Natural Course of Posttraumatic Stress Disorder: A 20-Month Prospective Study of Turkish Earthquake Survivors
J Clin Psychiatry 2006;67:882-889
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: A 20-month prospective follow-up
of survivors of the severe earthquake in Turkey in
1999 examined the natural course of posttraumatic
stress disorder (PTSD) and the contribution of
different symptom clusters to the emergence of PTSD.
Method: Subjects were randomly sampled in
a suburb of Istanbul that was severely affected by
the earthquake. A total of 464 adults were assessed
with a self-report instrument for PTSD symptoms on
3 consecutive surveys that were administered 1 to 3,
6 to 10, and 18 to 20 months following the earthquake.
Results: The prevalence of PTSD was 30.2%
on the first survey and decreased to 26.9% and
10.6% on the second and third surveys, respectively.
Female subjects showed initially higher (34.8%) PTSD
rates compared with male subjects (19.1%).
However, gender differences disappeared by the time of
the third survey due to high spontaneous remission
rates in female subjects. Low levels of chronic and
delayed-onset PTSD were observed. A major contribution of the avoidance symptoms to PTSD
diagnosis was identified by statistical analysis.
Conclusions: Initial PTSD following an
earthquake may be as prevalent as in other natural
disasters, but high rates of spontaneous remission lead
to low prevalence 1.5 years following the
earthquake. Initial avoidance characteristics play a major role
in the emergence of PTSD.