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Trajectory of post-traumatic stress following traumatic injury: 6-year follow-up
Richard A Bryant1, Angela Nickerson1, Mark Creamer1
1Richard A. Bryant, PhD, School of Psychology, University of New South Wales and Brain Dynamics Centre, University of Sydney and Westmead Millennium Institute, Sydney, Australia; Angela Nickerson, PhD, School of Psychology, University of New South Wales, New South Wales, Australia; Mark Creamer, PhD, Meaghan O'Donnell, PhD, David Forbes, PhD, Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne; Isaac Galatzer-Levy, PhD, Department of Psychiatry, New York University, New York, USA; Alexander C. McFarlane, MD, Centre for Military and Veteran Health, University of Adelaide, Adelaide, Australia; Derrick Silove, MD, School of Psychiatry, University of New South Wales, New South Wales, Australia.
Background:
Traumatic injuries affect millions of patients each year, and resulting post-traumatic stress disorder (PTSD) significantly contributes to subsequent impairment.
Aims:
To map the distinctive long-term trajectories of PTSD responses over 6 years by using latent growth mixture modelling.
Method:
Randomly selected injury patients (n = 1084) admitted to four hospitals around Australia were assessed in hospital, and at 3, 12, 24 and 72 months. Lifetime psychiatric history and current PTSD severity and funxctioning were assessed.
Results:
Five trajectories of PTSD response were noted across the 6 years: (a) chronic (4%), (b) recovery (6%), (c) worsening/recovery (8%), (d) worsening (10%) and (e) resilient (73%). A poorer trajectory was predicted by female gender, recent life stressors, presence of mild traumatic brain injury and admission to intensive care unit.
Conclusions:
These findings demonstrate the long-term PTSD effects that can occur following traumatic injury. The different trajectories highlight that monitoring a subset of patients over time is probably a more accurate means of identifying PTSD rather than relying on factors that can be assessed during hospital admission.
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