hecker, T., Augsburger, M., & Kliem, S. (2018). ICD-11 prevalence rates of posttraumatic stress disorder and complex posttraumatic stress disorder in a German nationwide sample. The Journal of Nervous and Mental Disease, 206(4), 270-276. doi: 10.1097/NMD.0000000000000790.

© 2019 by Global Collaboration on Traumatic Stress