Individual variation in PTSD course following trauma and treatment: how can we apply longitudinal research to increase our understanding?
Assigned to session0.11 Joost den Draaier, 29-09-2023, 13:30 - 14:45
Field of researchScreening, assessment & diagnosis
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Sex-differential analyses of common PTSD symptom trajectories across one year post-traumaMirjam Van Zuiden
Background: Recent years have shown an increase in investigations of heterogeneity in posttraumatic stress disorder (PTSD) course. Although women are generally considered at increased PTSD risk, sex and gender differences in PTSD course have not yet been extensively studied.
Aim: we investigated differences in PTSD symptom trajectories across one year post-trauma between men and women, comparing general trends, within-trajectory symptom course and prevalence rates.
Method: We included N=554 participants (62.5% men, 37.5% women) from a multi-center prospective cohort of emergency department patients with suspected severe injury. Bayesian latent growth mixture modeling on longitudinal PTSD symptoms assessed at 1, 3, 6 and 12 months post-trauma was performed within the sex-disaggregated samples and whole sample.
Results: In terms of general trends, the same trajectories were observed for men and women, i.e. resilient, recovery, chronic symptoms and delayed onset. Within-trajectory symptom courses were largely comparable between men and women. Sex differences in prevalence rates were observed for the recovery and delayed onset trajectories, but surprisingly not chronic trajectory. In terms of model diagnostics, the sex-disaggregated models outperformed the whole sample model. Importantly, analyses within the whole sample led to biased estimates of trajectory prevalence rates, and inflated prevalence of chronic trajectory in women (van Zuiden et al. (2022) EJPT).
Conclusions: Sex-disaggregated trajectory analyses revealed only modest sex differences in PTSD symptom trajectories within one year post-trauma. The observed biased trajectory prevalence rates in the whole sample emphasize the necessity to apply appropriate statistical techniques when conducting sex-sensitive research.
Mirjam Van Zuiden
Repeated measures data collection among a diverse sample of forced migrants undergoing trauma focussed treatment: challenges and lessons learned.Jetske Van Heemstra
Background: To find leads for improving trauma-focused therapy for forced migrants, insights in the trajectories of change during treatment are useful. Since forced migrants are underrepresented in scientific research there is a lack of knowledge on the feasibility of this type of data collection in this specific population.Aims: To explore the feasibility of repeated measures data collection among forced migrants receiving Narrative Exposure Therapy (NET).Methods: The study included eighty-six forced migrants with a diagnosis of PTSD. The following questionnaires were administered every NET session: the Primary Care Post-Traumatic Stress Disorder checklist, the Perceived Stress Scale, the impulsivity subscale of the Difficulties in Emotion Regulation Scale, and a single item for depressed mood. Results: Main challenges were high drop-out, differentiation in number of received NET sessions, and the duration of questionnaire administration. Language problems were not reported as a reason for drop-out or obstruction.Conclusion: The administration of repeated measures during the course of NET seems challenging but feasible.
Jetske Van Heemstra
Long-term PTSD course following traumatic injury: a 15-year longitudinal follow-upJeanet Karchoud
Neuroticism as vulnerability factor for PTSD: empirical data on theoretical controversy.Iris Engelhard
The personality trait of neuroticism has been repeatedly associated with PTSD symptoms. However, the nature of this relationship is still partly unclear: neuroticism could be a vulnerability factor for PTSD symptoms, a consequence, or both. Prospective longitudinal research has shown that pre-trauma neuroticism scores predict later PTSD symptoms, but not after controlling for baseline symptoms (e.g.., Engelhard et al., 2009, PAID). Research has also shown that neuroticism does not reliably change after trauma exposure in middle adulthood (e.g., Ogle et al., 2014, JPers), but the time between pre/post-trauma assessments was long (about 10 years) and stressor severity and PTSD symptoms were not taken into account.
In two prospective longitudinal studies, we examined whether neuroticism scores are elevated after trauma exposure a result of stressor severity and PTSD symptoms.
In the first study, 1339 women completed questionnaires early in pregnancy, measuring neuroticism and baseline symptoms. Of these, 126 had a pregnancy loss (9%), and most of them completed neuroticism and PTSD symptom measures about 1 and 3 months later. In the second study, infantry troops completed questionnaires measuring neuroticism and PTSD symptoms before deployment to Iraq (n = 214) and about five months later, including a measure of trauma exposure (n = 170; 76%).
Results and Conclusions
Details from these studies have been described elsewhere (e.g., Engelhard et al., 2001, PAID; Engelhard et al., 2009, PAID), but the current findings have not been presented or published yet and will be presented and discussed at the conference.