Severe Posttraumatic Stress Symptoms Research Articles

A Brief School-Based Cognitive-Behavioral Intervention for Japanese Adolescents With Severe Posttraumatic Stress.

This pilot study investigated the efficacy of a brief school-based cognitive-behavioral intervention program for Japanese adolescents exposed to the Great East Japan Earthquake in 2011. The participants were 22 adolescents with severe posttraumatic stress symptoms at the time of the study in March 2014. They completed a single-session 4-step intervention program based on Ehlers and Clark's (2000) model at their school. Symptom status was assessed at 3 time points (preintervention, postintervention, and 4-month follow-up) using the Impact of Event Scale-Revised (Weiss, 2004) and Center for Epidemiologic Studies Depression Scale (Radloff, 1977). The results showed significant improvements in all posttraumatic stress symptoms at postintervention (d = 0.81), and the effects were maintained throughout the 4-month follow-up period (d = 1.10). However, no improvement in depressive symptoms was shown. Results from this pilot study suggest that school-based cognitive-behavioral intervention programs are feasible and show promise for Japanese adolescents with posttraumatic stress symptoms regardless of cross-cultural differences, but that additional research examining effectiveness is needed. Despite the preliminary nature of the findings of this pilot study, the strengths of our intervention were that it was driven by a well-tested theoretical model and required only a single session to administer.

Challenging future, challenging past: the relationship of social integration and psychological impairment in traumatized refugees

BackgroundRefugees have been shown to present high prevalence rates of trauma-related mental disorders. Despite their psychological impairment, they are expected to meet high functional requirements in terms of social integration into, and financial independence from, the host society.MethodsThis cross-sectional study examined the relationship of mental health problems, post-migration living difficulties (PMLD), and social integration in a sample of 104 refugees seeking treatment for severe posttraumatic stress and comorbid symptoms in two outpatient clinics in Switzerland.ResultsDespite an average time of residence in Switzerland of over 10 years, participants showed poor integration and a high number of PMLD. Integration difficulties were closely associated with psychological symptoms, but not with socio-demographic parameters such as education or visa status.ConclusionsPsychological impairment in treatment-seeking traumatized refugees is associated with poor integration. To foster social integration, it is crucial to better understand and address the specific needs of this highly vulnerable population.

Acute post-traumatic stress symptoms and age predict outcome in military blast concussion.

High rates of adverse outcomes have been reported following blast-related concussive traumatic brain injury in US military personnel, but the extent to which such adverse outcomes can be predicted acutely after injury is unknown. We performed a prospective, observational study of US military personnel with blast-related concussive traumatic brain injury (n = 38) and controls (n = 34) enrolled between March and September 2012. Importantly all subjects returned to duty and did not require evacuation. Subjects were evaluated acutely 0-7 days after injury at two sites in Afghanistan and again 6-12 months later in the United States. Acute assessments revealed heightened post-concussive, post-traumatic stress, and depressive symptoms along with worse cognitive performance in subjects with traumatic brain injury. At 6-12 months follow-up, 63% of subjects with traumatic brain injury and 20% of controls had moderate overall disability. Subjects with traumatic brain injury showed more severe neurobehavioural, post-traumatic stress and depression symptoms along with more frequent cognitive performance deficits and more substantial headache impairment than control subjects. Logistic regression modelling using only acute measures identified that a diagnosis of traumatic brain injury, older age, and more severe post-traumatic stress symptoms provided a good prediction of later adverse global outcomes (area under the receiver-operating characteristic curve = 0.84). Thus, US military personnel with concussive blast-related traumatic brain injury in Afghanistan who returned to duty still fared quite poorly on many clinical outcome measures 6-12 months after injury. Poor global outcome seems to be largely driven by psychological health measures, age, and traumatic brain injury status. The effects of early interventions and longer term implications of these findings are unknown.

Combat high or traumatic stress: violent offending is associated with appetitive aggression but not with symptoms of traumatic stress.

Former members of armed groups in eastern DR Congo had typically witnessed, experienced, and perpetrated extreme forms of violence. Enhanced trauma-related symptoms had been shown in prior research. But also lashing out in self-defense is a familiar response to threat defined as reactive aggression. Another potential response is appetitive aggression, in which the perpetration of excessive violence is perceived as pleasurable (combat high). What roles do these forms of aggressive behavior play in modern warfare and how are they related to posttraumatic stress symptoms? To answer the question, we sought to determine predictors for appetitive aggressive and trauma-related mental illness, and investigated the frequency of psychopathological symptoms for high- and low-intensity conflict demobilization settings. To this end, we interviewed 213 former members of (para)military groups in the eastern Democratic Republic of Congo in regard to their combat exposure, posttraumatic stress, appetitive aggression, depression, suicidality, and drug dependence. Random forest regression embedded in a conditional inference framework revealed that perpetrated violent acts are not necessarily stressful. In fact, the experience of violent acts that typically implicated salient cues of hunting (e.g., blood, suffering of the victim, etc.) had the strongest association with an appetite for aggression. Furthermore, the number of lifetime perpetrated violent acts was the most important predictor of appetitive aggression. However, the number of perpetrated violent acts did not significantly affect the posttraumatic stress. Greater intensity of conflict was associated with more severe posttraumatic stress symptoms and depression. Psychotherapeutic interventions that address appetitive aggression in addition to trauma-related mental illness, including drug dependence, therefore seem indispensible for a successful reintegration of those who fought in the current civil wars.

Altered inflammatory activity associated with reduced hippocampal volume and more severe posttraumatic stress symptoms in Gulf War veterans

Inflammation may reduce hippocampal volume by blocking neurogenesis and promoting neurodegeneration. Posttraumatic stress disorder (PTSD) has been linked with both elevated inflammation and reduced hippocampal volume. However, few studies have examined associations between inflammatory markers and hippocampal volume, and none have examined these associations in the context of PTSD. We measured levels of the inflammatory markers interleukin-6 (IL-6) and soluble receptor II for tumor necrosis factor (sTNF-RII) as well as hippocampal volume in 246 Gulf War veterans with and without current and past PTSD as assessed with the Clinician Administered PTSD Scale (CAPS). Enzyme-linked immunosorbent assays were used to measure inflammatory markers, and 1.5Tesla magnetic resonance imaging (MRI) and Freesurfer version 4.5 were used to quantify hippocampal volume. Hierarchical linear regression and analysis of covariance models were used to examine if hippocampal volume and PTSD status would be associated with elevated levels of IL-6 and sTNF-RII. Increased sTNF-RII, but not IL-6, was significantly associated with reduced hippocampal volume (β=-0.14, p=0.01). The relationship between sTNF-RII and hippocampal volume was independent of potential confounds and covariates, including PTSD status. Although we observed no PTSD diagnosis-related differences in either IL-6 or sTNF-RII, higher PTSD severity was associated with significantly increased sTNF-RII (β=0.24, p=0.04) and reduced IL-6 levels (β=-0.24, p=0.04). Our results indicate that specific inflammatory proteins may be associated with brain structure and function as indexed by hippocampal volume and PTSD symptoms.

Sleep quality, problematic cannabis use and posttraumatic stress symptoms among medical cannabis users

This study aimed to investigate the interactive influence of problematic cannabis use on the relation between sleep quality and posttraumatic stress symptoms (PTSS). Hypotheses were tested cross-sectionally among 151 medical cannabis users with PTSS. Consistent with hypotheses, we found sleep quality to be associated with PTSS severity. In addition, results indicated a significant interaction such that individuals with poor sleep quality and problematic cannabis use had the highest PTSS severity (particularly hyperarousal symptoms). Results suggest that medical cannabis users with the greatest risk of severe PTSS may be those with a combination of poor sleep quality and problematic cannabis use.

Insomnia and emotion dysregulation: Independent and interactive associations with posttraumatic stress symptoms among trauma-exposed smokers

IntroductionTraumatic event exposure is common among cigarette smokers, and elevated posttraumatic stress symptoms (PTSS) are associated with increased smoking levels. As such, the current study examined factors that may contribute to elevated PTSS among trauma-exposed smokers. Insomnia and emotion dysregulation may be particularly relevant among smokers, and are each associated with PTSS. However, it remains unclear whether these factors are associated with PTSS after accounting for the effects of dispositional factors and each other, and whether they may interact to predict PTSS. Thus, the current study sought to test whether insomnia and emotion dysregulation are independently associated with PTSS after accounting for negative affectivity and number of traumas experienced, and to investigate the potential interactive influence of these factors on PTSS. MethodHypotheses were tested cross-sectionally among a community sample of trauma-exposed individuals who presented for smoking cessation treatment (n=349). ResultsResults demonstrated that insomnia and emotion dysregulation each predicted elevated PTSS after controlling for the other, negative affectivity and number of traumas experienced. In addition, the interaction between insomnia and emotion dysregulation was significant, such that higher levels of insomnia and emotion dysregulation were associated with the most severe PTSS. LimitationsFuture research should examine these factors among a clinical sample of individuals with PTSD, as well as utilize prospective designs. ConclusionsFindings highlight the roles of insomnia and emotion dysregulation in contributing to elevated PTSS among trauma-exposed smokers, and the potential importance of targeting these factors in the context of PTSD treatment.

Post-traumatic Stress Symptoms and Adult Attachment: A 24-year Longitudinal Study

Attachment theory has become a key framework for understanding responses to and consequences of trauma across the life course. We predicted that more severe post-traumatic stress (PTS) symptoms at age 37 years would be associated with insecure attachment at age 55 and with worse PTS symptoms 24 years later at age 61, and that age 55 attachment would mediate the influence of earlier PTS symptoms on later symptoms. Data on PTS self-reported symptoms were available for 975 community-dwelling participants from the longitudinal Vietnam Era Twin Study of Aging at ages 37 and 61 years. At age 55, participants completed the Experiences inClose Relationships Inventory, a measure of adult attachment. PTS symptoms at ages 37 and 61 correlated (r= 0.43; p<0.0001). Multiple mediation models found significant direct effects of age 37 PTS symptoms on age 61 PTS symptoms (β= 0.26; 95% confidence interval: 0.19-0.33). Anxious and avoidant attachment at age 55predicted PTS symptoms at age 61 (r= 0.34 and 0.25; ps<0.0001, respectively) andalso significantly mediated PTS symptoms over time, showing that insecure attachment increased PTS severity. Participants with higher age 37 PTS symptoms weremore likely to have a history of divorce; marital status did not mediate PTS. Analyses demonstrate the persistence of PTS symptoms from early midlife into early old age. Mediation analyses revealed that one path through which PTS symptoms persisted was indirect: through their influence on attachment insecurity.This study provides insight into ongoing interconnections between psychological and interpersonal responses to stress.

A study of posttraumatic stress symptoms among young adults in Japan : correlates and effects on mental health and quality of life

Objective：To ascertain posttraumatic stress symptoms（PTSS） as a result of experiencing intensely stressful events and to determine the correlates and effects of PTSS on mental health and quality of life（QOL） . Design：A cross sectional study. Subjects and Methods：An online survey of survey panelists ages 25－29 who registered with an online survey company. Results：1）Seventy percent of subjects had experienced stressful events, and the most stressful events they experienced related to“school” and“personal relationships”（in that order） . Subjects with an IES－R score of 25 points or more, suggesting PTSD, accounted for 28％ of subjects. 2）Severe PTSS were associated with a lower level of education. 3）Mental health and the mental component of health－related QOL tended to worsen with more severe PTSS. Overall mental health was also better with higher awareness of support from family. 4）Awareness of support from family or others was not found to moderate the effects of PTSS on mental health and health－related QOL. Conclusions：These findings suggested that a relatively high percentage of individuals experienced intensely stressful life events besides those that are considered to have a profound impact. Findings also suggested that some individuals with those experiences develop somewhat more intense stress symptoms and that these symptoms may affect mental health and quality of life.

Trauma experience, psychological resilience and dispositional optimism: Three adult generations in Lithuania

SummaryEpidemiological studies suggest that the vast majority of people experience at least one potentially traumatic event in their lifetime; however, severe posttraumatic stress symptoms affect only few of those ever exposed to trauma. This study has been aimed to find out whether trait resilience and dispositional optimism are associated with trauma experience and a probable Posttraumatic Stress Disorder (PTSD). A cross-sectional study was conducted, enrolling 300 Lithuanian adults of three different age groups. The Life Events Checklist (LEC), Trauma Screening Questionnaire (TSQ), Resilience Scale (RS-14), and Revised Life Orientation Test (LOT-R) were used to measure potentially traumatic events, posttraumatic reactions, psychological resilience, and dispositional optimism. Results of this study revealed a high prevalence of potentially traumatic events among its participants (95%). Nearly 7% of the total sample had probable PTSD. A significant moderate positive relationship was found between the resilience and optimism, r(300) = .40, p &lt; .01. Optimism was negatively associated with PTSD symptoms, r(214) = –.17, p &lt; .05; however, contrary to what was expected, there was no significant association between the trauma reactions and trait resilience.

Posttraumatic Stress, Depression, and Insomnia Among U.S. Air Force Pararescuemen

Few studies have examined rates of mental health problems among special duty military personnel, who often have frequent deployments and high exposure to operational stressors and trauma. The current study examined the severity and rates of positive screening for posttraumatic stress, depression, and insomnia among 194 U.S. Air Force pararescuemen (PJs) in the active duty (AD) and National Guard/Reserve (NG/R) components. Overall estimated rates were 11.6% for probable posttraumatic stress disorder (PTSD), 1.6% for probable depression, and 16.1% for clinical insomnia. PJs in the NG/R reported significantly more severe posttraumatic stress symptoms (F(1, 162) = 10.031, p = .002, partial η2 = .058) and were approximately twice as likely to screen positive for probable PTSD (8.5% vs. 19.1%; χ2[1] = 3.679, p = .055). No differences in the rate or severity of depression or insomnia symptoms were found. Rates of positive screens are comparable to or lower than previously published rates among military personnel.

Exposure to traumatic events and symptoms of post-traumatic stress among South African university students

We investigated the lifetime exposure to traumatic events and symptoms of post-traumatic stress disorder, depression, and anxiety among 1337 students at a large residential university in South Africa. Traumatic events were assessed using the Stressful Life Events Scaling Questionnaire, and the symptoms of post-traumatic stress, depression, and anxiety were measured using the Post-Traumatic Stress Disorder Symptom Scale–Self Report Version, the Beck Depression Inventory, and the Beck Anxiety Inventory, respectively. The sample consisted of females ( n = 857) and males ( n = 480). Approximately 90% of the sample reported at least one traumatic event in their lifetime, and male and female students reported similar levels of exposure to traumatic events. With regard to symptoms of post-traumatic stress, those students who had experienced a traumatic event reported more severe post-traumatic stress symptoms than those students who had not. Significant correlations were found among symptoms of post-traumatic stress, depression, and anxiety. The significant predictors of the severity of post-traumatic stress symptoms were gender, Black race, Coloured race, and year of study. The significant predictors of the frequency of traumatic events were gender, age, Black race, Coloured race, and private residence. These results are compared with South African trauma-related studies as well as findings from other countries.

Impact of prior traumatic life events on parental early stage reactions following a child's cancer.

BackgroundIn pediatric oncology, effective clinic–based management of acute and long–term distress in families calls for investigation of determinants of parents' psychological response to the child's cancer. We examined the relationship between parents' prior exposure to traumatic life events (TLE) and the occurrence of posttraumatic stress symptoms (PTSS) following their child's cancer diagnosis. Factors mediating the TLE–PTSS relationship were analyzed.MethodologyThe study comprised 169 parents (97 mothers, 72 fathers) of 103 cancer diagnosed children (median age: 5,9 years; range 0.1–19.7 years). Thirty five parents were of immigrant origin (20.7%). Prior TLE were collated using a standardized questionnaire, PTSS was assessed using the Impact of Events–Revised (IES–R) questionnaire covering intrusion, avoidance and hyperarousal symptoms. The predictive significance of prior TLE on PTSS was tested in adjusted regression models.ResultsMothers demonstrated more severe PTSS across all symptom dimensions. TLE were associated with significantly increased hyperarousal symptoms. Parents' gender, age and immigrant status did not significantly influence the TLE–PTSS relationship.ConclusionsPrior traumatic life–events aggravate posttraumatic hyperarousal symptoms. In clinic–based psychological care of parents of high–risk pediatric patients, attention needs to be paid to life history, and to heightened vulnerability to PTSS associated with female gender.

Deployment Cycle Stressors and Post-Traumatic Stress Symptoms in Army National Guard Women: The Mediating Effect of Resilience

This study examined the associations between deployment cycle stressors, post-traumatic stress symptoms (PTSS), and resilience in Army National Guard (ARNG) women deployed to Operations Enduring Freedom and Iraqi Freedom. Resilience was also tested as a mediator. Hierarchical linear regression indicated that deployment and post-deployment stressors were positively associated, and resilience was negatively associated with PTSS. Resilience fully mediated the association between post-deployment stressors and PTSS. Findings suggest assessing deployment and post-deployment stressors in ARNG women may be helpful in identifying those at risk for severe PTSS; and highlight the potential of individual-level resilient characteristics in mitigating the adverse impact of post-deployment stressors.

Differential roles of thought suppression and dispositional mindfulness in posttraumatic stress symptoms and craving

Exposure to traumatic events often results in severe distress which may elicit self-medication behaviors. Yet, some individuals exposed to trauma do not develop post-traumatic stress symptoms and comorbid addictive impulses. In the wake of traumatic events, psychological processes like thought suppression and mindfulness may modulate post-traumatic stress and craving for substances. We examined the differential roles of mindfulness and suppression in comorbid post-traumatic stress and craving among a sample of 125 persons with extensive trauma histories and psychiatric symptoms in residential treatment for substance dependence. Results indicated that thought suppression, rather than extent of trauma history, significantly predicted post-traumatic stress symptom severity while dispositional mindfulness significantly predicted both post-traumatic stress symptoms and craving. In multiple regression models, mindfulness and thought suppression combined explained nearly half of the variance in post-traumatic stress symptoms and one-quarter of the variance in substance craving. Moreover, multivariate path analysis indicated that prior traumatic experience was associated with greater thought suppression, which in turn was correlated with increased post-traumatic stress symptoms and drug craving, whereas dispositional mindfulness was associated with decreased suppression, post-traumatic stress, and craving. The maladaptive strategy of thought suppression appears to be linked with adverse psychological consequences of traumatic life events. In contrast, dispositional mindfulness appears to be a protective factor that buffers individuals from experiencing more severe post-traumatic stress symptoms and craving.

Posttraumatic stress disorders in long-term Egyptian survivors after childhood cancer

Middle East Current Psychiatry 2012, 19:40–47 Background Seventy-five percent of children who are diagnosed with cancer are expected to survive. As this population has grown, the study of the impact of this traumatic event has become increasingly important. Objectives The current study aimed to investigate the prevalence and risk factors of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in long-term childhood cancer survivors. Methods Eighty survivors of childhood cancer who were between 9 and 17 years of age (mean ± SD = 12.9 ± 2.28), had stopped therapy for at least 2 years, had no history of previous central nervous system relapse or cranial irradiation, and did not have premorbid medical diseases, were enrolled in the study. They were assessed in terms of PTSD, PTSS, and Children’s Global Assessment Scale. They were compared with age-matched and sex-matched healthy controls. Results Fourteen survivors (17.5%) met the criteria of lifetime diagnosis of PTSD according to Kiddie-Sads-Present and Lifetime Version diagnostic and clinical versus 5% of the control group (v = 6.26, P = 0.04, odds ratio = 4.03, confidence interval = 1.26–12.84). In the survivor group, current PTSS were severe in 10%; moderate in 32.5%; and mild in 50%, according to the children posttraumatic stress disorder reaction index. None of the children in the control group had severe PTSS. Severe PTSS are associated with older age at diagnosis, older age during study, relapse, increased duration of therapy, and use of chemotherapy plus irradiation and/or surgery. Severe PTSS are associated with lower scores on Children’s Global Assessment Scale. Conclusion Both PTSD and PTSS may be prevalent in cancer survivors even after a complete physical cure. Adequate treatment of traumatic memories, arousal and avoidance, may improve social and psychological functioning, and quality of life. This will lead to better orientation toward health services.

The mutual prospective influence of child and parental post‐traumatic stress symptoms in pediatric patients

Previous studies found notable rates of post-traumatic stress symptoms (PTSS) and post-traumatic stress disorder (PTSD) in pediatric patients and their parents and suggest a significant association between child and parent PTSS. However, little is known about mutual influences between child and parental PTSS over time. This study prospectively examined the presence of PTSS and PTSD and the mutual influence of child and parental PTSS in a large sample of pediatric patients with different medical conditions. A total of 287 children (aged 6.5-16 years) and their mothers (n = 239) and fathers (n = 221) were assessed at 5-6 weeks and 1 year after an accident or a new diagnosis of cancer or diabetes mellitus type 1 in the child. At the first assessment 11.1% and at the second assessment 10.2% of the children had moderate to severe PTSS. At 5-6 weeks 29.3% of mothers and 18.6% of fathers met criteria for PTSD. At 1 year the rates were 14.6% for mothers and 7.9% for fathers. There were considerable differences of PTSS among different medical diagnostic groups in children and parents. Mothers were more vulnerable than fathers. Structural equation analysis revealed that initially high PTSS in mothers and fathers were longitudinally related to poorer recovery from PTSS in the child. Cross-lagged effects from the child to the parents and from one parent to the other were not significant. This study highlights the long-term influence of parental PTSS on the child's recovery after trauma and calls for a family systems approach and for early interventions in the treatment of traumatized pediatric patients.

Posttraumatic stress disorder (PTSD) in survivors of Hodgkin's lymphoma: prevalence of PTSD and partial PTSD compared with sibling controls

Studies of posttraumatic stress disorder (PTSD) document a significant proportion of cancer survivors reporting severe posttraumatic stress symptoms, even when they do not meet full diagnostic criteria. However, few studies have directly examined the clinical significance of these 'partial PTSD' symptoms in survivors. This study aimed to investigate the prevalence of PTSD symptoms in a cohort of long-term survivors of Hodgkin's lymphoma (HL) and to explore the clinical relevance of the partial PTSD phenomenon by assessing impairment of function secondary to sub-threshold symptomatology. The Posttraumatic Diagnostic Scale was completed by 105 HL survivors and 101 sibling controls. Survivors' age at time of participation ranged from 24 to 71 years, age at time of diagnosis ranged from 6 to 61 years, and the median time since diagnosis was 16 years (range = 7-34). Posttraumatic stress disorder prevalence was not significantly higher in HL survivors (13%) compared with sibling controls (6.9%, p = 0.098). However, a significantly larger proportion of survivors (35.2%) met criteria for partial PTSD compared with siblings (17.8%, p = 0.004). Moreover, the majority of the survivors with partial PTSD (86.5%) reported experiencing some functional impairment related to these posttraumatic stress symptoms. A significant number of HL survivors experience posttraumatic stress symptoms severe enough to result in functional impairment. This finding underscores the importance of future research detailing the psychological and functional outcomes in survivors with partial PTSD and of careful clinical practice that assesses for functional impairment secondary to partial PTSD symptomatology, in male and female survivors, even years after completion of therapy.

Post-traumatic stress symptoms in relatives in the first weeks after severe traumatic brain injury

Introduction: Severe traumatic brain injury (STBI) can cause psychological stress in proxies in the long-term. This study assessed post-traumatic stress (PTS) symptoms in proxies of survivors of STBI in the short-term and investigated stress-associated factors.Methods: Prospective cross-sectional study, conducted at three Swiss trauma centres over 1 year. Patient and proxy demographics, trauma data including Glasgow Coma Scale (GCS) and management data were collected. The proxies’ PTS symptoms were assessed by applying the Impact of Event Scale–Revised (IES-R), once in the first month after the accident (median: 11 days).Results: Sixty-nine proxies were included; 52 proxies were female (77.8%). Mean IES-R sum score for intrusions was 13.38 (SD = 7.26), for avoidance 8.91 (SD = 5.94), and for hyperarousal 9.07 (SD = 6.75). Clinically significant PTS symptoms were observed in 36 proxies (52.2%); mean IES-R sum scores were significantly higher in women. IES-R sub-scale values were inversely related with GCS at the scene of the accident and on hospital admission.Conclusions: More than half of proxies had clinically significant PTS symptoms shortly after their relative's accident. More severe PTS symptoms were found in women and in proxies of patients with poorer initial GCS scores. Further research into risk groups in the short- and long-term and the long-term impact on patients of PTS syndrome in proxies is warranted.

How traumatic is breast cancer? Post-traumatic stress symptoms (PTSS) and risk factors for severe PTSS at 3 and 15 months after surgery in a nationwide cohort of Danish women treated for primary breast cancer

Background:The literature shows considerable between-study variation in the prevalence of post-traumatic stress symptoms (PTSS) among women with breast cancer. Our aim was, therefore, to explore the prevalence of and risk factors for cancer-related PTSS in a nationwide inception cohort of women treated for primary breast cancer.Methods:In all, 68% of all Danish women receiving surgery for primary breast cancer between October 2001 and March 2004 completed a questionnaire at 3 months post surgery (n=3343), which included the impact of event scale (IES). In all, 94% of the disease-free women also completed a follow-up questionnaire at 15 months post surgery. Data on pre-cancer demographic, socioeconomic, and psychiatric status were obtained from national registries. The Danish Breast Cancer Cooperative Group and surgical departments provided information on disease variables, treatment, and comorbidity.Results:At 3 months post surgery, 20.1% had IES total scores suggesting severe PTSS (⩾35), compared with 14.3% at 15 months. In all, 48% with severe PTSS at 3 months also had scores above the cutoff at 15 months. Main predictors of severe PTSS at 15 months were low social status, previous physical and mental illness, axillary lymph node involvement (>3), and reduced physical functioning (PF) at 3 months.Conclusion:The results confirm that receiving a breast cancer diagnosis can be a significant traumatic experience, and that many women experience persistent cancer-related PTSS. Low social status, poor health status, low levels of PF, and disease severity were found to be risk factors for severe PTSS.