@article {mclaughlin_subthreshold_2015, title = {Sub-threshold PTSD in the WHO World Mental Health Surveys.}, journal = {Biological Psychiatry}, volume = {77}, number = {4}, year = {2015}, month = {feb}, pages = {375{\textendash}384}, abstract = {BACKGROUND: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition. METHODS: The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions. RESULTS: Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0\% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6\% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones. CONCLUSIONS: Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD.}, keywords = {Diagnostic and Statistical Manual of Mental Disorders, Epidemiology, Female, Health Surveys, Humans, Male, Mental Health, nosology, Partial PTSD, Post-Traumatic, Posttraumatic stress disorder, Prevalence, PTSD, Severity of Illness Index, Stress Disorders, Subthreshold PTSD, World Health Organization}, issn = {1873-2402}, doi = {10.1016/j.biopsych.2014.03.028}, author = {McLaughlin, Katie A. and Koenen, Karestan C. and Friedman, Matthew J. and Ruscio, Ayelet Meron and Karam, Elie G. and Shahly, Victoria and Stein, Dan J. and Hill, Eric D. and Petukhova, Maria and Alonso, Jordi and Andrade, Laura Helena and Angermeyer, Matthias C. and Borges, Guilherme and Girolamo, Giovanni de and de Graaf, Ron and Demyttenaere, Koen and Florescu, Silvia E. and Mladenova, Maya and Posada-Villa, Jose and Scott, Kate M. and Takeshima, Tadashi and Ronald C. Kessler} }