Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature

https://doi.org/10.1016/j.cpr.2013.05.002Get rights and content

Highlights

  • PTSD research has overwhelmingly relied on retrospective accounts of trauma.

  • Prospective, longitudinal studies allow for examination of pretrauma vulnerability.

  • Pretrauma characteristics historically thought to be symptoms may predict PTSD.

  • Coping and cognitive abilities, personality, health, and environment affect risk.

  • Pretrauma predictor categories used to conceptualize variable risk for PTSD.

Abstract

As it has become clear that most individuals exposed to trauma do not develop PTSD, it has become increasingly important to examine pretrauma risk factors. However, PTSD research has overwhelmingly relied on retrospective accounts of trauma, which is beleaguered by problems of recall bias. To further our understanding of PTSD's etiology, a systematic review of 54 prospective, longitudinal studies of PTSD published between 1991 and 2013 were examined. Inclusion criteria required that all individuals were assessed both before and after an index trauma. Results revealed six categories of pretrauma predictor variables: 1) cognitive abilities; 2) coping and response styles; 3) personality factors; 4) psychopathology; 5) psychophysiological factors; and 6) social ecological factors. The results indicated that many variables, previously considered outcomes of trauma, are pretrauma risk factors. The review considered these findings in the context of the extant retrospective PTSD literature in order to identify points of overlap and discrepancy. Pretrauma predictor categories were also used to conceptualize variable risk for PTSD. Limitations and directions for future research are discussed.

Section snippets

Inclusion criteria and procedure

A systematic review was based on the following sources: PsycINFO, PILOTS, and PubMed. The search terms included forms of the following terms alone and in combination: birth cohort, longitudinal, retrospective, military, posttraumatic stress disorder, prospective, pre-combat, pretrauma, pre-trauma, PTSD, recall, recall bias, premorbid, risk factors and trauma. Thesauruses of the three databases were searched to ensure that appropriate search terms were used. To maximize search effectiveness,

Results

Utilizing the inclusion criteria above, the review yielded a total of 54 articles that were prospective, longitudinal studies of posttraumatic stress. There were no publication date constraints for inclusion in the review; however, no studies published prior to 1991 met the inclusion criteria. All of the studies were prospective in that participants were enrolled prior to index trauma exposure and longitudinal in that they followed participants through trauma exposure and assessed subsequent

Discussion

We systematically reviewed prospective studies of trauma and PTSD to determine how pretrauma factors affected the development of PTSD symptomatology following an index trauma exposure. Categories of pretrauma predictor variables that influenced vulnerability to the disorder were identified. Subsequently, the 54 articles reviewed herein were distilled into six categories of predictors: 1) cognitive abilities; 2) coping and response styles; 3) personality factors; 4) psychopathology; 5)

General conclusions

Although sequelae of trauma can be profound, the conclusions of these 54 studies suggest that not all negative aspects of trauma are outcomes of it; rather these studies suggest that certain factors predispose individuals to PTSD. The major conclusion of this review is that many factors, historically thought to be consequences of trauma, are most likely risk factors for PTSD. More specifically, some studies suggest that the very symptoms of PTSD are, in fact, not symptoms of an index trauma,

References (90)

  • N. Pole et al.

    Prospective prediction of posttraumatic stress disorder symptoms using fear potentiated auditory startle responses

    Biological Psychiatry

    (2009)
  • M. van Zuiden et al.

    Glucocorticoid receptor pathway components predict posttraumatic stress disorder symptom development: A prospective study

    Biological Psychiatry

    (2012)
  • M. van Zuiden et al.

    Glucocorticoid sensitivity of leukocytes predicts PTSD, depressive and fatigue symptoms after military deployment: A prospective study

    Psychoneuroendocrinology

    (2012)
  • M. van Zuiden et al.

    A prospective study on personality and the cortisol awakening response to predict posttraumatic stress symptoms in response to military deployment

    Journal of Psychiatric Research

    (2011)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (1980)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2000)
  • A.M. Bardone et al.

    Adult mental health and social outcomes of adolescent girls with depression and conduct disorder

    Development and Psychopathology

    (1996)
  • C.G. Beevers et al.

    Association of predeployment gaze bias for emotion stimuli with later symptoms of PTSD and depression in soldiers deployed in Iraq

    The American Journal of Psychiatry

    (2011)
  • E.B. Binder et al.

    Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults

    JAMA : The Journal of the American Medical Association

    (2008)
  • S. Boney-McCoy et al.

    Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study

    Journal of Consulting and Clinical Psychology

    (1996)
  • I. Bramsen et al.

    Predeployment personality traits and exposure to trauma as predictors of posttraumatic stress symptoms: A prospective study of former peacekeepers

    The American Journal of Psychiatry

    (2000)
  • N. Breslau et al.

    Traumatic events and posttraumatic stress disorder in an urban population of young adults

    Archives of General Psychiatry

    (1991)
  • N. Breslau et al.

    Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma

    Archives of General Psychiatry

    (1998)
  • N. Breslau et al.

    Intelligence and other predisposing factors in exposure to trauma and posttraumatic stress disorder

    Archives of General Psychiatry

    (2006)
  • N. Breslau et al.

    The structure of posttraumatic stress disorder

    Archives of General Psychiatry

    (2005)
  • R.A. Bryant et al.

    Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder

    Journal of Consulting and Clinical Psychology

    (2007)
  • R.A. Bryant et al.

    A prospective study of psychophysiological arousal, acute stress disorder, and posttraumatic stress disorder

    Journal of Abnormal Psychology

    (2000)
  • R.A. Bryant et al.

    Impaired specific autobiographical memory as a risk factor for posttraumatic stress after trauma

    Journal of Abnormal Psychology

    (2007)
  • J.I. Constans et al.

    Pre-Katrina mental illness, postdisaster negative cognitions, and PTSD symptoms in male veterans following Hurricane Katrina

    Psychological Trauma: Theory, Research, Practice, and Policy

    (2012)
  • W.E. Copeland et al.

    Traumatic events and posttraumatic stress in childhood

    Archives of General Psychiatry

    (2007)
  • M.C. Cornelis et al.

    Genetics of post-traumatic stress disorder: Review and recommendations for genome-wide association studies

    Current Psychiatry Reports

    (2010)
  • P.T. Costa et al.

    Personality in adulthood: A six-year longitudinal study of self-reports and spouse ratings on the NEOPersonality inventory

    Journal of Persoanlity and Social Psychology

    (1988)
  • K. de Jong et al.

    Exposure to violence and PTSD symptoms among Somali women

    Journal of Traumatic Stress

    (2011)
  • S. Gil

    Coping style in predicting posttraumatic stress disorder among Israeli students

    Anxiety, Stress, & Coping: An International Journal

    (2005)
  • S. Gil et al.

    Personality traits, coping style, and perceived threat as predictors of posttraumatic stress disorder after exposure to a terrorist attack: A prospective study

    Psychosomatic Medicine

    (2006)
  • R.M. Guthrie et al.

    Auditory startle response in firefighters before and after trauma exposure

    The American Journal of Psychiatry

    (2005)
  • R.M. Guthrie et al.

    Extinction learning before trauma and subsequent posttraumatic stress

    Psychosomatic Medicine

    (2006)
  • M. Heinrichs et al.

    Predicting posttraumatic stress symptoms from pretraumatic risk factors: A 2-year prospective follow-up study in firefighters

    The American Journal of Psychiatry

    (2005)
  • G.A. Hodgins et al.

    Risk factors for posttrauma reactions in police officers: A longitudinal study

    The Journal of Nervous and Mental Disease

    (2001)
  • R.C. Kessler et al.

    Posttraumatic stress disorder in the National Comorbidity Survey

    Archives of General Psychiatry

    (1995)
  • D.W. King et al.

    Posttraumatic stress disorder and retrospectively reported stressor exposure: A longitudinal prediction model

    Journal of Abnormal Psychology

    (2000)
  • G. Knezevic et al.

    Do personality traits predict post-traumatic stress?: A prospective study in civilians experiencing air attacks

    Psychological Medicine

    (2005)
  • K.C. Koenen et al.

    The developmental mental-disorder histories of adults with posttraumatic stress disorder: A prospective longitudinal birth cohort study

    Journal of Abnormal Psychology

    (2008)
  • K.C. Koenen et al.

    Early childhood factors associated with the development of post-traumatic stress disorder: Results from a longitudinal birth cohort

    Psychological Medicine

    (2007)
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