Predictors of PTSD and Delayed PTSD After Disaster

Abstract

In the present study we sought to identify factors associated with posttraumatic stress disorder (PTSD) following the World Trade Center Disaster (WTCD) and examine changes in PTSD status over time. Our data come from a two-wave, prospective cohort study of New York City adults who were living in the city on September 11, 2001. We conducted a baseline survey 1 year after the attacks (year 1), followed by a survey 1 year later (year 2). Overall, 2368 individuals completed the year 1 survey, and 1681 were interviewed at year 2. Analyses for year 1 indicated that being younger, being female, experiencing more WTCD events, reporting more traumatic events other than the WTCD, experiencing more negative life events, having low social support, and having low self-esteem increased the likelihood of PTSD. For year 2, being middle-aged, being Latino, experiencing more negative life events and traumas since the WTCD, and having low self-esteem increased the likelihood of PTSD. Exposure to WTCD events was not related to year 2 PTSD once other factors were controlled. Following previous research, we divided study respondents into four categories: resilient cases (no PTSD years 1 or 2), remitted cases (PTSD year 1 but not year 2), delayed cases (no PTSD year 1 but PTSD year 2), and acute cases (PTSD both years 1 and 2). Factors predicting changes in PTSD between year 1 and year 2 suggested that delayed PTSD cases were more likely to have been Latino, to have experienced more negative life events, and to have had a decline in selfesteem. In contrast, remitted cases experienced fewer negative life events and had an increase in selfesteem. We discuss these findings in light of the psychosocial context associated with community disasters and traumatic stress exposures. KeywordsPosttraumatic stress disorder; delayed PTSD; disasters; psychosocial factors; stress exposure It has been well documented that exposure to severe psychological trauma such as war, sexual assault, and community disasters can result in psychological and physical health problems (Boscarino, 1997;Bromet et al., 1982;Kessler et al., 1995b;Kulka et al., 1990;Norris, 1992). The inclusion of stress response syndromes in the DSM-III (American Psychiatric Association, 1980) under posttraumatic stress disorder (PTSD) has stimulated research and focused attention on what constitutes a traumatic event (McFarlane, 2004;Yehuda, 2002). It has also resulted in numerous etiological investigations of stress disorders (Adams et al., 2002;Brewin et al., 2000;Bromet et al., 1982;McFarlane, 1988;1989), and has generated discussions of the consequences of PTSD for physical health and social role obligations (Boscarino, 2004;Kessler, 2000).Recent studies examining PTSD in community samples have estimated that almost 90% of adults have experienced at least one lifetime traumatic event, yet only about 15% of those exposed developed PTSD (Breslau et al., 2004b;Breslau et al., 2005). Thus, factors beyond the traumatic event itself are required to explain the onset of these stre...

The longitudinal course of PTSD among disaster workers deployed to the World Trade Center following the attacks of September 11th

“…Though Norris et al notes that cases of delayed-onset PTSD are less common, reports of their occurrence exist (Koren, Arnon, & Klein, 1999;Mayou et al, 1997;Sungur & Kaya, 2001). Indeed this rate of delayed-onset PTSD is similar to those found in community samples 2-3 years following 9/11 (Adams & Boscarino, 2006;Neria et al, 2010;Norris et al, 2009), though longer-term studies in this population are rare.…”

“…A prospective study using a self-report measure in a communitybased population sample of adults living in New York City on 9/11 assessed 1,681 participants 1 and 2 years following the WTC attacks and found about 3% had delayed-onset probable PTSD over the past year at the follow-up assessment (Adams & Boscarino, 2006). Those with delayed-onset PTSD were more likely to be Latino, to have experienced more negative life events and prior traumas, and to have a decline in self-esteem between time points (Boscarino & Adams, 2009).…”

The Effects of a <b><i>BDNF</i></b> Val66Met Polymorphism on Posttraumatic Stress Disorder: A Meta-Analysis

“…Of those who report experiencing a traumatic event, 5–31% meet the criteria for posttraumatic stress disorder (PTSD; [2-4]). Those who develop PTSD are at risk of adverse outcomes including major depression [5], substance misuse [6], physical health problems [7, 8], unemployment, and marital instability [9].…”

A systems approach to stress, stressors and resilience in humans

“…In the World Trade Center disaster resilience, measured by a likelihood of developing PTSD, was related to age (older did better), gender (males did better), social support (more did better), self-esteem (higher did better) and lifetime history of depression (worse with a positive history), but was not related to education [98]. …”