March 13, 2020
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30% of injury survivors experience moderate-to-severe PTSD symptoms

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More than 30% of civilian-related injury survivors who are treated in EDs exhibited moderate-to-severe PTSD symptoms during the first year after the initial incident, according to study results published in Psychological Medicine.

Those who reported assaultive violence demonstrated greater risk for immediate and longer-term symptoms, researchers found.

“The results provide important information about the form and course of PTSD trajectories, and the factors that are associated with both initial PTSD reactions and the course of symptoms over the first post-trauma year,” Sarah R. Lowe, PhD, assistant professor at Yale University School of Public Health, and colleagues wrote. “The findings highlight the diversity of responses to [post-traumatic events] and the need for researchers and clinicians to approach assessment and treatment with this heterogeneity in mind.”

Studies on the longitudinal course of PTSD symptoms have documented four modal trajectories — low, remitting, high and delayed — with varied proportions across studies. The researchers noted that differences in patient demographic characteristics and trauma types may cause heterogeneity.

To advance the literature on PTSD trajectories, Lowe and colleagues pooled data from six longitudinal studies that included 3,083 adults who sustained civilian-related injuries and were admitted to general hospital EDs in six countries. Each study included three or more assessments of the clinician-administered PTSD scale in the first year after trauma. The researchers used latent class growth analysis to determine the proportion of participants with various PTSD symptom trajectories within and across data sets. Further, they used multinomial logistic regression analyses to examine the type of event leading to the injury, demographic characteristics and trauma history as predictors of trajectories differentiated by their initial course and severity.

Results showed five symptom trajectories across the data sets — low (64.5%), remitting (16.9%), moderate (6.7%), high (6.5%) and delayed (5.5%). Assaultive injuries, female gender, nonwhite race and prior interpersonal trauma were associated with increased risk for initial PTSD reactions. Assaultive injuries, lower education and prior interpersonal trauma were associated with risk for membership in the high (vs. remitting) trajectory, whereas assaultive injuries and female gender were associated with risk for membership in the delayed vs. low trajectory.

“Future research is needed that examines injury across the lifespan to understand the degree to which trajectories may differ by stage of development,” the researchers wrote. “In addition, studies with longer follow-up periods and various types of trauma exposure will enable us to understand whether trajectories may change across the post-trauma period or across types of trauma.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.