National Religiosity, Collectivism and the “Vulnerability Paradox” in the Cross-National Prevalence of Post-traumatic stress disorder

Although post-traumatic stress disorder (PTSD) occurs throughout the world, studies indicate that it is more prevalent in affluent countries, such as Canada, with greater coping capacity (e.g., higher gross domestic product, number of physicians and hospital beds) than in less affluent nations (countries in Africa, Asia, and South America). In one study, PTSD prevalence was inversely associated with a country’s coping capacities when exposure to trauma was high (Dückers et al., 2016). PTSD prevalence was unexpectedly higher in countries with greater societal and adaptive capacities for coping with trauma than in countries with less coping capacities. In the majority-world, adverse events appear to trigger less PTSD and individuals diagnosed with the disorder are less likely to avoid people that remind them of the traumatic event (Maercker, 2019; Rasmussen et al., 2015). The reasons for these discrepancies are not fully understood, but one explanation might be found in cultural factors (Heine, 2015). Why would trauma exposure more likely lead to PTSD in a country with greater coping capacity than in a majority-world nation with less coping capacity? One might hypothesize that two central aspects of culture that moderate the impact of a traumatic event are religiosity and collectivism. At the country-level, religiosity and collectivism are highest in the majority-world: African countries, India, Muslim-majority Asian and Middle Eastern countries, as well as South and Latin America (Saucier et al., 2015; Berkessel et al., 2021; Pelham et al., 2022). Religiosity and spirituality are also found to be commonly used indigenous models for explaining and treating psychological distress across cultures in Africa, Asia, South America, the Middle East, and the Caribbean. A greater level of religiosity in majority-world nations may facilitate the use of religion- and spirituality-based explanations for traumatic events, as well as collective forms of resilience including communal rituals. Higher collectivism in the majority-world may play a compensatory role where there is a lack of resources by functioning to disperse the burden of individual adversity (Pelham et al., 2022). For example, in Sub-Saharan African contexts, botho/ubuntu, a uniquely African collectivist notion, places community ahead of individual members, and this may confer protective effects. Botho defines a person in relation to others leading to a social interconnectedness that may discourage avoidance and ease the burden of individual adversity (Sodi et al., 2021). Although often overlooked, religiosity and collectivism may be important factors in helping to explain “the vulnerability paradox” in the cross-national prevalence of PTSD. Traumatic events occurring in highly religious and collectivist contexts may be more explainable and less shockingly discrepant than those occurring in nations with lower levels of religiosity and collectivism, and therefore, less likely to trigger PTSD.

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