Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD.
Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD.
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DOI：
10.1017/s0033291719004008
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发表时间：
2021-05
影响因子：
6.9
通讯作者：
Kessler RC
中科院分区：
文献类型：
--
作者：
Lowe SR;Ratanatharathorn A;Lai BS;van der Mei W;Barbano AC;Bryant RA;Delahanty DL;Matsuoka YJ;Olff M;Schnyder U;Laska E;Koenen KC;Shalev AY;Kessler RC
探索创伤后应激障碍（PTSD）症状纵向过程的研究记录了四种模式轨迹（低，缓解，高和延迟），各研究的比例各不相同。异质性可能是由于创伤类型和患者人口统计学特征的差异。该分析汇总了6项纵向研究的数据，这些研究涉及6个国家的综合医院急诊科（ED）收治的与创伤相关的成人幸存者（汇总N = 3，083）。每项研究包括至少三个评估的临床医生管理的创伤后应激障碍量表在创伤后的第一年。潜在类别增长分析确定了在数据集内和数据集之间表现出各种PTSD症状轨迹的参与者比例。多项逻辑回归分析检查人口统计学特征，类型的事件导致的伤害，和创伤史的轨迹的预测区分其初始严重程度和过程。在数据集中发现了5种轨迹：低（64.5%）、缓解（16.9%）、中度（6.7%）、高（6.5%）和延迟（5.5%）。女性、非白人、先前的人际创伤和攻击性伤害与初始PTSD反应的风险增加相关。女性性别和攻击性伤害与延迟（与低）轨迹中的成员资格风险相关，教育程度较低，先前的人际创伤和攻击性伤害与高（与缓解）轨迹中的成员资格风险相关。研究结果表明，超过30%的急诊室相关伤害幸存者在创伤后的第一年内经历了中度到高度的创伤后应激障碍症状，那些报告攻击性暴力的人立即和长期症状的风险增加。
Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3,083). Each study included at least three assessments of the Clinician-Administered PTSD Scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (vs. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (vs. Remitting) trajectory. The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.