Prior histories of posttraumatic stress disorder and major depression and their onset and course in the three months after a motor vehicle collision in the AURORA study

Abstract

Background: A better understanding of the extent to which prior occurrences of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) predict psychopathological reactions to subsequent traumas might be useful in targeting posttraumatic preventive interventions. Methods: Data come from 1306 patients presenting to 29 U.S. emergency departments (EDs) after a motor vehicle collision (MVC) in the advancing understanding of recovery after trauma study. Patients completed self-reports in the ED and 2-weeks, 8-weeks, and 3-months post-MVC. Associations of pre-MVC probable JOORMANN ET AL.| 57 PTSD and probable MDE histories with subsequent 3-months post-MVC probable PTSD and probable MDE were examined along with mediation through intervening peritraumatic, 2-, and 8-week disorders.Results: 27.6% of patients had 3-month post-MVC probable PTSD and/or MDE.Pre-MVC lifetime histories of these disorders were not only significant (relative risk = 2.6-7.4) but were dominant (63.1% population attributable risk proportion [PARP]) predictors of this 3-month outcome, with 46.6% prevalence of the outcome among patients with pre-MVC disorder histories versus 9.9% among those without such histories. The associations of pre-MVC lifetime disorders with the 3-month outcome were mediated largely by 2-and 8-week probable PTSD and MDE (PARP decreasing to 22.8% with controls for these intervening disorders). Decomposition showed that pre-MVC lifetime histories predicted both onset and persistence of these intervening disorders as well as the higher conditional prevalence of the 3-month outcome in the presence of these intervening disorders.Conclusions: Assessments of pre-MVC PTSD and MDE histories and follow-ups at 2 and 8 weeks could help target early interventions for psychopathological reactions to MVCs.

Childhood adversities and risk of posttraumatic stress disorder and major depression following a motor vehicle collision in adulthood

“…This might be because patients who come to EDs after MVCs without serious injuries and/or who agree to be in studies like AURORA have high CA prevalence. Consistent with this possibility, a prior AURORA report noted that pre-MVC lifetime PTSD and MDE were substantially higher than in general population surveys (Joormann et al ., 2022 ). Although we have no way to investigate causes, it is noteworthy that prior research has shown that people who experience MVCs have high prevalence of substance problems (Bogstrand et al ., 2012 ) and that people who choose to go to EDs after traumas are more likely than those who do not to have preexisting mental health problems (Krieg et al ., 2016 ).…”

“…However, only the first three of these were used as controls in multivariable models, as the others might have been influenced by CAs and thus more likely to be mediators than confounders. A previous AURORA investigation found that three MVC characteristics predicted 3-month PTSD and/or major depressive episode (MDE), the two types of APNS considered here: any vehicle damage, concussion and severe pain reported in the ED (Joormann et al ., 2022 ). Vehicle damage was reported by the patient in the ED.…”

“…Self-rated global pain was reported on a 0–10 visual response scale (Farrar et al ., 2001 ). Patients in the top 40% were categorised as having severe pain based on prior analyses documenting that this dichotomisation best captures the association of the 0–10 pain scale with the 3-months outcome (described below) (Joormann et al ., 2022 ).…”

“…The APNS outcome was defined as meeting criteria for either PTSD or MDE in the 3-month survey. This outcome was determined based on evidence presented previously that 90 + % of respondents who met criteria for either 3-month PTSD or MDE had PTSD, that a great many significant predictors were found for having PTSD and/or MDE, but that we were unable to find significant predictors either of (i) depression without PTSD in the total sample or (ii) comorbid MDE in the subsample of respondents with PTSD (Joormann et al ., 2022 ).…”

“…Once the final specification was estimated in Model D, we sequentially added pre-MVC histories of PTSD and MDE, peritraumatic symptoms assessed in the ED, 2-week PTSD and MDE, and 8-week PTSD and MDE to the model to investigate how much these controls explained the overall associations of CAs with 3-month APNS. In doing this, we built on our previously published derivation of functional forms of these control variables in predicting 3-month APNS (Joormann et al ., 2022 ). We calculated the AUCs of the sequential models in the 30% test sample.…”