Relationship between depression and arousal symptom in trauma survivors

Abstract

Depression is highly comorbid with post-traumatic stress disorder (PTSD). However, there have been few studies investigating the risk factors for depression in PTSD patients. The aim of this study was to evaluate the prevalence of depression in PTSD and relationship between depressive symptoms, PTSD symptom clusters, and anxiety. Participants were 24 survivors from the disaster of the Taegu subway fire (29.4±9.3 years, 9 men) who had diagnosis of PTSD by the Structured Clinical Interview for DSM-IV (SCID-IV) and 39 healthy comparison subjects (30.5 ± 7.2 years, 20 men). Depressed mood and anxiety were examined by Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in all subjects. In PTSD subjects, the severity of PTSD symptoms including arousal, avoidance, and re-experience were assessed by the Clinician-Administered PTSD Scale for DSMIV (CAPS). The mean HAMD score of PTSD subjects was significantly higher than that of control subjects (13.4±4.8 vs 3.5±3.9, t=8.8, pb0.001). When applying standard HAMD cut-off score of 11 or higher, 15 PTSD subjects (62.5%) and 2 control subjects (5.1%) had significant depressive symptoms (χ = 24.8, pb0.001). The mean HAMA score was also significantly higher in PTSD subjects than control subjects (15.5±4.7 vs 1.3±1.6, t=12.1, pb0.001). HAMD scores were positively correlated with arousal (r=0.78) and avoidance (r=0.65) scores, intensity/ frequency of PTSD symptoms (r=0.69; r=0.69), and HAMA scores (r=0.49). However, multiple linear regression analysis controlling for sex and age indicated that only arousal score was a significant predictor of HAMD score in PTSD subjects (regression coefficient=0.53, pb0.01). This study showed that survivors from trauma had significant depressive symptoms and that arousal symptoms appeared to be a salient factor contributing to depressive symptoms observed in the survivors. Further prospective study should be necessary to clarify the role of arousal symptoms to development of depression in PTSD patients.