Key Papers

The Economic Burden of PTSD in Northern Ireland

Journal of Traumatic Stress, June 2015; Vol 28, issue 3; pp 191-197

Ferry, F; Brady, SE; Bunting, BP; Murphy, SD; Bolton, D; O’Neill, SM

We think this might be currently the only health economic assessment of population level PTSD in the English language literature.   The study was undertaken by the Northern Ireland Centre for Trauma and Transformation in partnership with the Ulster University, with support from the Lupina Foundation of Canada.  It will be of interest to readers concerned with the costs of trauma on populations and of particular interest to those with responsibilities for planning and funding responses for emergency, war and conflict-affected communities.  Through an investigation of the costs associated with PTSD in the population in Northern Ireland, the study provides an insight into the costs of not addressing early and effectively the impact of traumatic events on populations.  The findings provide a basis for policy decisions that secure the development of appropriate services.

You can access our earlier report based on the same analysis here.  To access the actual published paper you will need an account with the publisher.  In summary, the objective of this study was to estimate the economic costs of posttraumatic stress disorder (PTSD) among the Northern Ireland (NI) adult population. The authors present a prevalence-based, bottom-up study based primarily on data from 1,986 participants in the Northern Ireland Study of Health and Stress (NISHS). Both direct costs of treatment and indirect costs of productivity losses were included. Units of service and medication resource use were obtained from the NISHS and combined with their relevant unit costs from the Personal Social Services Research Unit and Prescription Costs Analysis data for NI. Indirect costs included the costs of incapacity days due to PTSD and presenteeism costs, with gender-specific wage rates used as the relevant unit costs. The total direct and indirect cost of PTSD in NI (2008) was £172,756,062. This figure is likely to be conservative due to the exclusion of a number of cost categories. Nevertheless, comparison of estimates of the burden of PTSD with the estimated cost of treating all adults with PTSD with the recommended treatments shows the potential for substantial economic gains to be made through the extension of, and investment in, effective evidence-based services and therapeutic interventions.

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The effects of the Omagh bomb on adolescent mental health: a school-based study

PubMed February 2015

Duffy, M; McDermott, M; Percy, A; Ehlers, A; Clark, DM; Fitzgerald, M; Moriarty, J.

The main objective of this study was to assess psychiatric morbidity among adolescents following the Omagh car bombing in Northern Ireland in 1998. With the assistance of the Western Education and Library Board, local schools and parents – data was collected within schools from adolescents aged between 14 and 18 years via a self-completion booklet comprised of established predictors of PTSD; type of exposure, initial emotional response, long-term adverse physical problems, predictors derived from Ehlers and Clark’s (2000) cognitive model, a PTSD symptoms measure (PDS) and the General Health Questionnaire (GHQ).  Those with more direct physical exposure were significantly more likely to meet caseness on the GHQ and the PDS. The combined pre and peri trauma risk factors highlighted in previous meta-analyses accounted for 20% of the variance in PDS scores but the amount of variance accounted for increased to 56% when the variables highlighted in Ehlers and Clark’s cognitive model for PTSD were added.

High rates of chronic PTSD were observed in adolescents exposed to the bombing. Whilst increased exposure was associated with increased psychiatric morbidity, the best predictors of PTSD were specific aspects of the trauma (‘seeing someone you think is dying’), what you are thinking during the event (‘think you are going to die’) and the cognitive mechanisms employed after the trauma. As these variables are, in principle, amenable to treatment – the results have implications for teams planning treatment interventions after future traumas.

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Patterns of Suicidal Ideation and Behavior in Northern Ireland and Associations with Conflict Related Trauma, O’Neill, S; Ferry, F; Murphy, S; Corry, C; Bolton, D; Devine, B; Ennis, E; Bunting, B; Published 19th March 2014

The paper can be accessed here on the Plos One website, or follow this link:  2014 Suicide and the Northern Ireland Conflict:Troubles FINAL.

2013Nov Title Symposium

Photograph courtesy of © Lieven Van Assche

“To be a victim no more – the progressive aim of post-conflict transformation.”

Paper given by the ICRT at The International Symposium for Trauma Treatment and the Transformation of Societies; Brussels; 4th November 2013.  The paper can be accessed here.  2013 Nov D.Bolton Symposium Final


Title: A School Based Study of Psychological Disturbance in Children following the Omagh Bomb

The paper can be downloaded here, or 2013 Oct Omagh Childrens Study camhp published pdf.

TITLE: A Community Study of the Psychological Effects of the Omagh Car Bomb on Adults

An important paper on the psychological impact of the Omagh car bombing on adults with implications for those suffering trauma-related psychological problems and disorders, for therapeutic practice and goals and for trauma service design in areas of conflict.  The paper was published in October 2013 by  

Full text: 2013 Oct The Omagh car bomb community study Published

DBolton, MVervernne, PLuyten


ICRT contributes to landmark event at Flemish Parliament to mark the announcement of commemorations for the Great War

Click here to read David Bolton’s paper for the Flemish Parliament meeting. Address by David Bolton of the Initiative for Conflict

Click here to read Patrick Luyten’s response. 2013 Jul Response by Patrick Luyten to David Bolton of the Initiative for Conflict

Launch of key report into the human impact of the Troubles, March 2013

Click here to read more about the launch and the Report’s key findings.   2013 Mar Launch of Troubled Consequences Report


Staff of the Northern Ireland Commission for Victims and Survivors, Adrain McNamee and Neil Foster, with David Bolton and Barney Devine of the Initiative for Conflict-Related Trauma, and Professor Brendan Bunting and Doctors Siobhan O’Neill and Finola Ferry of the Bamford Centre, University of Ulster, at the launch of the ‘Troubled Consequences’ Report on the 14th March 2013, Malone House, Belfast.

Bunting, B; Ferry, F; O’Neill, S; Murphy, S; Bolton, D; Trauma Associated With Civil Conflict and Posttraumatic Stress Disorder: Evidence From the Northern Ireland Study of Health and Stress; Journal of Traumatic Stress; vol 26, Issue 1, pages 134-141, February 2013

Ferry, F; Bolton, D; Bunting, B; O’Neill, S; Murphy, S; The Experience and Psychological Impact of ‘Troubles’ related Trauma in Northern Ireland; The Irish Journal of Psychology; Volume 31, Issue 3-4, 2010

Related papers from the University of Ulster Bamford Centre for Mental Health and Well-being

Bunting, B; Murphy, S; O’Neill, S; Ferry, F; Lifetime prevalence of mental health disorders and delay in treatment following initial onset; evidence from the Northern Ireland Study of Health and Stress;

Bunting, B; Murphy, S; O’Neill, S; Ferry, F; Prevalence and treatment of 12-month DSM-IV disorders in the Northern Ireland Study of Health and Stress; Social Psychiatry and Psychiatric Epidemiology; Jan 2013; Vol 48 Issue 1; pp 81-93