Beyond Direct Trauma: Epidemiology of Exposure Modalities, Event Types, and PTSD in a National Polish Sample

Abstract

The epidemiological literature on trauma has largely centered on direct exposure, leaving other exposure pathways underexamined. We broaden this perspective by (1) mapping population-wide trauma exposure across four modalities—direct personal exposure, witnessing, indirect exposure via a close other, and work-related indirect exposure—and (2) estimating event-specific conditional risk of PTSD within each trauma exposure modality, with particular attention to indirect and multimodal exposures. Data came from a national sample of Polish adults (N = 808) collected in 2017. Trauma exposure was assessed with the Multidimensional Trauma Exposure Scale (MTES) and PTSD with the PTSD Checklist for DSM-5 (PCL-5). Trauma exposure was nearly universal (95.1%). Modality-specific exposure rates were 89.5% (direct), 78.9% (witnessed), 63.7% (via close other), and 29.4% (occupational), with significant gender-specific patterns. PTSD prevalence was 23.8%, higher in women than men (26.7% vs. 15.1%; OR = 2.09, 95% CI [1.47, 2.97]). Notably, all PTSD cases reported multimodal exposure. Event-specific patterns within modalities were associated with elevated PTSD risk. These findings show the trauma landscape extends far beyond direct events: indirect and multimodal exposures are common and consequential, suggesting PTSD often reflects the cumulative burden of overlapping exposures. Representing the pre-COVID-19 landscape, the findings constitute a critical baseline for evaluating the subsequent surge in mental health challenges. Consequently, public health surveillance should systematically incorporate these broader exposure pathways to monitor epidemiological trends while requiring rigorous operationalization to avoid diagnostic inflation.