Prof. Dan Stein

Dan J. Stein is Professor and Chair of the Dept of Psychiatry at the University of Cape Town, and Director of the South African Medical Research Council's Unit on Risk & Resilience in Mental Disorders. His training includes doctoral degrees in clinical neuroscience and in philosophy, and a post-doctoral fellowship in psychopharmacology. His work has focused on anxiety and related disorders, including obsessive-compulsive spectrum conditions and posttraumatic stress disorder, with research ranging from basic neuroscience through clinical research and on to public mental health. He has contributed to the field via collaboration (around Africa and the globe), mentorship (many past students are leaders in their field), and publication (google h-index > 160). His most recent volume is "Problems of Living: Perspectives from Philosophy, Psychiatry, and Cognitive-Affective Science".

I will begin this presentation by providing a conceptual framework for psychiatric epidemiology. A classic perspective suggests that psychiatric epidemiology is a value-free effort focused on the measurement of natural kinds, a critical perspective suggests that psychiatric epidemiology is a value-bound social activity that deals with social constructs of human kinds, while an integrative approach sees psychiatric epidemiology as a theory-laden and value-bound activity that employs soft natural kinds and that progresses by discovering underlying causal mechanisms [1].

I then focus on a range of findings concerning trauma and PTSD in the World Mental Health Surveys (WMHS). I explore not only the prevalence of trauma and PTSD, but also a range of analyses that help shed light on the mechanisms underlying PTSD. This part of the presentation summarizes work on dissociation, on subthreshold PTSD, and on broad vs narrow concepts of PTSD, among other areas [2–6]. It is emphasized that traumatic events which are common, such as motor vehicle accidents, although not often associated with PTSD, may contribute substantially to the burden of PTSD.

In the last part of the presentation I consider how epidemiological data has helped inform nosological and treatment issues [7,8]. For example, controversy existed about the utility of DSM-IV PTSD criterion A2: that exposure to a traumatic experience is accompanied by intense fear, helplessness, or horror. In WMHS, PTSD with or without criterion A2 did not differ in persistence or predicted consequences. Indeed, in DSM-5, this criterion was omitted. WMHS data also suggest that the great majority of people with PTSD would receive treatment they considered helpful if they persisted in help-seeking after initial unhelpful encounters, but most patients whose initial treatment is unhelpful give up before receiving helpful treatment.

1. Stein, D. J. Towards a philosophy of psychiatric epidemiology. International Journal of Epidemiology 52, 1670–1672 (2023).
2. Stein, D. J. et al. Dissociation in Posttraumatic Stress Disorder: Evidence from the World Mental Health Surveys. Biological Psychiatry 73, 302–312 (2013).
3. Benjet, C., et al. The epidemiology of traumatic event exposure worldwide: results from the World Mental Health Survey Consortium. Psychological Medicine 46, 327–343 (2016).
4. Koenen, K. C. et al. Posttraumatic stress disorder in the World Mental Health Surveys. Psychol. Med. 47, 2260–2274 (2017).
5. McLaughlin, K. A. et al. Subthreshold Posttraumatic Stress Disorder in the World Health Organization World Mental Health Surveys. Biological Psychiatry 77, 375–384 (2015).
6. Stein, D. J., et al. DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating ‘narrow’ and ‘broad’ approaches. Depression & Anxiety 31, 494–505 (2014).
7. Stein, D. J., Scott, K. M., de Jonge, P. & Kessler, R. C. Epidemiology of anxiety disorders: from surveys to nosology and back. Dialogues Clin Neurosci 19, 127–136 (2017).
8. Stein, D. J. et al. Perceived helpfulness of treatment for posttraumatic stress disorder: Findings from the World Mental Health Surveys. Depress Anxiety 37, 972–994 (2020).