Sarah R Lowe1, Andrew Ratanatharathorn2, Betty S Lai3, Willem van der Mei4, Anna C Barbano5, Richard A Bryant6,7, Douglas L Delahanty8, Yutaka J Matsuoka9, Miranda Olff10,11, Ulrich Schnyder12, Eugene Laska13, Karestan C Koenen14, Arieh Y Shalev15, Ronald C Kessler16. 1. Yale University, School of Public Health. 2. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. 3. Lynch School of Education and Human Development, Boston College, Chestnut Hill, USA. 4. Data Scientist, New York County Defender Services. 5. Department of Psychology, University of Toledo. 6. School of Psychology, University of New South Wales, Sydney, NSW2052, Australia. 7. Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, Australia. 8. Kent State University, Department of Psychological Sciences, Kent, OH, USA. 9. Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan. 10. Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 11. ARQ National Psychotrauma Centre, Diemen, The Netherlands. 12. University of Zurich, Zurich, Switzerland. 13. Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University School of Medicine. 14. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 15. Department of Psychiatry, New York University School of Medicine, New York, New York. 16. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. METHODS: This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. RESULTS: Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. CONCLUSIONS: The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
BACKGROUND: Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. METHODS: This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. RESULTS: Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. CONCLUSIONS: The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
Entities:
Keywords:
Latent class growth analysis; posttraumatic stress; resilience; traumatic injuries
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