Individual Participant Data Meta-Analysis Identifies Risk Factors for Acute and Persistent Posttraumatic Stress...

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are common sequelae to trauma. Identifying individuals at risk for persistent symptomology allows for targeted interventions.

We conducted an individual participant data meta-analysis (IPD-MA) by pooling data from five prospective emergency room and critical care unit studies (N participants = 2571) to examine risk factors for PTSD and MDD. We derived harmonized measures of PTSD and MDD in the acute period (0-60 days) following a traumatic event and in the follow-up persistent period (122-456 days). Multinomial logistic regression was used to estimate associations between seven risk factors for acute and persistent MDD and PTSD. Logistic models examined the association between acute symptoms and persistence of PTSD and MDD.

Female sex (odds ratio [OR] range: 1.48-2.14) was associated with increased risk for acute and persistent MDD and PTSD while individuals who experienced an accident versus an assault or other traumatic event as the index trauma were at reduced risk (OR range: 0.39-0.66). Acute MDD symptom severity was associated with persistent PTSD (OR: 1.17; 95% CI: 1.08, 1.27) and remained significant after inclusion of acute PTSD symptom severity (OR: 1.14; 95% CI: 1.01, 1.29). In an analysis of PTSD symptom clusters, reexperiencing symptoms (OR: 1.18; 95% CI: 1.02, 1.36) and MDD symptom severity were associated with persistent PTSD. In models of persistent MDD, acute PTSD symptom severity was associated with persistence (OR: 1.15; 95% CI: 1.03, 1.28), but neither overall symptom severity nor cluster symptom severities were associated with persistence after inclusion of acute MDD symptom severity (OR: 1.13; 95% CI: 1.00, 1.26).

Early symptoms of MDD and reexperiencing were associated with the persistence of psychopathology indicating that depressive rumination may play a role in the maintenance of MDD and PTSD.