Social support and post-traumatic stress symptoms: Longitudinal bidirectional relationships in the AURORA study

While social impairment is a hallmark of increasing severity of post-traumatic stress disorder (PTSD), the dynamics between social support and trauma recovery are less clear. Current theories suggest either social support is responsible for reducing PTSD severity (social causation), or worsening PTSD ultimately degrades supportive networks (social erosion). Furthermore, there is a paucity of research on social support and longitudinal trauma recovery within the civilian population. We hypothesized a bidirectional relationship exists between social support and PTSD, such that both social causation and erosion impact the trajectory of recovery at different times post-trauma.

A total of n = 2943 participants were recruited following a traumatic event leading to Emergency Department visit in the AURORA study, reported perceived emotional support (PROMIS) and severity of PTSD symptoms (PCL-5) at 2 weeks, 8 weeks, 3 months, 6 months, and 12 months post trauma. PTSD symptom severity overall and within symptom criteria (B-E) were assessed.

A 5-wave cross-lagged panel model showed a statistically significant negative association between emotional support and subsequent PTSD symptoms across the majority of timepoints in the year following trauma. Concurrently, we observed a negative association between PTSD severity and subsequent perceived emotional support. Additional analyses showed emotional support was mainly correlated with subsequent negative mood and feelings, whereas avoidant behavior was most correlated with lower emotional support.

Our analyses emphasize the importance of initiating social interventions and establishing robust social networks immediately after a traumatic event.