Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4

Lifetime traumatic events were defined as experiences that put a person – or someone close to them – at risk of serious harm or death. Examples include experiencing a major natural disaster, serious car accident, physical and sexual abuse and assault or a loved one dying by murder or suicide. Individuals who experience such an event may go on to develop PTSD. PTSD can be severe and disabling, characterised by flashbacks, nightmares, avoidance, numbing and hypervigilance.

As in APMS 2014, all participants completed the 17-item PTSD Checklist - Civilian (PCL-C) irrespective of whether they reported a traumatic event. Those scoring 50 or more who also scored positively for specific domains in the Diagnostic Statistical Manual (DSM) IV were identified as screening positive for PTSD in the past month. A positive screen did not indicate presence of PTSD, rather the presence of sufficient symptoms to warrant further investigation.

• The proportion reporting a lifetime trauma increased from 31.2% in 2014 to 37.4% in 2023/4 for females. It remained stable for males (31.5% in 2014 and 32.0% in 2023/4). Self-reported lifetime trauma was similar across age groups in 2023/4. 
• Overall, one in twenty adults screened positive for PTSD using the PCL-C. Prevalence was 4.4% in 2014 (95% CI 3.8, 5.0) and 5.7% in 2023/4 (95% CI 4.9, 6.6).
• Screening positive for PTSD varied between demographic groups. Women (6.1%) were more likely than men (5.0%) to screen positive for PTSD, and prevalence was higher in younger than older age groups. In terms of variation by ethnicity, prevalence was highest for the Mixed/multiple and other group (8.1%) and lowest for the Asian/Asian British group (2.4%).

• There was a strong socioeconomic association with both self-reported trauma and screening positive for PTSD. Those with problem debt (16.4%) were three times more likely to screen positive for PTSD than those with no problem debt (4.6%). Screening positive for PTSD was also more likely among adults living in the most deprived fifth of areas (9.4%), and among those who were unemployed (19.9%) or economically inactive (15.1%).

• One in ten adults in poor physical health screened positive for PTSD. People with a limiting physical health condition (44.7%) were more likely than those without (29.5%) to report a traumatic event, and about three times more likely to screen positive for PTSD (10.1% compared with 3.4%).

• Over half (55.7%) of those screening positive for PTSD were receiving mental health treatment. This was more likely to take the form of medication (45.6%) than psychological therapy (23.8%). Some were receiving both medication and psychological therapy (13.8%).  

Many people will experience traumatic events during their life, such as road traffic accidents, assaults or natural disasters. Traumatic events are defined as those sufficiently severe to make individuals fear for their own – or their loved ones’ – lives or safety. They are not randomly distributed among the general population. Certain groups or individuals are at higher risk of exposure (Breslau et al. 2008), including military personnel, emergency service workers and refugees. Prevalence of reported traumatic events has been found to be higher among people with low income, low social support and a history of mental health conditions (Brewin et al. 2000; Knipscheer et al. 2020; NICE 2024). In addition, research has shown that subjective perception of threat is more important for the development and maintenance of PTSD than objective severity of the trauma itself (Ehlers and Clarke 2000).

People commonly feel distressed during and immediately after traumatic events, experiencing, for example, symptoms of insomnia and anxiety. These symptoms usually dissipate with time. Although this is the usual response, symptoms may sometimes persist, and some individuals go on to develop posttraumatic stress disorder (PTSD) (Royal College of Psychiatrists 2021). This can be a severe and disabling condition, characterised by flashbacks, nightmares, avoidance, numbing and hypervigilance. PTSD is often comorbid with other mental (Rytwinski et al. 2013) and physical (Sareen 2014) health conditions.

Epidemiological studies of PTSD typically rely on a subjective assessment by the participant as to whether a particular event was sufficiently severe to justify being a trauma, as well as relying on self-reported assessment of their symptoms. This raises the possibility of reporting bias (Roemer et al. 1998). In the 2014 and 2023/4 Adult Psychiatric Morbidity Surveys (APMS), PTSD screening questions were therefore asked of everyone irrespective of whether they reported trauma. This chapter presents the proportion of the whole sample screening positive for PTSD, without adjustment for whether traumatic experiences were reported. Self-reported trauma and screening positive for PTSD were analysed independently of each other.

The National Institute for Health and Care Excellence (NICE) guidelines highlight that people with PTSD may feel apprehensive, anxious, or ashamed. They may avoid treatment, believe that PTSD is untreatable, or have difficulty developing trust. The guidelines recommend active monitoring with people in the first month after a trauma is experienced, and that trauma focused cognitive behavioural therapy should be offered to those diagnosed with PTSD or who have symptoms. Eye movement desensitisation and reprocessing (EMDR) should be considered for those who prefer it (NICE 2018).

In this chapter, the prevalence of self-reported exposure to trauma and screening positive for PTSD are reported, overall and in relation to demographic and socioeconomic factors. Levels of comorbidity with mental and physical health conditions are presented, as well as mental health related service use and treatment.

PTSD

Individuals who have experienced, witnessed, or been confronted with an event or events involving actual or threatened death or serious injury, or a threat to the physical integrity of self or others may go on to develop PTSD (American Psychiatric Association 1994). Their response must have involved intense fear, helplessness, or horror. Symptoms can develop within weeks but according to the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (World Health Organization 1993) onset is almost always within six months. It may take months or even years for individuals to recognise the symptoms and to seek help from appropriate services. Delayed presentation is common but there is also some evidence that PTSD may have a delayed onset (Andrews et al. 2007).

According to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV, APA 1994) the symptoms are grouped into three clusters:

• Re-experiencing (including recurrent distressing images, thoughts, dreams or perceptions of the event)
• Avoidance and numbing (avoiding thoughts, feelings, activities or conversations associated with the trauma, diminished interest or participation in activities, feelings of detachment or estrangement from others)
• Hyperarousal (including difficulty falling or staying asleep, irritability or outbursts of anger, difficulty concentrating, hypervigilance and an exaggerated startle response)

A key aim of the APMS series is to understand trends over time, so the DSM-IV scoring approach has been applied to the data for the purposes of current reporting (Pai et al. 2017). While DSM-5 (APA 2013) separates the avoidance and numbing symptoms into different groups, this report has not followed this approach to ensure consistency across the series. For a diagnosis of PTSD, symptoms must have been evident for more than one month and must cause clinically significant distress or impairment in social, occupational, or other areas of functioning.

PTSD Checklist - Civilian (PCL-C)

The PTSD Checklist (PCL) is a 17-item self-report measure reflecting DSM-IV symptoms of PTSD (Blanchard et al. 1996). It was used in both APMS 2014 and 2023/4 and formed part of the self-completion section of the interview.

The PCL has a variety of clinical and research purposes, including:

• Identifying individuals with probable PTSD
• Aiding in diagnostic assessment of PTSD
• Monitoring change in PTSD symptoms over time. 

The PCL-C (civilian) asks about symptoms in relation to ‘a stressful experience’ (i.e. generic “stressful experiences”) and can be used with any population. This version simplifies assessment based on multiple traumas because symptoms are not attributed to a specific event.

The response options are:

• not at all (scored 1) 
• a little bit (2)  
• moderately (3) 
• quite a bit (4) 
• extremely (5). 

A total symptom severity score (ranging from 17 to 85) can be obtained by summing the scores from each of the 17 items listed below. There are several ways of scoring the PCL. For this report, a positive screen was defined as a score of 50 or more, together with endorsement of the DSM-IV criteria, identified as positive responses to:

• at least one B item (questions 1–5, re-experiencing symptoms)
• three C items (questions 6–12, avoidance and numbing)
• two D items (questions 13–17, hyperarousal symptoms).

Where a participant missed three or more items, for example due to responding ‘don’t know’ or refusing to answer, no score was derived. This applied in 62 cases (1.0%).

The PCL-C is referred to in this chapter as a screen for reasons of convention. However, it is not currently recommended as part of an official screening programme in England. A positive screen for PTSD does not mean that someone necessarily has the disorder; instead, it indicates that someone has sufficient symptoms to warrant a clinical assessment.

Note that all participants undertaking the self-completion section of the interview were asked the PCL-C items, and screening positive for PTSD was not conditional on reporting a traumatic event or experience. This was because assessment of whether an experience counts as traumatic is subjective and can vary between groups, potentially introducing bias.

The PTSD Checklist - Civilian (PCL-C)

Below is a list of problems and complaints that individuals sometimes have in response to stressful life experiences. Please read each one carefully, and indicate how much you have been bothered by that problem in the last month:

Exposure to traumatic events or experiences

Irrespective of responses to the PCL-C, all participants were asked, after completing the PCL-C, whether a traumatic event or experience had happened to them at any time in their life. This was also part of the self-completion section of the interview. To clarify the nature and severity of traumatic stressor that should be included, the following was stated:

‘The term traumatic event or experience means something like a major natural disaster, a serious automobile accident, being raped, seeing someone killed or seriously injured, having a loved one die by murder or suicide, or any other experience that either put you or someone close to you at risk of serious harm or death.’

Participants were not asked to specify the nature or number of events experienced. Screening positive for PTSD was not conditional on reporting a traumatic event or experience.

Self-reported Trauma, by age and gender

Lifetime experience of self-reported trauma

Overall, about one in three (34.8%) adults reported having experienced at least one major trauma during their lifetime. If all adults in the population had been asked this, it is likely that the proportion reporting that they had ever experienced a trauma would be between 33.2% and 36.4% (referred to as the 95% confidence interval (CI)). It should be noted that whether a participant reports having experienced a traumatic event involves a subjective assessment and is dependent on recall.

This proportion varied by gender. Women (37.2%, 95% CI 35.1, 39.3) were more likely than men (31.9%, CI 29.5, 34.3) to report a traumatic event in their lifetime. The proportion of adults reporting a traumatic event was similar across age groups.

In 2023/4, based on self-reported data, an estimated 16.2 million adults living in England had experienced at least one major trauma during their lifetime.

Screening positive for PTSD in past month, by age and gender

About one in twenty (5.7%) adults screened positive for PTSD in the past month (95% CI 4.9, 6.5). This equates in the general population in England to an estimated 2.6 million adults screening positive for PTSD.

Women (6.1%, CI 5.1, 7.2) were more likely to screen positive for PTSD than men (5.0%, CI 3.8, 6.4). The proportion with a positive PTSD screen varied by age, from 11.4% (CI 7.8, 16.4) of those aged 16 to 24 years, decreasing to 0.5% (CI 0.2, 1.2) of those aged 75 years and over.

Experience of PTSD symptoms, by age and gender

To identify people screening positive for PTSD, all participants were asked about a range of symptoms in the past month. A quarter (25.0%) reported re-experiencing a traumatic event and 22.6% reported symptoms of arousal such as difficulty with sleep, irritability, concentration and hypervigilance. 13.9% reported avoidance.

Women (27.8%) were more likely than men (21.6%) to report re-experiencing a traumatic event. A similar pattern was observed for arousal (experienced by 24.5% of women and 20.3% of men). There was no difference by gender in the reporting of avoidance.

The prevalence of individual PTSD symptoms varied by age. For all symptoms, prevalence was highest in younger people and decreased with age. For example, 36.6% of those aged 16 to 24 reported re-experiencing a trauma, decreasing to 17.6% of those aged 65 to 74 and 17.9% of those aged 75 and over.

For more information: Table 3.1 and Table A1 for confidence intervals

Self-reported Trauma and screening positive for PTSD in 2014 and 2023/4

Note that the trend data analyses were carried out by sex (male and female) rather than gender (men and women) to allow for comparison with 2014. See How to interpret the findings for information on how changes over time were assessed.

The proportion of adults reporting having experienced at least one traumatic event during their lifetime was higher in 2023/4 (34.8%, 95% CI 33.2 to 36.4) than in 2014 (31.4%, CI 30.0, 32.7). This upward trend was evident among females (31.2% in 2014, CI 29.6, 32.8; 37.4% in 2023/4, CI 35.4, 39.5) but not among males (31.5% in 2014, CI 29.5, 33.6; and 32.0% in 2023/4, CI 29.7, 34.5).

The proportion of adults screening positive for PTSD was 4.4% in 2014 (CI 3.8, 5.0) and 5.7% in 2023/4 (CI 4.9, 6.6). The pattern was similar for male and female participants.

For more information: Table 3.2 and Table B1 for confidence intervals

Variation in self-reported Trauma and screening positive for PTSD by other characteristics

Ethnic group

The age-standardised prevalence of self-reported trauma varied between ethnic groups. It was highest among Black/Black British adults (37.8%, 95% CI 29.3, 47.2) and lowest among Asian/Asian British adults (20.0%, CI 14.7 26.6).

There was also variation by ethnic group in the proportion screening positive for PTSD. 8.1% of adults from a Mixed/multiple or other background screened positive for PTSD (CI 4.3, 14.8), 6.4% of White British adults (CI 5.4, 7.6) and 4.4% of Black/Black British adults (CI 2.3, 8.5). Screening positive for PTSD was lowest among the Asian/Asian British group (2.4%, CI 1.3, 4.4). It should be noted that the confidence intervals for some estimates were wide and overlapping, so apparent differences between ethnic groups should be treated with caution.

For more information: Table 3.3 and A2 for confidence intervals 

Employment status

Among participants of working age (those aged 16 to 64 years), the age-standardised prevalence of self-reported trauma and of screening positive for PTSD both varied by employment status.  

• Those who were economically inactive were more likely to recall experiencing a traumatic event (41.5%) than those who were unemployed (31.2%) or in employment (32.7%).  
• The proportion screening positive for PTSD was higher in people who were unemployed (19.9%) or  economically inactive (15.1%) than among those who were in employment (4.7%).  

For more information: Table 3.4

Problem debt

In age-standardised analyses, being seriously behind with debt repayments or having utilities cut off was associated with both having experienced a traumatic event and screening positive for PTSD. See the APMS 2023/4 Methods documentation for more information on how problem debt was derived.

• One in two (50.5%) adults with problem debt had experienced a traumatic event, compared with one in three (33.4%) of those not experiencing problem debt.
• One in six (16.4%) adults with problem debt screened positive for PTSD, compared with one in twenty (4.6%) among those not experiencing problem debt.

For more information: Table 3.5

Area-level deprivation

Age-standardised comparisons showed that the likelihood of experiencing a trauma and of screening positive for PTSD both varied by IMD quintile.

• The proportion reporting a traumatic event ranged from 39.9% of adults living in the most deprived areas to 32.8% of those living in the least.
• One adult in ten living in the most deprived areas (9.4%) screened positive for PTSD, compared with 3.9% of those in the least deprived areas.

For more information: Table 3.6

Region

There was no statistically significant variation in levels of exposure to traumatic events or screening positive for PTSD across regions.

For more information: Table 3.7

Comorbidity

Physical health conditions

Those with a limiting physical health condition were more likely than those without a limiting physical health condition to have experienced trauma (44.7% compared with 29.5%) and three times as likely to screen positive for PTSD (10.1% compared with 3.4%). 

For more information: Table 3.8

Common mental health conditions

• About half (53.2%) of people with a CMHC reported experiencing a major lifetime trauma, compared with 30.1% of those without a CMHC. 
• Among people with a CMHC, 22.2% screened positive for PTSD. At 1.1%, screening positive for PTSD was rare among those not identified with a CMHC. 

For more information: Table 3.8

Self-diagnosis and professional diagnosis of PTSD

Participants were shown a list of mental health conditions and asked whether they thought that they had ever had any of them. The list included ‘posttraumatic stress disorder’. Those who reported that they thought that they have had posttraumatic stress disorder were asked if this had been diagnosed by a professional, and if so, whether the condition had been present in the past 12 months. 

Overall, 4.9% of adults reported that they felt that they have had PTSD, and 3.1% of adults reported that they had been diagnosed with PTSD by a professional. 

Among those screening positive for PTSD, 27.9% believed that they have had PTSD (compared with 3.5% of those who screened negative). 18.9% of those who screened positive reported that they had been diagnosed with PTSD by a professional, and 17.1% of those who screened positive reported that they had been diagnosed by a professional and had experienced symptoms in the past 12 months. 

For more information: Table 3.9

Treatment

Treatment and service use

Participants were asked about use of different types of mental health treatment and services. Two types of mental health treatment were asked about: current medication and psychological therapy for a mental or emotional problem. The use of a range of health, community and day care services over the past year were also asked about. This treatment and service use could have been for any mental health condition and was not necessarily related to their PTSD.

Over half of those who screened positive for PTSD (55.7%) were currently receiving some form of treatment for a mental or emotional problem, compared with 13.1% of those who screened negative.

The most common form of treatment among those who screened positive for PTSD was psychotropic (mental health) medication, either on its own (31.9%), or in combination with psychological therapy (13.8%). About one quarter of those who screened positive for PTSD were currently having psychological therapy (23.8%). Psychological therapy without medication was the least common form of treatment (10.1%).

People screening positive for PTSD were five times more likely than those who screened negative to have used a healthcare service in the past year for a mental or emotional problem (53.7% compared with 10.8%). They were also five times more likely to have used community care services (29.0% compared with 5.8%) and three times as likely to have used day care services in the past year (10.9% compared with 3.4%).  

For more information: Table 3.10

Psychotropic medication

Participants were asked which psychotropic medications, used to treat mental health conditions, they take. These could have been for any mental health condition and were not necessarily related to PTSD.

About one in two adults who screened positive for PTSD were currently taking psychotropic medication (45.6%), compared with one in ten (10.4%) among those who screened negative. The most common types of medication used among adults who screened positive for PTSD were those primarily used for the treatment of depression (43.2%) or anxiety (38.5%). These were also the most commonly reported psychotropic medications used by those who screened negative for PTSD (9.8% and 9.0% respectively).

For more information: Table 3.11

APMS provides insight on self-reported trauma and PTSD, but the data are limited by being subjective and cross-sectional. Epidemiological studies on PTSD in the general population are relatively rare, as most studies have focused on groups at high risk of exposure to trauma, notably military personnel (Palmer et al. 2019), other specific occupational groups like police (Stevelink et al. 2020), firefighters (Boffa et al. 2017) and content moderators (Zalta et al. 2021), or populations exposed to natural disasters (Wang et al. 2019) or war (Johnson et al. 2022). This chapter presents the prevalence of self-reported lifetime trauma and screening positive for PTSD in the past month based on a general population sample of adults living in England. This is the second time the PTSD Checklist - Civilian (PCL-C) has been used in APMS, enabling comparison between 2014 and 2023/4.

Around a third (34.8%) of adults reported a major trauma in their lifetime, similar to the 31.4% reporting this in 2014. Both figures are lower than the World Mental Health (WMH) surveys multi-country estimate of 70%. The APMS and WMH survey methodology differed: WMHS covered 29 specific types of events (Kessler et al. 2017) while APMS had a single question in the PTSD section of the interview. This question gave examples of types of events and specified that they involved the participant, or someone close to them, being at risk of severe harm or death. Major challenges, however, have been noted with both approaches given their reliance on subjectivity and recall (Frissa et al. 2016). 

In APMS 2023/4, women were more likely than men to report traumatic exposure, while in 2014 they had been equally likely to report this (Fear et al. 2016). When comparing results for APMS 2014 and 2023/4, the proportion recalling trauma increased for female participants but not for male participants. The WMH surveys considered the types of traumatic experiences reported and found that women were much more likely than men to report exposure to intimate partner sexual violence, equally likely to report the unexpected death of a loved one, but less likely than men to report other specific trauma types. It also found that sexual violence was a form of trauma with particularly strong associations with subsequent PTSD (Kessler et al. 2017). The APMS did not ask participants in the PTSD section of the interview about the nature of the specific trauma (or traumas) they had experienced, given concern that this may cause distress in the interview (McManus and Brugha 2025).

One in twenty adults screened positive for PTSD in the past month (5.7%), while prevalence in 2014 was 4.4% (Fear et al. 2016). The confidence intervals for these two results overlap slightly. As described in How to Interpret the Findings, this was not considered an increase in prevalence since 2014. Consequently these results were not considered to be a significant change over time. It should be noted that this is the proportion of all adults, and the prevalence estimates presented in this chapter were not conditional on participants reporting trauma exposure. A quarter of those screening positive for PTSD reported that they thought they have had PTSD at some point in their life and 17.1% reported having been professionally diagnosed with PTSD and having symptoms in the past year. Examination of the PTSD symptom clusters showed that the most commonly reported were re-experiencing symptoms, more often reported by women than men. Screening positive for PTSD varied by age, with the younger age groups being more likely to screen positive. Younger people were as likely as older age groups to report having experienced trauma in their lives. It is possible that traumatic experiences have increased, that younger people are more likely to describe events as traumatic or that memory of traumatic experiences can decline over time.

Patterns of association between screening positive for PTSD and sex and ethnicity may be shifting. In 2014, the proportion screening positive for PTSD was similar for male and female participants, while in 2023/4 prevalence was higher in female than male participants. Similarly, while in 2014 differences across ethnic groups did not reach statistical significance (although appeared highest among Black/Black British adults), in 2023/4 prevalence was highest among adults in the Mixed/multiple and other ethnic group and lowest among those from an Asian or Asian British background.

People who may be more likely to be experiencing socioeconomic adversity were more likely to report trauma and screen positive for PTSD. Socioeconomic factors are known to be associated with a range of mental health problems, but due to the cross-sectional nature of these data it is not possible to examine causality. Recall of a traumatic lifetime event and screening positive for PTSD were both higher for those who were economically inactive and those with problem debt, while screening positive for PTSD was additionally associated with being unemployed. This is consistent with results from a longitudinal study in the Netherlands which found that, after controlling for pre-trauma mental health problems and lack of support, pre- and post-trauma financial problems further increased the risk of probable PTSD (van der Velden et al. 2023). 

Over half of those screening positive for PTSD were receiving mental health treatment, a similar level to APMS 2014. NICE guidelines for treatment for people with PTSD (NICE 2018) recommend psychological interventions, with medication use not recommended as the primary treatment. In the current study, of those screening positive for PTSD, about a third were receiving antidepressants and/or anxiolytics (medication to treat anxiety) and a quarter were receiving some form of psychological therapy either on its own (the NICE recommended treatment for PTSD) or in combination with medication. It is important to note that APMS data cannot be used to assess the appropriateness or not of the treatment participants reported receiving, especially given the survey only used a brief screening tool for PTSD, not a detailed assessment. There were also inequalities in who received psychological therapies. APMS 2014 showed that people in the Black/Black British group were the least likely to be in receipt of any mental health treatment (Ahmad et al. 2022). A review of services provided by NHS Talking Therapies found that people from Black and other minoritised ethnic backgrounds experienced poorer access to, and outcomes from, NHS Talking Therapies (National Collaborating Centre for Mental Health 2023).  

Screening positive for PTSD is prevalent and there remain inequalities, but these data go some way towards improving the evidence base for England.

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Please cite this chapter as:

Wilson, H., Wilson, C., Morris, S., Fear, N., Hatch, S., McManus, S., Oram, S., & Wessely, S. (2025). Posttraumatic stress disorder. In Morris, S., Hill, S., Brugha, T., McManus, S. (Eds.), Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. NHS England.