Predictors of post-traumatic stress disorder following severe injury

Abstract

The chronicity and morbidity of established post-traumatic stress disorder (PTSD) has stimulated interest in recognizing and understanding the early development of the disorder. Acute stress disorder, a new diagnosis intended to facilitate early case detection, rests on the occurrence of dissociative reactions. It remains uncertain whether dissociation is a universal or unique early predictor of subsequent PTSD. Traumatic injury is an important and relatively understudied antecedent of PTSD. The objective of this study was to preliminarily identify which previously implicated early reactions and risk factors would apply to the prediction of PTSD following severe traumatic injury. Patients admitted to a regional Level I trauma center following life threatening events who had recall of the incident and did not have signs of traumatic brain injury or recent psychopathology were enrolled. Comprehensive assessments were conducted during hospitalization and after discharge approximately 2 months after the traumatic event. At follow-up, 24% of the available 50 subjects met full criteria for PTSD and an additional 22% met criteria for two of three symptom clusters. Early symptoms of heightened arousal and coping with disengagement were independent predictors of PTSD severity at follow-up. Relationships to initial dissociative reactions and a diagnosis of ASD were not significant. These early predictors found in a setting of severe injury only partially overlap findings from previous PTSD studies.

Coping Strategies and Posttraumatic Stress Symptoms in Post-ICU Family Decision Makers

“…Some authors have presumed the presence of PTSD symptoms causes the use of avoidant coping (36,50). However, other authors have reported avoidant coping as a predictor of later PTSD symptoms in populations of Gulf War victims, domestic violence victims, and traumatic injury victims (51)(52)(53). A recent study measured coping strategy in 56 mothers of premature infants in the neonatal ICU (31).…”

Trauma-induced insomnia: A novel model for trauma and sleep research

“…It is possible that nightmares may emerge after a longer interval of time where more complex emotional processing of the traumatic event has had the opportunity to occur [17], whereas insomnia may be proximally linked to, and a more immediate consequence of, acute trauma exposure [15]. However, this is not supported by other studies showing that nightmares also manifest in the immediate aftermath of trauma, and that peritraumatic nightmares often resolve [18,19].…”

Avoidant coping and PTSD symptoms related to domestic violence exposure: A longitudinal study

“…Similarly, cross-sectional studies have found avoidant coping positively associated with PTSD symptoms among war veterans (e.g., Sutker, Davis, Uddo, & Ditta, 1995), motor vehicle accident survivors (e.g., Bryant & Harvey, 1995), and victims of sexual and nonsexual assault (Dunmore, Clark, & Ehlers, 1999;Valentiner, Foa, Riggs, & Gershuny, 1996). The few longitudinal studies of the impact of coping behaviors on posttraumatic stress have also demonstrated that more avoidant coping (e.g., Benotsch et al, 2000;Mellman, David, Bustamante, Fins, & Esposito, 2001;Sharkansky et al, 2000) predicted more psychological symptoms at a later time point. However, no longitudinal study has yet included a sample of IPV survivors.…”