Stress Trajectories Research Articles

Trajectories of resilience and posttraumatic stress in childhood cancer: Consistency of child and parent outcomes.

Childhood cancer represents a potentially traumatic experience for both patients and caregivers. We examined trajectories of posttraumatic stress symptoms (PTSS) across a 5-year period in children with a history of cancer and their parents/caregivers. Medical, demographic, and dispositional variables were examined as predictors of PTSS trajectories. Using a longitudinal design, children with cancer history (n = 254, age 8-17 years at baseline) and one parent or caregiver (n = 255) completed measures of PTSS at baseline, and 1-, 3-, and 5-years poststudy entry. Children and caregivers completed dispositional measures including optimism, positive or negative affect, and Five-Factor Inventories. Latent class growth analysis (LCGA) was used to identify latent trajectories of PTSS, and univariate logistic regression models were conducted to predict LCGA class membership from medical, demographic, and disposition factors Results: Very similar trajectories were observed in children and caregivers, with two-class solutions providing the best fit: a "resilient" class, with low PTSS at baseline, which declined significantly over time (83.5% in children; 71.5% in parents), and an "elevated PTSS" class, which was moderately high at baseline and increased significantly over time. There was a small, but significant relationship between child and caregiver trajectories. Latent trajectories observed in children and parents were more strongly associated with dispositional variables than medical factors. Resilience, depicted by low PTSS, is by far the most common outcome observed in both children and caregivers. However, the smaller subset with elevated PTSS do not show recovery over time, and are identified as a group in need of targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

3D printing and epoxy-infusion treatment of curved continuous carbon fibre reinforced dual-polymer composites

A manufacturing technique was developed to fabricate curved continuous carbon fibre reinforced composites based on 3D printing and epoxy-infusion treatment. Composite preforms were first manufactured by material-extrusion based 3D printing of continuous carbon fibre reinforced thermoplastic polyamide-6 (PA-6) filaments. Powder thermoset epoxy was added to the preforms to fill up the gaps, remove air voids and enhance the interfacial bonding through a traditional vacuum bagging and oven curing process. Uniaxial tensile tests showed that the stiffness and strength of the printed composites were increased by 29.3% and 22.1%, respectively, compared to the thermoplastic-only composite specimens . The epoxy-infusion treatment technique was also adopted to manufacture composites with curved fibre alignment and investigate the performance of 3D printed notched specimens under uniaxial tension. It was shown that the placement of continuous carbon fibres along the principal stress trajectories increased the failure strength and the fracture toughness of the composites by 81% and 157% respectively, compared to the unidirectional and concentric placement methods.

Exploring the inclusion of developmental stress trajectories on past adult mortality patterns: Quantifying skeletal plasticity and adult mortality risk in post‐medieval London using a probability tree model

AbstractSufficient evidence supports arguments that early life conditions can influence adult morbidity and mortality in the past and present. Critical periods in which individuals are more susceptible to stressors leading to long‐term effects vary, but how often and to what degree these long‐term effects occur is less certain. To evaluate skeletal stress markers that fully develop during different life history stages (i.e., childhood and adolescence) and explore their influence on adult morbidity and mortality, we constructed four growth trajectory categories to estimate the effect of developmental timing of stress indicators on adult mortality risk in skeletal samples from post‐medieval London (n = 118 individuals). To construct these growth trajectory categories, linear enamel hypoplasia and tibial length were used as evidence of early life stress during childhood and extended into adolescence. Pairwise relationships between growth trajectory scores and variables such as age, sex, and cemetery were explored using Chi‐square and Fisher's exact tests. Long‐term effects were also evaluated using Factorial ANOVA as a multifactorial method to test correlations between categorical variables of early life stress and adult mortality risk. Results suggest there was no relationship between age‐at‐death and growth trajectory score, with the only significance in growth disruption score being between tibial stunting and age‐at‐death in males. Socioeconomic status did not impact results of this study, with only two statistically significant relationships noted for one cemetery. Results comparing males and females also yielded no significant differences, indicating sex was not a significant covariate. Overall, this paper presents a model that can help investigate differences between various developmental origins frameworks and be built upon by future researchers using different stress indicators, datasets, and skeletal samples to investigate potential change through time in lived experiences and how that change through time impacts patterns of mortality risk.

Adolescent stress experiences over time study (ASETS) protocol: design and methods of a prospective longitudinal study of sexual minority adolescents in the USA

IntroductionSexual minority adolescents (SMA) report higher rates of anxiety, self-harm, depression and suicide than heterosexual peers. These disparities appear to persist into adulthood and may worsen for certain subgroups, yet...

Trajectory of post-traumatic stress and depression among children and adolescents following single-incident trauma

ABSTRACT Objective Post-traumatic stress disorder and depression have high comorbidity. Understanding their relationship is of clinical and theoretical importance. A comprehensive way to understand post-trauma psychopathology is through symptom trajectories. This study aims to look at the developmental courses of PTSD and depression symptoms and their interrelationship in the initial months post-trauma in children and adolescents. Methods Two-hundred-and-seventeen children and adolescents aged between eight and 17 exposed to single-event trauma were included in the study. Post-traumatic stress symptoms (PTSS) and depression symptoms were measured at 2 weeks, 2 months and 9 months, with further psychological variables measured at the 2-week assessment. Group-based trajectory modelling (GBTM) was applied to estimate the latent developmental clusters of the two outcomes. Logistic regression was used to identify predictors associated with high symptom groups. Results The GBTM yielded a three-group model for PTSS and a three-group model for depression. PTSS trajectories showed symptoms reduced to a non-clinical level by 9 months for all participants (if they were not already in the non-clinical range): participants were observed to be resilient (42.4%) or recovered within 2 months (35.6%), while 21.9% experienced high level PTSS but recovered by 9 months post-trauma. The depression symptom trajectories predicted a chronic non-recovery group (20.1%) and two mild symptom groups (45.9%, 34.0%). Further analysis showed high synchronicity between PTSS and depression groups. Peri-event panic, negative appraisals, rumination and thought suppression at 2 weeks predicted slow recovery from PTSS. Pre-trauma wellbeing, post-trauma anxiety and negative appraisals predicted chronic depression. Conclusions Post-trauma depression was more persistent than PTSS at 9 months in the sampled population. Cognitive appraisal was the shared risk factor to high symptom groups of both PTSS and depression.

Mental health across the early years in the military.

The mental health impact of the initial years of military service is an under-researched area. This study is the first to explore mental health trajectories and associated predictors in military members across the first 3-4 years of their career to provide evidence to inform early interventions. This prospective cohort study surveyed Australian Defence personnel (n = 5329) at four time-points across their early military career. Core outcomes were psychological distress (K10+) and posttraumatic stress symptoms [four-item PTSD Checklist (PCL-4)] with intra-individual, organizational and event-related trajectory predictors. Latent class growth analyses (LCGAs) identified subgroups within the sample that followed similar longitudinal trajectories for these outcomes, while conditional LCGAs examined the variables that influenced patterns of mental health. Three clear trajectories emerged for psychological distress: resilient (84.0%), worsening (9.6%) and recovery (6.5%). Four trajectories emerged for post-traumatic stress, including resilient (82.5%), recovery (9.6%), worsening (5.8%) and chronic subthreshold (2.3%) trajectories. Across both outcomes, prior trauma exposure alongside modifiable factors, such as maladaptive coping styles, and increased anger and sleep difficulties were associated with the worsening and chronic subthreshold trajectories, whilst members in the resilient trajectories were more likely to be male, report increased social support from family/friends and Australian Defence Force (ADF) sources, and use adaptive coping styles. The emergence of symptoms of mental health problems occurs early in the military lifecycle for a significant proportion of individuals. Modifiable factors associated with wellbeing identified in this study are ideal targets for intervention, and should be embedded and consolidated throughout the military career.

Trajectories of depression, anxiety and stress among adults during the COVID-19 pandemic in Southern Switzerland: the Corona Immunitas Ticino cohort study

ObjectivesUsing longitudinal data from Southern Switzerland we assessed ten-month temporal trajectories of moderate to severe depression, anxiety and stress among adults after the first pandemic wave and explored differences between sociodemographic and health status groups. Study designThis was a population-based prospective cohort study. MethodsParticipants were 732 (60% women) adults aged 20–64 years who completed the Depression, Anxiety and Stress Scale on a monthly base since August 2020 until May 2021, as part of the Corona Immunitas Ticino study based on a probability sample of non-institutionalized residents in Ticino, Southern Switzerland. ResultsPrevalence of moderate to severe depression increased from 7.5% in August 2020 to 12.5% in May 2021, anxiety increased from 4.8% to 8.1% and stress increased from 5.5% to 8.8%. A steeper increase in poor mental health was observed between October 2020 and February 2021. Men had a lower risk for anxiety (odds ratio [OR] = 0.58, 95% confidence interval [CI] = 0.36–0.95) and stress (OR = 0.61, 95% CI = 0.44–0.95) than women. Suffering from a chronic disease increased the risk for depression (OR = 1.82, 95% CI = 1.12–2.96), anxiety (OR = 2.38, 95% CI = 1.44–3.92) and stress (OR = 1.87, 95% CI = 1.14–3.08). The differences between these groups did not vary over time. ConclusionsIn a representative Swiss adult sample, prevalence of moderate to severe depression, anxiety and stress almost doubled in the course of ten months following the end of the first pandemic wave in spring 2020. Women and participants with pre-existing chronic conditions were at a higher risk of poor mental health.

Analysis of Face Stability Based on Incomplete Soil Arching Effect

The excavation face stability is a critical issue in the analysis of the tunneling disturbance to the surrounding environment, in which the soil arching effect is a phenomenon that cannot be ignored. Based on the wedge-prism model, this study proposed a slice method to calculate the limit support pressure, taking into account both the vertical soil arching effect of the prism and the horizontal arching effect of the wedge. In addition, the rotation of the principal stress was introduced to improve the lateral stress ratio on the vertical sliding faces including the wedge and the prism, in which two new trajectories of the major principal stress were recommended, based on a previous numerical study. Furthermore, the contribution of the incomplete soil arching effect was discussed in this study, assuming that there was a function between the effective internal friction angle of the soil and the tunnel cover depth. Through the comparison of the results with theoretical and numerical models, the improved model was validated and showed agreement with them. Finally, parameters related to the limit support pressure were thoroughly investigated to provide a better understanding of the proposed model.

Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis

ABSTRACT Background The course and different characteristics of acute and posttraumatic stress disorder (ASD, PTSD) in trauma populations are unclear. Objective The aims were to identify longitudinal trajectories of PTSD, to establish a risk profile for ASD and PTSD based on patients’ sociodemographic, clinical, and psychological characteristics, and to study the effect of ASD and dissociation on PTSD during 12 months after trauma. Method Patients completed questionnaires after inclusion and at 3, 6, 9, and 12 months afterwards. Trajectories were identified using repeated measures latent class analysis (RMLCA). The risk profile was based on a ranking of importance of each characteristic using Cohen’s d effect sizes and odds ratios. The impact of ASD and dissociation on PTSD was examined using logistic regression analyses. Results Altogether, 267 patients were included. The mean age was 54.0 (SD = 16.1) and 62% were men. The prevalence rate of ASD was approximately 21.7% at baseline, and 36.1% of trauma patients exhibited PTSD at 12 months after injury. Five trajectories were identified: (1) no PTSD symptoms, (2) mild, (3) moderate, (4) subclinical, and (5) severe PTSD symptoms. These trajectories seemed to remain stable over time. Compared with patients in other trajectories, patients with ASD and (subclinical) PTSD were younger and scored higher on anxiety, depressive symptoms, neuroticism, and trait anxiety. Regarding dissociation symptoms, inability to recall memories about the event was significantly more present than an altered sense of reality, (105 (40.7%) versus 56 (21.7%), p = .031), although that symptom had the strongest likelihood for PTSD. Patients with dissociation were significantly at risk for PTSD than patients without dissociation (OR = 4.82; 95%CI: 1.91–12.25). Conclusions Psychological factors characterized ASD and trajectories of PTSD during 12 months post-trauma. Healthcare providers who are aware of these findings could early identify patients at risk for ASD and PTSD and refer them for patient-centred interventions.

Effectiveness of fibre placement in 3D printed open-hole composites under uniaxial tension

The emerging 3D printing technology of continuous fibres enables fibre steering and customised curved fibre paths during the manufacturing process, which could potentially enhance the mechanical properties of composites with geometric singularities. In this paper, the effect of fibre placement on the mechanical performance of open-hole composites under uniaxial tension is comprehensively studied. A hybrid manufacturing technology is presented to enable the fabrication of 3D printed dual-polymer composites with low porosity and customised continuous carbon fibre reinforcement. A concept of placing continuous fibres along the maximum principal stress trajectories is adopted and found to improve the strength of the composites and dramatically postpone the crack initiation, compared with the drilled samples. Additional fibres, along the minimum principal stress trajectories and around the hole, are found to dramatically alter the failure mode and mechanical performance of the samples. Together with the digital image correlation measurement, a finite element model is also developed based on the actual printing paths to understand the stress distributions due to different fibre placement methods. The study offers a very useful tool for the customised design of 3D printed composites with complex shapes and/or geometric singularities.

A longitudinal study of post-traumatic stress, depressive, and anxiety symptoms trajectories in subjects with bipolar disorder during the COVID-19 pandemic.

Bipolar disorder (BD) is recognized to be at high risk for developing negative psychopathological sequelae to potentially traumatic events. Nevertheless, scant data are still available about the effects of the COVID-19 emergency on the clinical course of BD. The present study examined prospectively the development and trajectories of post-traumatic stress, depressive, and anxiety symptoms among subjects with BD that were followed in an outpatient psychiatric clinic at the time of pandemic onset. A cohort of 89 subjects with BD was enrolled during the first wave of the COVID-19 pandemic, and assessed at baseline (T0), 2-months (T1), and 6-months (T2) follow-up. A K-means cluster analysis was used to identify distinct trajectories of depressive, anxiety, and post-traumatic stress symptoms during the three time points. We identified three trajectories: the Acute reaction (13.5%); the Increasing severity (23.6%); and the Low symptoms (62.9%) groups, respectively. In the Acute reaction group a significant prevalence of female gender was reported with respect to the Low symptoms one. Subjects in the Increasing severity group reported significantly lower employment rate, and higher rate of relatives at risk for COVID-19 medical complications. Subjects in the Increasing Severity group reported higher rates of previous hospitalization and manic symptoms at baseline than those included in the Low symptoms one. Our results describe three distinct symptom trajectories during the COVID-19 emergency in a cohort of subjects suffering from BD, suggesting the need of a long-term follow-up for detecting the impact of the COVID-19 pandemic in this vulnerable population.

Supplemental Material for A Systematic Review of Posttraumatic Stress and Resilience Trajectories: Identifying Predictors for Future Treatment of Veterans and Service Members

Supplemental Material for A Systematic Review of Posttraumatic Stress and Resilience Trajectories: Identifying Predictors for Future Treatment of Veterans and Service Members

Age Differences and Longitudinal Change in Exposure to Daily Stressors: Three Waves of Diary Data Across 20 Years

Exposure to daily stress is an important risk factor for healthy aging. We examined cross-sectional age-related differences and longitudinal aging-related change in stressor exposure across three waves of the National Study of Daily Experiences (N=2,914, M=51.53 years, SD=13.55, 56.35% Female) spanning 20 years. Exposure to six types of stressors (arguments, avoided arguments, work overloads, home overloads, network stressors, other) were obtained from telephone interviews over 8 consecutive days in waves conducted in ~1996, ~2008, and ~2017. Longitudinal analyses revealed declines in stressor exposure across 20 years (p <.01), driven by declines in arguments, work overloads, and network stressors specifically. Cross-sectional analyses indicated that older individuals reported stressors less frequently (p <.01), driven by decreases in arguments, avoided arguments, work overloads, and home overloads specifically. Rates of longitudinal decline did not depend on age at baseline. Results suggest that aging-related changes and baseline age differences inform daily stress trajectories in mid- and later-life.

Theories of plasticity under complex loading along flat trajectories of deformations

The paper considers variants of theories of plastic flow with combined hardening, which are widely used in applied calculations of structures. A comparative analysis of the theories under complex loading along flat strain trajectories is carried out and covers the entire range of strain paths from multilink polylines to curved trajectories of constant and variable curvatures. The strain path from medium to large curvatures are considered. The analysis of the research results is carried out in the vector space of A.A. Il’yushin. We consider plane trajectories of deformations in the form of a square, three circles passing the origin of coordinates, and trajectories in an asteroid-like form. The results of the calculations are compared with the results of the experimental studies of the response stress trajectories, scalar and vector properties. Variants of theories are considered: isotropic hardening model; Ishlinsky-Prager-Kadashevich-Novozhilov model (linear kinematic and isotropic hardening); model similar to Ono-Wang's model; the Armstrong-Frederick-Kadashevich model (the Korotkikh model is based on this model); the Shabosh model with three evolutionary Armstrong-Frederick-Kadashevich equations; Themis model based on the invariant theory of plasticity; Bondar model with a three-term structure of the evolutionary equation for kinematic hardening. We give the material parameters (functions) that close the variants of plasticity theories. A satisfactory agreement with the experiment for all deformation trajectories is achieved in calculations based on the models of Ishlinsky-Prager-Kadashevich-Novozhilov, Shabosh and Temis. The difference between the results of calculations and experiments does not exceed 30 %. The best agreement with the experiment is achieved on the basis of the Bondar model with the difference between the results of the calculations and experiments for all trajectories less than 10 %.

Trajectories of family and employment stress associated with cerebrovascular accidents.

ABSTRACTOBJECTIVES:Reconstruct types of simultaneous stress trajectories in the family and employment domain at different stages of life and estimate their association with cerebrovascular accident (CVA) in old age.METHODS:We used a retrospective, face-to-face, representative survey of people aged 65 to 75 years in the city of Santiago, Chile, (n = 802). We performed a multichannel sequence analysis to reconstruct family and employment stress trajectory types at various life stages and then used logistic regression models to estimate the association of these trajectory types with CVA in old age, controlled for traditional cardiovascular risk factors.RESULTS:Four representative types of family and employment stress trajectories were identified: (1) Absence of family and employment stress, (2) Absence of family stress, persistent employment stress, (3) Absence of family stress, out of the labor market, and (4) Persistent family stress, absence of employment stress. The 61.7% of the sample followed trajectories marked by the permanent presence of family and/or employment stress. Likewise, 18.3% had a trajectory characterized by prolonged absence from the labor market. Individuals with persistent family or employment stress trajectories, as well as those with extended periods of inactivity, are more at risk of developing CVA.CONCLUSIONS:Stress is a risk factor for cardiovascular disease experienced by many people at different stages and domains of life on a prolonged basis. Consequently, prevention systems for this type of chronic diseases should emphasize the highly harmful effects of daily and cumulatively stressful life experiences. This could mitigate the multiple health and financial consequences associated with CVA.

An analytic element model for highly fractured elastic media

AbstractWe present an analytic formulation for an elastic medium under uniform stress and in plane strain, with a very large number of cracks that are allowed to intersect. The singularities at the tips of the cracks are represented exactly; the solution is written in terms of series expansions of negative powers of a complex variable defined outside the unit circle in a complex reference plane. We modeled an assembly of 10,000 cracks and show stress trajectories both for the whole model and for individual cracks, chosen at random from the assembly.

Full-range nonlinear analysis of post-tensioned anchorage zones based on modified strut-and-tie model

The strut-and-tie model (STM) has been adopted as a preferred methodology for the design of the post tensioned concentric anchorage zones. However, the STM is just a design model at ultimate limit state developed based on the elastic stress trajectory without the consideration of stress redistribution after cracking, which can not be used to predict the serviceability behavior of anchorage zones. To address this issue, this paper is devoted to developing a modified strut-and-tie model (MSTM) to predict the behavior of concentric anchorage zones throughout loading process. The compatibility condition was introduced into MSTM based on the principle of stationary complementary energy at each load step. According to MSTM, the elastic and inelastic behavior of concentric anchorage zones, including load-strain response, load-deformation response and crack width, can be estimated from loading to failure. Moreover, simplified formulas have been proposed to calculate the first cracking load, ultimate load and the maximum crack width. Finally, the proposed MSTM was validated by the testing results.

The Impact of Anthropogenic Climate Change on Egyptian Livestock Production.

Simple SummaryEgypt is one of the hottest countries on the planet, with significant warming predicted to occur over the course of this century. It has a substantial livestock population to feed its growing human population, but the hotter temperatures will constrain the production of ruminants in particular because of their high internal heat production during the digestion of fibrous material by micro-organisms. The net result will be the diminished availability of animal products per human member of the Egyptian population. Some products can be imported, but this is difficult for products with a short shelf life, such as milk. We use estimates of climate change, population growth and the impact of higher temperatures on cow productivity to predict that milk availability per person will decline from 61 kg/year in 2011 to 26 kg/year in 2064. We discuss the range of alternative options available to make up for diminished animal product availability per person as the century progresses.Egypt is one of the hottest countries in the world, and extreme climate events are becoming more frequent, which is consistent with the warming of the planet. The impact of this warming on ecosystems is severe, including on livestock production systems. Under Egyptian conditions, livestock already suffer heat stress periods in summer. The predicted increases in temperature as result of climate change will affect livestock production by reducing growth and milk production because of appetite suppression and conception rate reductions and will increase animal welfare concerns. In severe cases, these effects can result in death. We review the heat stress effects on livestock behaviour, reproduction, and production in the context of predicted climate change for Egypt over the course of this century and offer alternative scenarios to achieve food security for a growing human population. As an example, we combine predictions for reduced milk production during heat stress and human population trajectories to predict that milk availability per person will decline from 61 kg/year in 2011 to 26 kg/year in 2064. Mitigation strategies are discussed and include the substitution of animal-based foods for plant-based foods and laboratory-grown animal products.

Patterns of Maternal Distress from Pregnancy Through Childhood Predict Psychopathology During Early Adolescence.

Capitalizing on a longitudinal cohort followed from gestation through adolescence (201 mother-child dyads), we investigate the contributions of severity and stability of both maternal depressive and perceived stress symptoms to adolescent psychopathology. Maternal depressive and perceived stress trajectories from pregnancy through adolescence were identified with latent class growth analyses, and associations with adolescent internalizing and externalizing symptoms were examined. For both depression and stress, the most common trajectory group comprised mothers displaying stable and low symptom levels over time, and adolescents of these mothers had the fewest internalizing and externalizing symptoms. Maternal membership to one or more aberrant trajectory groups predicted higher levels of internalizing and externalizing symptoms, determined by both maternal and adolescent self-report. This study indicates that profiles of multiple indicators of maternal psychopathology assessed across childhood, beginning prenatally, can provide critical additional insight into child psychopathology risk.

Adaptation to Limb Loss: Heterogeneous Trajectories of Resilience and Depression Predict Posttraumatic Stress

<h3>Research Objectives</h3> To identify longitudinal trajectories of depression in the first six months following amputation and to explore baseline predictors of these trajectories. A secondary aim was to utilize trajectories as predictors of PTSD as a 6-month distal outcome. <h3>Design</h3> Archival data from two inception cohort studies of persons with new onset limb loss. Participants completed assessments at initial, -3 and 6-month follow-ups. <h3>Setting</h3> hospitalized care, acute rehabilitation, ambulatory care, and community. <h3>Participants</h3> Individuals with new limb loss were recruited from consecutive cases within a large metropolitan hospital system over a four-year period (2002-2007). Final sample (n = 203) was predominantly male (78.8%) and white (83.3%) with an average age of 49.4 years (SD = 14.58) at the time of amputation. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Patient Health Questionnaire-9 (PHQ-9); PTSD checklist – Civilian Version (PCL-C). <h3>Results</h3> Using Latent Growth Mixture Modeling, four trajectories of depression were identified: resilience (73.2%), recovery (6.7%), emerging depression (8.9%), and chronic depression (11.2%). Pain intensity was a significant baseline predictor of trajectory membership, whereas demographic covariates were non-significant. In distal outcome analyses, trajectory membership significantly predicted PTSD at 6-months. Pairwise comparisons revealed significantly elevated PTSD in the chronic-depression trajectory versus all other classes; the resilient class had significantly fewer PTSD symptoms than the emerging depression class but did not differentiate from the recovery trajectory. <h3>Conclusions</h3> Findings support the conclusion that the course of depression post-amputation is heterogeneous, with varying profiles of symptom development and remission. Although the majority of individuals were classified as resilient, average depression was mildly elevated in the resilient class immediately post-amputation, underscoring the challenging nature of acute recovery. Further, a substantial minority of individuals (8.9%) developed clinically significant depression between 3 and 6-months, suggesting that early screening during acute care may be insufficient for the detection of emerging depression. The derivation of latent classes of depression in longitudinal data may prove useful as a clinical tool for the early identification of those at risk for PTSD, a diagnosis with unique time-course requirements. <h3>Author(s) Disclosuress</h3> None