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Stressors, mild traumatic brain injury may compound delayed PTSD

The symptom trajectory of delayed-onset posttraumatic stress disorder is complex, and ongoing stress and mild traumatic brain injury may play a role in symptom severity, according to new study results published in JAMA Psychiatry.

“There is increasing attention on the trajectories of PTSD,” researchers wrote. “The present study demonstrates longitudinally that there is not a linear relationship between acute trauma response and long-term PTSD and highlights that PTSD levels fluctuate markedly in the initial years after trauma exposure.”

The study included 785 traumatically injured patients admitted to four major trauma centers in Australia. Patients were followed up at 3, 12 and 24 months using the Clinician-Administered PTSD Scale.

Results indicated a significant fluctuation of PTSD symptom severity during follow-up. For example, of those patients who met PTSD criteria at 24 months, 44.1% reported no PTSD at 3 months and 55.9% reported subsyndromal or full PTSD. A prior psychiatric disorder, initial symptom severity and the type of trauma predicted PTSD severity at 24 months in those who had subsyndromal or full PTSD during their first follow-up. Of those who did not meet PTSD criteria at 3 months, initial PTSD symptom severity, mild traumatic brain injury, length of hospital stay, and the number of stressful events experienced between 3 and 24 months all predicted PTSD symptom severity at 24 months.

“The complexity of these trajectories is further indicated by the delayed occurrence of PTSD responses, which appears to result from a combination of the immediate stress response and cumulative stress in the aftermath of the trauma,” the researchers concluded. “Identifying the factors that contribute to these fluctuations at different points during adaptation will facilitate attempts at prevention, treatment, and relapse prevention.”

Disclosure: The researchers report no relevant financial disclosures.