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Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD

Published online by Cambridge University Press:  03 February 2020

Sarah R. Lowe*
Yale University, School of Public Health
Andrew Ratanatharathorn
Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
Betty S. Lai
Lynch School of Education and Human Development, Boston College, Chestnut Hill, USA
Willem van der Mei
Data Scientist, New York County Defender Services
Anna C. Barbano
Department of Psychology, University of Toledo
Richard A. Bryant
School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
Douglas L. Delahanty
Kent State University, Department of Psychological Sciences, Kent, OH, USA
Yutaka J. Matsuoka
Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
Miranda Olff
Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands ARQ National Psychotrauma Centre, Diemen, The Netherlands
Ulrich Schnyder
University of Zurich, Zurich, Switzerland
Eugene Laska
Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University School of Medicine
Karestan C. Koenen
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Arieh Y. Shalev
Department of Psychiatry, New York University School of Medicine, New York, New York
Ronald C. Kessler
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
Author for correspondence: Sarah R. Lowe, E-mail:



Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics.


This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course.


Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory.


The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

Original Article
Copyright © The Author(s) 2020. Published by Cambridge University Press

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ICPP members: Soraya Seedat, Stellenbosch University; Terri deRoon-Cassini, Medical College of Wisconsin; Sara Freedman, Bar IlanUniversity; Joanne Mouthaan, Leiden University; Marit Sijbrandij, VU University; Mirjam van Zuiden, Academic Medical Center; Daisuke Nishi, University of Tokyo School of Medicine; Alexander McFarlane, Center for Traumatic Studies, University of Adelaide, Derrick Silove, University of New South Wales School of Psychiatry; Meaghan O'Donnell, University of Melbourne; Wei Qi, New York University; Martin Gevonden, Vrije Universiteit


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