Is there a vulnerability paradox in PTSD? : Pitfalls in cross-national comparisons of epidemiological data

Dückers et al analyse the relationship between prevalence estimates of trauma exposure and post-traumatic stress disorder (PTSD) in published data-sets from 24 countries, and between PTSD and vulnerability (based on a country vulnerability index developed in the 2013 World Risk report). The findings are substantially counterintuitive; countries with low vulnerability have higher life-time rates of PTSD, meaning that countries with low vulnerability and high trauma exposure have the highest rates of lifetime PTSD. The authors do emphasise a number of limitations of their work, and yet they conclude that a ‘vulnerability paradox’ exists for both PTSD and depression, with rates higher in countries with more resources and better healthcare systems.