Abstract
ContextUncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis.ObjectivesTo describe discrete symptom trajectories and examine their relevance for preventive interventions.DesignLatent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data.SettingHadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity.ParticipantsAdult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months.ApproachWe used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.8±5.7 days after ED admission, or delayed PE (n = 35) starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample.Main Outcome MeasureLatent trajectories of PTSD symptoms; effects of CBT on these trajectories.ResultsThree trajectories were identified: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes.ConclusionsThe early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.
Highlights
Recent events repeatedly show the extent of devastation and trauma caused by war, violence and disasters
The early course of Post-traumatic stress disorder (PTSD) symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence
Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables
Summary
Recent events repeatedly show the extent of devastation and trauma caused by war, violence and disasters. Chronic PTSD is prevalent, debilitating, and tenacious [1,2,3]. It occurs in a significant proportion of those who express acute. Numerous studies have shown that early, trauma-focused, cognitive behavioral therapy (CBT) reduces the prevalence of chronic PTSD among survivors with acute PTSD (e.g., [8,9,10]). The effectiveness of this family of resource-demanding interventions is limited by barriers to receiving care [11,12,13], by our inability to identify survivors who might remit without treatment (up to 45% of those with Acute PTSD [3,8,9]) as well as those who do not recover despite properly dispensed treatment (about 20%; [9])
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