Abstract
Objective
We sought to identify common risk factors associated with posttraumatic stress disorder (PTSD) onset and course, including delayed, persistent, and remitted PTSD following a major traumatic exposure.
Method
Based on a prospective study of New York City adults following the World Trade Center disaster (WTCD), we conducted baseline interviews with 2,368 persons one year after this event and then at follow-up 1 year later to evaluate changes in current PTSD status based on DSM-IV criteria.
Results
Baseline analysis suggested that current PTSD, defined as present if this occurred in the past 12 months, was associated with females, younger adults, those with lower self-esteem, lower social support, higher WTCD exposure, more lifetime traumatic events, and those with a history of pre-WTCD depression. At follow-up, current PTSD was associated with Latinos, non-native born persons, those with lower self-esteem, more negative life events, more lifetime traumatic events, and those with mixed handedness. Classifying respondents at follow-up into resilient (no PTSD time 1 or 2), remitted (PTSD time 1, not 2), delayed (no PTSD time 1, but PTSD time 2), and persistent (PTSD both time 1 and 2) PTSD, revealed the following: compared to resilient cases, remitted ones were more likely to be female, have more negative life events, have greater lifetime traumatic events, and have pre-WTCD depression. Delayed cases were more likely to be Latino, be non-native born, have lower self-esteem, have more negative life events, have greater lifetime traumas, and have mixed handedness. Persistent cases had a similar profile as delayed, but were the only cases associated with greater WTCD exposures. They were also likely to have had a pre-WTCD depression diagnosis. Examination of WTCD-related PTSD at follow-up, more specifically, revealed a similar risk profile, except that handedness was no longer significant and WTCD exposure was now significant for both remitted and persistent cases.
Conclusion
PTSD onset and course is complex and appears to be related to trauma exposure, individual predispositions, and external factors not directly related to the original traumatic event. This diagnostic classification may benefit from additional conceptualization and research as this relates to changes in PTSD status over time.
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References
American Psychiatric Association (1980) Diagnostic and statistical manual of mental disorders, 3rd edn. American Psychiatric Association, Washington, DC
Boscarino JA (2008) Psychobiologic predictors of disease mortality after psychological trauma: implications for research and clinical surveillance. J Nerv Ment Dis 196:100–107
Adams RE, Bromet EJ, Panina N, Golovakha E, Goldgaber D, Gluzman S (2002) Stress and well-being after the Chornobyl nuclear power plant accident. Psychol Med 32:143–156
Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68:748–766
Bromet EJ, Parkinson DK, Schulberg HC, Dunn LO, Gondek PC (1982) Mental health of residents near the Three Mile Island reactor: a comparative study of selected groups. J Prev Psychiatry 1:225–276
McFarlane AC (1988) Aetiology of post-traumatic stress disorders following a natural disaster. Br J Psychiatry 152:116–121
Kessler RC, Sonnega A, Bromet E, Hughes H (1995) Posttraumatic stress disorder in the national comorbidity survey. Arch Gen Psychiatry 52:1048–1060
McFarlane A (2004) The contribution of epidemiology to the study of traumatic stress. Soc Psychiatry Psychiatr Epidemiol 39:874–882
Yehuda R (2002) Post-traumatic stress disorder. N Engl J Med 346:108–114
Boscarino JA (2004) Association between posttraumatic stress disorder and physical illness: results and implications from clinical and epidemiologic studies. Ann NY Acad Sci 1032:141–153
Kessler RC (2000) Posttraumatic stress disorder: the burden to the individual and to society. J Clin Psychiatry 61(Suppl 5):4–12
Breslau N, Peterson EL, Schultz LR, Lucia VC (2004) Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychol Med 34:889–898
Breslau J, Kendler KS, Su M, Gaxiola-Aguilar S, Kessler RC (2005) Lifetime risk and persistence of psychiatric disorders across ethnic groups in the United States. Psychol Med 35:317–327
Adams RE, Boscarino JA (2005) Differences in mental health outcomes among Whites, African Americans, and Hispanics following a community disaster. Psychiatry 68:250–265
Boscarino JA (1995) Post-traumatic stress and associated disorders among Vietnam veterans: the significance of combat exposure and social support. J Traumatic Stress 8:317–336
Galea S, Ahern J, Resnick H, Kilpatrick D, Bucuvalas M, Gold J, Vlahov D (2002) Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med 346:982–987
Boscarino JA, Hoffman SN (2007) Consistent association between mixed lateral preference and PTSD: confirmation among a national study of 2,490 US Army Vietnam veterans. Psychosom Med 69:365–369
Bromet EJ, Dew MA (1995) Review of psychiatric epidemiologic research on disasters. Epidemiol Rev 17:113–119
Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K (2002) 60, 000 disaster victims speak: part I: an empirical review of the empirical literature, 1981–2001. Psychiatry 65:207–239
Rubonis AV, Bickman L (1991) Psychological impairment in the wake of disaster: the disaster-psychopathology relationship. Psychol Bull 109:384–399
Gray MJ, Bolton EE, Litz BT (2004) A longitudinal analysis of PTSD symptom course: delayed-onset PTSD in Somalia Peacekeepers. J Consult Clin Psychol 72:909–913
Adams RE, Boscarino JA (2006) Predictors of PTSD and delayed-PTSD after disaster: the impact of exposure and psychological resources. J Nerv Ment Dis 194:485–493
Buckley TC, Blanchard DB, Hickling EJ (1996) A prospective examination of delayed onset PTSD secondary to motor vehicle accidents. J Abnorm Psychol 105:617–625
Prigerson HG, Maciejewski PK, Rosenheck RA (2001) Combat trauma: trauma with highest risk of delayed onset and unresolved posttraumatic stress disorder symptoms, unemployment, and abuse among men. J Nerv Ment Dis 189:99–108
Freedy JR, Kilpatrick DG, Resnick HS (1993) Natural disasters and mental health: theory, assessment, and intervention. J Soc Behav Pers 8:49–103
Boscarino JA (2006) PTSD and mortality among US Army veterans: a 30-year follow-up. Ann Epidemiol 16:248–258
North CS, Nixon SJ, Shariat S, Mallonee S, McMillen JC, Spitznagel EL, Smith EM (1999) Psychiatric disorders among survivors of the Oklahoma City bombing. J Am Med Assoc 282:755–762
Andrews B, Brewin CR, Philpott R, Stewart L (2007) Delayed posttraumatic stress disorder: a systematic review of the evidence. Am J Psychiatry 164:1319–1326
Bryant RA, Harvey AG (2002) Delayed-onset posttraumatic stress disorder: a prospective evaluation. Aust NZ J Psychiatry 36:205–209
North CS, Pfefferbaum B, Tivis L, Kawasaki A, Reddy C, Spitznagel EL (2004) The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing. Ann Clin Psychiatry 16:209–215
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. 4th edn. American Psychiatric Association, Washington, DC
Atkinson RM, Henderson RG, Sparr LF, Deale S (1982) Assessment of Vietnam veterans for posttraumatic stress disorder in Veterans Administration disability claims. Am J Psychiatry 139:1118–1121
Brewin CR (2003) Posttraumatic stress disorder: malady or myth. Yale University Press, New Haven
American Association for Public Opinion Research (2000) Standard definitions: final dispositions of case codes and outcomes rates for surveys. American Association for Public Opinion Research, Ann Arbor
Adams RE, Boscarino JA, Galea S (2006) Social and psychological resources and health outcomes after World Trade Center disaster. Soc Sci Med 62:176–188
Kessler RC, Little RJ, Groves RM (1995) Advances in strategies for minimizing and adjusting for survey nonresponse. Epidemiol Rev 17:192–204
Kilpatrick DG, Ruggiero KJ, Acierno R, Saunders BE, Resnick HS, Best CL (2003) Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the national survey of adolescents. J Consult Clin Psychol 71:692–700
Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61:984–991
Boscarino JA, Adams RE, Figley CR (2004) Mental health service use 1-year after the World Trade Center disaster: implications for mental health care. Gen Hosp Psychiatry 26:346–358
Boscarino JA, Galea S, Adams RE, Ahern J, Resnick H, Vlahov D (2004) Mental health service and psychiatric medication use following the terrorist attacks in New York City. Psychiatr Serv 55:274–283
Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32:705–714
Rosenberg M (1979) Conceiving the self. Basic Books, New York
Spitzer RL, Williams JB, Gibbon M (1987) Structured clinical interview for DSM-III-R—non-patient version. Biometrics Research Department, New York State Psychiatric Institute, New York
Acierno R, Kilpatrick DG, Resnick H, Saunders B, De Arellano M, Best C (2000) Assault, PTSD, Family substance use, and depression as risk factors for cigarette use in youth: findings from the National Survey of Adolescents. J Trauma Stress 13:381–396
Robins LN, Cottler LB, Bucholz KK, Compton WM, North CS, Rourke KM (1999) Diagnostic interview schedule for DSM-IV. Washington University School of Medicine, Department of Psychiatry, St. Louis (Revised January 9, 2002)
Adams RE, Boscarino JA (2005) Stress and well-being in the aftermath of the World Trade Center attack: the continuing effects of a community-wide disaster. J Community Psychol 33:175–190
Boscarino JA, Galea S, Ahern J, Resnick H, Vlahov D (2003) Psychiatric medication use among Manhattan residents following the World Trade Center disaster. J Trauma Stress 16:301–306
Boscarino JA (1997) Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care. Psychosom Med 59:605–614
Derogatis LR (2001) Brief symptom inventory 18 (BSI-18) manual. NCS Assessments, Minnetonka
Long JS, Freese J (2006) Regression models for categorical dependent variables using Stata, 2nd edn. Stata Corporation, College Station
Stata Corporation (2007) Stata, version 9.2. Stata Corporation, College Station
Bromet EJ, Sonnega A, Kessler RC (1998) Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 147:353–361
National Academy of Sciences (2007) PTSD compensation and military service. National Academy of Sciences Press, Washington. DC
Grieger TA, Cozza SJ, Ursano RJ, Hoge C, Martinez PE, Engel CC, Wain HJ (2006) Posttraumatic stress disorder and depression in battle-injured soldiers. Am J Psychiatry 163:1777–1783
Horowitz MJ, Solomon GF (1975) A prediction of delayed stress response syndromes in Vietnam veterans. J Soc Issues 31:67–80
Shatan CF (1973) The grief of soldiers: Vietnam combat veterans’ self-help movement. Am J Orthopsychiatry 43:640–653
Solomon Z, Mikulincer M (2006) Trajectories of PTSD: a 20-year longitudinal study. Am J Psychiatry 163:659–666
Breslau N, Lucia VC, Davis GC (2004) Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychol Med 34:1205–1214
Galea S, Vlahov D, Resnick H, Ahern J, Susser E, Gold J, Bucuvalas M, Kilpatrick D (2003) Trends of probable post-traumatic stress disorder in New York City after the September 11 terrorist attacks. Am J Epidemiol 158:514–524
Picou JS, Marshall BK, Gill DA (2004) Disaster, litigation, and the corrosive community. Soc Forces 82:1493–1522
Fehm L, Beesdo K, Jacobi F, Fiedler A (2008) Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Soc Psychiatry Psychiatr Epidemiol 43:257–265
Palinkas LA, Downs MA, Petterson JS, Russell J (1993) Social, cultural, and psychological impacts of the Exxon Valdez oil spill. Hum Organ 52:1–13
Palinkas LA, Petterson JS, Russell J, Downs MA (1993) Community patterns of psychiatric disorder after the Exxon Valdez oil spill. Am J Psychiatry 150:1517–1523
Verschuur MJ, Spinhoven P, van Emmerik AA, Rosendaal FR (2008) Participation in a trauma-focused epidemiological investigation may result in sensitization for current health problems. Soc Psychiatry Psychiatr Epidemiol 43:132–139
Acknowledgments
Supported in part by funding from the National Institute of Mental Health (Grant No. R01 MH-66403) and Pennsylvania Department of Health (Contract No. 4100042573).
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Boscarino, J.A., Adams, R.E. PTSD onset and course following the World Trade Center disaster: findings and implications for future research. Soc Psychiat Epidemiol 44, 887–898 (2009). https://doi.org/10.1007/s00127-009-0011-y
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DOI: https://doi.org/10.1007/s00127-009-0011-y