Socio-demographic and trauma-related predictors of PTSD within 8 weeks of a motor vehicle collision in the AURORA study

Abstract

This is the initial report of results from the AURORA multisite longitudinal study of adverse post-traumatic neuropsychiatric sequelae (APNS) among participants seeking emergency department (ED) treatment in the aftermath of a traumatic life experience. We focus on n=666 participants presenting to EDs following a motor vehicle collision (MVC) and examine associations of participant socio-demographic and participant-reported MVC characteristics with 8-week posttraumatic stress disorder (PTSD) adjusting for pre-MVC PTSD and mediated by peritraumatic symptoms and 2-week acute stress disorder (ASD). Peritraumatic Symptoms, ASD, and PTSD were assessed with self-report scales. Eight-week PTSD prevalence was relatively high (42.0%) and positively associated with participant sex (female), low socioeconomic status (education and income), and several self-report indicators of MVC severity. Most of these associations were entirely mediated by peritraumatic symptoms and, to a lesser degree, ASD, suggesting that the first 2 weeks after trauma may be a uniquely important time period for intervening to prevent and reduce risk of PTSD. This observation, coupled with substantial variation in the relative strength of mediating pathways across predictors, raises the possibility of diverse and potentially complex underlying biological and psychological processes that remain to be elucidated with more in-depth analyses of the rich and evolving AURORA data.

Brain-Based Biotypes of Psychiatric Vulnerability in the Acute Aftermath of Trauma

“…To test whether the fMRI-based clustering provided incremental information above and beyond pretrauma symptom levels, we conducted secondary models including pretrauma symptoms that participants reported in the emergency department. Initial AURORA study findings indicated that among sociodemographic risk factors, pretrauma symptom levels were the strongest predictor of later PTSD and depression symptom severity (36,37).…”

Prior sleep problems and adverse post-traumatic neuropsychiatric sequelae of motor vehicle collision in the AURORA study

“…As detailed in previous AURORA reports [14,15], information was recorded in the ED about sociodemographics (age, sex, raceethnicity, marital status, education, family income, and employment status), key characteristics of the MVC (e.g. patient was a driver versus passenger, severity of vehicular damage, and injuries sustained by people other than the participant), and information about the patient's injuries.…”

“…In initial AURORA reports, we focused on AURORA respondents experiencing motor vehicle collision (MVC), the most common life-threatening traumatic experience in industrialized countries [13]. We examined patterns and associations of several predictors for acute stress disorder (ASD) and PTSD [14] and MDE [15] 2-weeks and 8-weeks post-MVC. These predictors included PTSD and MDE in the 30 days before the MVC along with sociodemographic characteristics and MVC experiences.…”

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

“…j An earlier AURORA report used a PCL-5 modification to assess 2-week DSM-5 acute stress disorder criterion B rather than 2-week PTSD (Kessler et al, 2020), but we instead used criteria for 2-week PTSD here to allow parallel analysis across all 3 follow-up assessments. when 3-month probable PTSD was the outcome (Table S8, Models 2-3).…”

“…We focus on motor vehicle collision (MVC), as most AURORA patients presented with MVCs and the number of patients with other individual traumas is currently too small for comparative analysis. Previous AURORA reports examined PTSD and MDE separately in a smaller MVC sample (Joormann et al, 2020;Kessler et al, 2020), documenting that history of PTSD predicts post-MVC PTSD, and history of MDE predicts post-MVC MDE. The sample in these reports was too small, though, to consider joint histories of PTSD-MDE as we do in the current report.…”