Trajectories of posttraumatic stress symptoms after civilian or deployment traumatic event experiences.

Abstract

Objective Growth mixture model studies have observed substantial differences in the longitudinal patterns of posttraumatic stress symptom (PTSS) trajectories. This variability could represent chance iterations of some prototypical trajectories or measurable variability induced by some aspect of the source population or traumatic event experience. Testing the latter, we analyzed a nationally representative sample of U.S. Reserve and National Guard members to identify the influence of civilian versus deployment trauma on the number of PTSS trajectories, the nature of these trajectories, and proportion of respondents in each trajectory. Method Data were collected from 2010 to 2013 and latent class growth analysis was used to identify different patterns of PTSS in persons exposed to both a civilian and a deployment trauma and to test whether respondents’ exposure to civilian trauma developed similar or distinct patterns of response compared to respondents exposed to deployment trauma. Results PTSS were found to follow three trajectories, with respondents predominantly clustered in the lowest symptom trajectory for both trauma types. Covariates associated with each trajectory were similar between the two traumas, except number of civilian-related traumatic events; specifically, a higher number of civilian traumatic events was associated with membership in the ‘borderline-stable,’ compared to ‘low-consistent,’ trajectory, for civilian traumas and associated with the ‘pre-existing chronic’ trajectory for military traumas. Conclusions Holding the source population constant, PTSS trajectory models were similar for civilian and deployment-related trauma, suggesting that irrespective of traumatic event experienced there might be some universal trajectory patterns. Thus, the differences in source populations may have induced the heterogeneity observed among prior PTSS trajectory studies.

Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD

“…When we evaluated risk factors for initial PTSD reactions, the risk factors we identified (i.e. female gender, non-white race, prior interpersonal trauma, and assault) were consistent with prior research (Bryant et al, 2015; Fink et al, 2017; Sripada et al, 2017). These findings suggest that these risk factors should be included in prediction tools to identify survivors at risk for initially high levels of PTSD symptoms as part of routine post-injury psychiatric evaluations.…”

“…One important characteristic appears to be the type of PTE to which participants were exposed, such that a consistently low trajectory is more common following less severe PTEs (e.g. Fink et al, 2017). A second source of heterogeneity could be timing of assessment, with the length of follow-up across trajectory studies ranging from months to several years post-trauma.…”

Exploring resilience models in a sample of combat-exposed military service members and veterans: a comparison and commentary

“…Longitudinal and trajectory-based examinations of resilience (e.g. Andersen, Karstoft, Bertelsen, & Madsen, 2014; Fink et al, 2017; Norris, Tracy, & Galea, 2009) that measure the timing of traumatic events and dates of onset for diagnostic conditions are essential. The examination of new-onset or ongoing stressors in these studies is suggested to provide a more nuanced picture of the process of resilience in the face of ongoing adversity to better understand the relationships among resilience antecedents, attributes, consequences, and long-term trajectories of resilience and stress.…”

Adjustment Disorder: Current Developments and Future Directions

“…Research into the course of PTSD may hold some answers to the trajectory of adjustment disorder over time. There have been a number of studies that have examined the trajectory of PTSD symptoms over time [29,30,31,32,33,34,35]. Generally, these studies show that the majority of those who are exposed to trauma typically fall into one of four to five prototypical trajectories (see Figure 1).…”