{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T19:36:03Z","timestamp":1790624163492,"version":"4.1.0"},"reference-count":64,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T00:00:00Z","timestamp":1723593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute of Health","award":["R01MH119193 (SG)"],"award-info":[{"award-number":["R01MH119193 (SG)"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>Posttraumatic Stress Disorder (PTSD) affects millions of people worldwide. While the relationship between direct exposure to traumatic events and PTSD is well-established, the influence of indirect trauma exposure on PTSD remains unclear. It is similarly unclear what role cumulative exposure to direct and indirect traumas play in the risk of PTSD.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>The study uses data from the Houston Trauma and Recovery Study, conducted on 2020\u20132021, and involved a random sampling of 1,167 individuals residing in Houston during Hurricane Harvey in 2017. Participants were asked about their experiences related to both Hurricane Harvey and the subsequent COVID-19 pandemic. Exposures were categorized as direct or indirect traumas, in line with the criteria delineated in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Cumulative exposures were also calculated.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among participants, 12.6% were experiencing current PTSD. There were significant associations between both direct [OR = 3.18, 95% CI 1.85, 5.46] and indirect [OR = 1.91, 95% CI 1.05, 3.46] traumas related to Harvey, as well as direct [OR = 2.13, 95% CI 1.20, 3.77] and indirect [OR = 1.69, 95% CI 0.93, 3.09] traumas due to COVID and the risk of PTSD in fully adjusted models. Further, significant associations were found between the cumulative exposure to traumas from both Hurricane Harvey and COVID-19 and the risk of PTSD, considering both direct [OR = 2.53, 95% CI 1.36, 4.70] and indirect exposures [OR = 2.79, 95% CI 1.47, 5.28].<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Our study offers support for connections between exposure to both direct and indirect traumas stemming from large-scale disasters and PTSD. Moreover, we show that cumulative exposures to multiple large-scale events increase the risk of PTSD. This highlights the importance of the consideration of a range of exposures as risks for PTSD, particularly in a time of compounding disasters and broad population exposures to these events.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0307593","type":"journal-article","created":{"date-parts":[[2024,8,14]],"date-time":"2024-08-14T17:31:43Z","timestamp":1723656703000},"page":"e0307593","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["The cumulative contribution of direct and indirect traumas to the production of PTSD"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3963-0064","authenticated-orcid":true,"given":"Dan","family":"Even","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory H.","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruochen","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandro","family":"Galea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,14]]},"reference":[{"issue":"7","key":"pone.0307593.ref001","doi-asserted-by":"crossref","first-page":"e006303","DOI":"10.1136\/bmjgh-2021-006303","article-title":"Global burden of post-traumatic stress disorder and major depression in countries affected by war between 1989 and 2019: a systematic review and meta-analysis","volume":"6","author":"TH Hoppen","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"13","key":"pone.0307593.ref002","doi-asserted-by":"crossref","first-page":"2260","DOI":"10.1017\/S0033291717000708","article-title":"Posttraumatic stress disorder in the World Mental Health Surveys","volume":"47","author":"KC Koenen","year":"2017","journal-title":"Psychol Med"},{"issue":"4","key":"pone.0307593.ref003","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1176\/ajp.2006.163.4.659","article-title":"Trajectories of PTSD: a 20-year longitudinal study","volume":"163","author":"Z Solomon","year":"2006","journal-title":"Am J Psychiatry"},{"issue":"3","key":"pone.0307593.ref004","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1177\/1524838009334448","article-title":"The epidemiology of trauma, PTSD, and other posttrauma disorders","volume":"10","author":"N. 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