Prediction of remission of acute posttraumatic stress disorder in motor vehicle accident victims

Abstract

One hundred forty five individuals who sought medical attention as a result of a motor vehicle accident (MVA), and who were initially assessed 1 to 4 months post-MVA, were followed up prospectively for 6 months to determine how many of the 55 with posttraumatic stress disorder (PTSD) and the 43 with sub-syndromal PTSD would remit and what variables would predict remission. Thirty (55%) of those with initial PTSD had remitted at least in part by 6 months while 67% of those with sub-syndromal PTSD had remitted (and 5% had worsened). Four variables, including severity of initial symptoms, degree of initial physical injury, relative degree of physical recovery by 4 months and whether a close family member suffered a trauma during the follow-up interval, combined to classify 6-month clinical status of 84% of those with initial PTSD secondary to MVAs.

Risk factors for the development versus maintenance of posttraumatic stress disorder

“…A recent study found that shame measured 1 month following a trauma predicted a higher amount of PTSD symptoms at 6 months (Andrews, Brewin, Rose, & Kirk, 2000). Our finding that serious injury was associated with chronicity is consistent with prospective studies that have found injury severity and the persistence of posttraumatic injury to predict chronic PTSD (Blanchard et al, 1997;Ehlers, Mayou, & Bryant, 1998).…”

“…Most studies, including ours, have found that chronicity is related primarily to peritraumatic and posttraumatic factors, compared with pretraumatic factors (e.g., Blanchard et al, 1997;Ehlers et al, 1998). Particularly interesting are studies that suggest the cognitive processing of traumatic material as a key factor in the maintenance of PTSD (Dunmore et al, 1999(Dunmore et al, , 2001Ehlers et al, 1998).…”

“…A preferable way to address the questions we have posed is through prospective studies of recently traumatized individuals (e.g., Blanchard et al, 1997;Freedman et al, 1999). We did not have variables that capture important psychological processes in recovery, such as rumination (e.g., Dunmore et al, 2001;Ehlers et al, 1998).…”

“…In analyses that separately compared each group with survivors who never developed PTSD, factors identified as predictors of chronic PTSD but not acute PTSD were female gender, family history of antisocial behavior, preexisting anxiety or depression, and neuroticism. Blanchard et al (1997) studied accident victims who had PTSD or partial PTSD when assessed after the accident. Comparing those whose PTSD had remitted 6 months after the initial assessment with those who still had PTSD, Blanchard et al found that continued PTSD was associated with higher initial PTSD severity, more severe injury, a greater amount of injury remaining at 4 months, and familial trauma after the accident.…”

Peripheral blood mononuclear cell gene expression profiles identify emergent post-traumatic stress disorder among trauma survivors

“…6 Twin data show that each cluster possesses a distinct genetic basis, 7 suggesting they represent discrete biological dimensions. Whereas early symptoms are often transient, a significant minority of survivors remains highly symptomatic exhibiting the full persisting clinical disorder, 2,[8][9][10] marked by a disabling and unremitting longer-term course. 2,9,10 Early treatment might prevent PTSD, 11 but known risk factors 12 and early PTSD symptoms 13 do not effectively predict chronic PTSD, and therefore have limited use in guiding early treatment.…”