Understanding Onset, Dynamic Transitions, and Associated Inequality Risk Factors for Adverse Posttraumatic...

Several gaps remain in the understanding of the onset, dynamic transitions, and associated risk factors of adverse posttraumatic neuropsychiatric sequelae (APNS) in the acute post-trauma window. Based on serial assessments of symptoms from a large cohort study, we identified homogeneous statuses across multiple APNS symptom domains and investigated the dynamic transitions among these statuses during the first 2 months after trauma exposure. Furthermore, we studied how symptom onset and transitions are affected by equity-relevant characteristics.

The analysis was based on 2557 participants enrolled in the Advancing Understanding of RecOvery afteR traumA (AURORA). APNS symptoms comprised pain, depression, sleep discontinuity, nightmares, avoidance, re-experience, anxiety, hyperarousal, somatic symptoms, and mental fatigue. We identified the homogeneous status of APNS symptoms at baseline, 1 month, and 2 months, and explored transition probabilities among these statuses using latent transition analysis. Equity-relevant characteristics included gender, race, education, family income, childhood trauma, and area deprivation.

Three homogeneous statuses-low-, moderate-, and severe-symptom-were identified. While the majority of trauma survivors with severe- or moderate-symptom status maintained the same status over time, some transitioned to a less severe symptom status, particularly within the first month. Specifically, females, non-whites, and those with higher childhood trauma were associated with a decreased likelihood of transitioning to a less severe symptom status. From one to 2 months, lower income was associated with a decreased likelihood of transitioning from moderate-to low-symptom status.

The findings can inform early intervention strategies for APNS, potentially reducing health disparities among trauma survivors.