Danny Horesh1, Sarah R Lowe2, Sandro Galea3, Allison E Aiello4, Monica Uddin5, Karestan C Koenen6. 1. Department of Psychology, Bar-Ilan University & Depratment of Psychiatry, NYU School of Medicine. Electronic address: danny.horesh@biu.ac.il. 2. Department of Psychology, Montclair State University. 3. Boston University School of Public Health. 4. Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Electronic address: aaiello@email.unc.edu. 5. Department of Psychology, University of Illinois at Urbana-Champaign. Electronic address: muddin@illinois.edu. 6. Department of Epidemiology, Harvard T.H. Chan School of Public Health. Electronic address: kkoenen@hsph.harvard.edu.
Abstract
BACKGROUND: Although PTSD-major depressive disorder (MDD) co-morbidity is well-established, the vast majority of studies have examined comorbidity at the level of PTSD total severity, rather than at the level of specific PTSD symptom clusters. This study aimed to examine the long-term associations between MDD and PTSD symptom clusters (intrusion, avoidance, hyperarousal), and the moderating role of gender in these associations. METHODS: 942 residents of urban Detroit neighborhoods were interviewed at 3 waves, 1 year apart. At each wave, they were assessed for PTSD, depression, trauma exposure, and stressful life events. RESULTS: At all waves, hyperarousal was the PTSD cluster most strongly correlated with MDD. For the full sample, a reciprocal relationship was found between MDD and all three PTSD clusters across time. Interestingly, the relative strength of associations between MDD and specific PTSD clusters changed over time. Women showed the same bidirectional MDD-PTSD pattern as in the entire sample, while men sometimes showed non-significant associations between early MDD and subsequent PTSD clusters. LIMITATIONS: First, our analyses are based on DSM-IV criteria, as this was the existing edition at the time of this study. Second, although this is a longitudinal study, inferences regarding temporal precedence of one disorder over another must be made with caution. CONCLUSIONS: Early identification of either PTSD or MDD following trauma may be crucial in order to prevent the development of the other disorder over time. The PTSD cluster of hyper-arousal may require special therapeutic attention. Also, professionals are encouraged to develop more gender-specific interventions post-trauma.
BACKGROUND: Although PTSD-major depressive disorder (MDD) co-morbidity is well-established, the vast majority of studies have examined comorbidity at the level of PTSD total severity, rather than at the level of specific PTSD symptom clusters. This study aimed to examine the long-term associations between MDD and PTSD symptom clusters (intrusion, avoidance, hyperarousal), and the moderating role of gender in these associations. METHODS: 942 residents of urban Detroit neighborhoods were interviewed at 3 waves, 1 year apart. At each wave, they were assessed for PTSD, depression, trauma exposure, and stressful life events. RESULTS: At all waves, hyperarousal was the PTSD cluster most strongly correlated with MDD. For the full sample, a reciprocal relationship was found between MDD and all three PTSD clusters across time. Interestingly, the relative strength of associations between MDD and specific PTSD clusters changed over time. Women showed the same bidirectional MDD-PTSD pattern as in the entire sample, while men sometimes showed non-significant associations between early MDD and subsequent PTSD clusters. LIMITATIONS: First, our analyses are based on DSM-IV criteria, as this was the existing edition at the time of this study. Second, although this is a longitudinal study, inferences regarding temporal precedence of one disorder over another must be made with caution. CONCLUSIONS: Early identification of either PTSD or MDD following trauma may be crucial in order to prevent the development of the other disorder over time. The PTSD cluster of hyper-arousal may require special therapeutic attention. Also, professionals are encouraged to develop more gender-specific interventions post-trauma.
Authors: Marieke J van Leijden; Brenda W J H Penninx; Charles Agyemang; Miranda Olff; Marcel C Adriaanse; Marieke B Snijder Journal: Soc Psychiatry Psychiatr Epidemiol Date: 2018-05-23 Impact factor: 4.328