A Paradox in Individual Versus National Mental Health Vulnerability: Are Higher Resource Levels Associated With Higher Disorder Prevalence?

An earlier study (Dückers, Alisic, & Brewin, 2016) found that countries with greater social and economic resources were characterized by a higher lifetime prevalence of posttraumatic stress disorder (PTSD). Here, we present a similar analysis of national population survey data to examine this vulnerability paradox in relation to other disorders. We predicted the lifetime prevalence of any mental health disorder (i.e., anxiety, mood, substance, and externalizing disorders) in 17 countries based on trauma exposure and country vulnerability data. A substantial proportion of variance in all disorder categories, 32.9% to 53.9%, could be explained by trauma exposure. Explained variance increased by 5 and up to 40 percentage points after adding the variable of vulnerability to the equation. Higher exposure and lower vulnerability levels were accompanied by a higher prevalence in any mental disorder, with the largest effect size in mood disorders (R2 = .76). The interaction between exposure and vulnerability did not explain significant additional variance as it did for PTSD. Because a PTSD diagnosis links psychological, physical, and functional symptoms explicitly to trauma exposure, this might mean that populations in less‐vulnerable countries are more likely to attribute health complaints to exposure. The results of this study suggest that country‐level data can help to better explain the multilayered mechanisms of resilience and vulnerability in the context of trauma. Resumen Spanish s by the Asociación Chilena de Estrés Traumático (ACET) Una paradoja en la vulnerabilidad en salud mental individual versus nacional Vulnerabilidad en Salud Mental Individual vs Nacional Un estudio anterior (Dückers et al., 2016) encontró que los países con mayores recursos económicos y sociales se caracterizan por una mayor prevalencia del trastorno de estrés postraumático (TEPT) a lo largo de la vida. A continuación, presentamos un análisis similar de los datos de la encuesta nacional de población para examinar esta paradoja de la vulnerabilidad en relación a otros trastornos. Predijimos la prevalencia en la vida de cualquier trastorno de salud mental (por ejemplo, trastornos de ansiedad, del estado de ánimo, de sustancias y de externalización) en 17 países basados en la exposición al trauma y datos de vulnerabilidad del país. Una proporción sustancial de la varianza en todas las categorías de trastornos, 32,9% a 53,9%, podría explicarse por la exposición al trauma. La varianza e