Predicting Trajectories of Post Traumatic Stress Disorder Following Discharge from A Level 1 Trauma Center
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Posttraumatic stress disorder (PTSD) is a mental health disorder impacting an ever-increasing number of Americans every year. There is a lack of information about how physical trauma impacts the development of PTSD. Level 1 trauma centers provide expert care to individuals experiencing physical injuries who are at risk of developing PTSD. Trajectories of PTSD, assessed with the Primary Care PTSD (PC-PTSD) Screen, were examined among individuals admitted to a Level 1 trauma center for severe physical injuries. Hierarchical linear modeling (HLM) was used to investigate whether injury and demographic characteristics, as well as self-reported resilience may predict PTSD trajectories over a 12-month period following discharge. The average initial score for all individuals on the PC-PTSD was 1.54 points. At 12 months, 17% of the sample had positive screens warranting a possible PTSD diagnosis. Individuals experiencing intentional injuries had significantly higher initial PC-PTSD scores than the unintentional injury group (p = .044) but their trajectories decreased at a faster rate than trajectories observed among those with unintentional injuries (p = .017), such that by 12 months post-injury, there were no longer significant differences between the two groups. Age of injury was also significant at initial (p = .019), but did not impact PTSD trajectories over time. Initial resiliency, measured by the Connor Davidson Resilience Scale 10 (CD-RISC 10), showed a significant inverse relationship in the random intercept model (p < .001; M = 30.69; SD = 8.39) and the random slope model (p = .035), indicating individuals with higher initial resiliency experience a decrease in PC-PTSD scores at a slower rate than individuals with lower initial resiliency. By 12 months, individuals with high initial resiliency scores had significantly lower PC-PTSD scores compared to those with lower resiliency (p = 0.029). No statistically significant differences were seen among traumatic brain injury, injury severity and gender at initial, nor did these variables significantly predict PTSD trajectories. These findings indicate that injury type and psychological resilience play an important role in predicting PTSD outcomes soon after injury. While differences between groups were supported in intentional injury, age of injury, and resiliency group membership, clinical outcomes are limited in that many of the participants met criteria for sub-threshold PTSD and much of these statistically significant differences seen at the initial time point were no longer significant at 12 months post-discharge. Clinical implications involve increased clinician awareness surrounding individuals admitted to trauma centers with pertinent injury characteristics, with aims of helping to decrease patient and clinician burden by helping to further delineate unsupported variables in predicting PTSD trajectories.
Chang, Jessica (2016). Predicting Trajectories of Post Traumatic Stress Disorder Following Discharge from A Level 1 Trauma Center. Doctoral dissertation, Texas A & M University. Available electronically from