Daily variation in post traumatic stress symptoms in individuals with and without probable post traumatic stress disorder

Abstract

BackgroundLittle is known about the extent to which post traumatic stress symptoms (PTSS) vary from day to day in individuals with post traumatic stress disorder (PTSD). This study examined the variation of PTSS by day of the week, and whether daily or day of week variation differs between individuals with and without probable PTSD.MethodsSubjects (N = 80) were assessed for probable PTSD at enrollment. Using an ecological momentary assessment methodology, PTSS were assessed four times daily by self-report for 15 days. Linear mixed models were used to assess the relationship of PTSS and day of the week.ResultsPTSS varied across the seven days of the week among participants with PTSD (p = .007) but not among those without PTSD (p = .559). Among those with PTSD, PTSS were lowest on Saturday. PTSS were higher on weekdays (Monday through Friday) versus weekends (Saturday and Sunday) in those with PTSD (p = .001) but there were no weekday/weekend differences among those without PTSD (p = .144). These variations were not explained by sleep medication, caffeine or alcohol use.ConclusionsAmong individuals with probable PTSD, post traumatic stress symptoms vary by the day of the week, with more symptoms on weekdays compared to weekends. Determination of the factors associated with the daily variation in PTSD symptoms may be important for further developing treatments for PTSD.

Association Between Positive Results on the Primary Care–Posttraumatic Stress Disorder Screen and Suicide Mortality Among US Veterans

“…Another reason to use and incorporate the PC-PTSD into suicide risk assessment strategies is that, unlike a medical records diagnosis, the PC-PTSD asks a patient about PTSD symptoms experienced within the past month. The symptom severity of PTSD may fluctuate daily, 25 and this fluctuation has been linked to adverse health outcomes. 44 Although further research is warranted, findings from the present analysis suggest that the PC-PTSD might be a better indicator of immediate suicide mortality risk than a static diagnosis obtained from the medical record.…”

Post traumatic stress symptom variation associated with sleep characteristics

“…Future research may determine whether sleep characteristics have a greater impact on specific symptoms (e.g., hyperarousal symptoms) versus other symptoms. Some sleep characteristics such as sleep duration may vary during the week and it will be important to examine whether they influence the day of week variation in PTSS [32]. Finally, future studies should examine whether interventions for sleep disturbance can prevent the onset of PTSD.…”

“…Of the N = 141 who enrolled, n = 61 with probable PTSD were included in data analyses, n = 59 did not have PTSD, n = 12 did not return the daily assessments, n = 6 did not provide four or more daily assessments, n = 2 did not complete the assessment of probable PTSD, and n = 1 was removed as an outlier. This study was part of a larger data collection project looking at post traumatic stress in U.S. military personnel and methods common to the larger study can be found in a prior publication [32].…”

“…Using an EMA methodology, participants completed four daily assessments per day for the following 15 days (see prior publication [32] for details of daily assessments). The first 19 consecutive subjects (31.1%) completed daily assessments on paper questionnaires and the next 42 subjects (68.9%) completed the same assessments on an Apple Inc. iPad 2 with software designed for this study.…”

“…Ecological momentary assessment (EMA), a method of repeated experience sampling of subjects in their natural environment, is well-suited to assessing change in symptoms over time [30,31]. Recent studies have used EMAs to examine PTSS from day to day [32][33][34][35], sleep diaries to examine sleep disturbance from night to night [8,36], and EMAs and sleep diaries combined to examine the temporal relationship between sleep disturbance and PTSS [37][38][39].…”