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Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS).

Galatzer-Levy IR, Ankri Y, Freedman S, Israeli-Shalev Y, Roitman P, Gilad M, Shalev AY - PLoS ONE (2013)

Bottom Line: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity.THREE TRAJECTORIES WERE IDENTIFIED: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%).CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, NYU School of Medicine, New York, New York, United States of America.

ABSTRACT

Context: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis.

Objectives: To describe discrete symptom trajectories and examine their relevance for preventive interventions.

Design: Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data.

Setting: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity.

Participants: Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months.

Approach: We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.8±5.7 days after ED admission, or delayed PE (n = 35) starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample.

Main outcome measure: Latent trajectories of PTSD symptoms; effects of CBT on these trajectories.

Results: THREE TRAJECTORIES WERE IDENTIFIED: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes.

Conclusions: The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.

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Related in: MedlinePlus

Three Trajectory Model of PTSD Symptom Severity Recovery Trajectories (n = 957).
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pone-0070084-g001: Three Trajectory Model of PTSD Symptom Severity Recovery Trajectories (n = 957).

Mentions: This model identified three substantively distinct classes. The largest class (Rapid Remitting; 56% of the sample) displayed a precipitous drop in symptoms from 1 to 5 months as captured by a significant negative slope (Est = −26.72, SE = 2.28, p<.001), indicating a significant overall drop in symptoms from 10 days to five months, accompanied by a significant positive quadratic parameter, indicating a curvilinear rate of change (Est = 17.16.23, SE = 1.93, p<.001). The second largest class (Slow Remitting; 27%) demonstrated a relatively consistent rate of symptom reduction across time points, as indicated by a significant negative slope (Est = −8.83, SE = 2.50, p<.001) and a non-significant quadratic parameter (Est = 1.95, SE = 0.63, p = .23). Finally, the smallest class (Non-Remitting; 17%) demonstrated consistently high symptom severity across time points with no significant change over time, indicated by a non-significant slope (Est = −1.19, SE = 1.68, p = .48) and a non-significant quadratic parameter (Est = −2.67, SE = 1.62, p = .10; Figure 1). Members of the rapid remitting class also reached lower PTSD symptom levels at 15 months compared to those of slow remitting class, and the latter had lower levels of PTSD symptoms than the non-remitting class (Table 1). The frequency of full PTSD in the entire sample is 21.8% while rates of sub-syndromal PTSD based on meeting at least 2 of the three symptom cluster criteria is 15.8% based on the PSS.


Early PTSD symptom trajectories: persistence, recovery, and response to treatment: results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS).

Galatzer-Levy IR, Ankri Y, Freedman S, Israeli-Shalev Y, Roitman P, Gilad M, Shalev AY - PLoS ONE (2013)

Three Trajectory Model of PTSD Symptom Severity Recovery Trajectories (n = 957).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3750016&req=5

pone-0070084-g001: Three Trajectory Model of PTSD Symptom Severity Recovery Trajectories (n = 957).
Mentions: This model identified three substantively distinct classes. The largest class (Rapid Remitting; 56% of the sample) displayed a precipitous drop in symptoms from 1 to 5 months as captured by a significant negative slope (Est = −26.72, SE = 2.28, p<.001), indicating a significant overall drop in symptoms from 10 days to five months, accompanied by a significant positive quadratic parameter, indicating a curvilinear rate of change (Est = 17.16.23, SE = 1.93, p<.001). The second largest class (Slow Remitting; 27%) demonstrated a relatively consistent rate of symptom reduction across time points, as indicated by a significant negative slope (Est = −8.83, SE = 2.50, p<.001) and a non-significant quadratic parameter (Est = 1.95, SE = 0.63, p = .23). Finally, the smallest class (Non-Remitting; 17%) demonstrated consistently high symptom severity across time points with no significant change over time, indicated by a non-significant slope (Est = −1.19, SE = 1.68, p = .48) and a non-significant quadratic parameter (Est = −2.67, SE = 1.62, p = .10; Figure 1). Members of the rapid remitting class also reached lower PTSD symptom levels at 15 months compared to those of slow remitting class, and the latter had lower levels of PTSD symptoms than the non-remitting class (Table 1). The frequency of full PTSD in the entire sample is 21.8% while rates of sub-syndromal PTSD based on meeting at least 2 of the three symptom cluster criteria is 15.8% based on the PSS.

Bottom Line: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity.THREE TRAJECTORIES WERE IDENTIFIED: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%).CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, NYU School of Medicine, New York, New York, United States of America.

ABSTRACT

Context: Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis.

Objectives: To describe discrete symptom trajectories and examine their relevance for preventive interventions.

Design: Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data.

Setting: Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity.

Participants: Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months.

Approach: We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.8±5.7 days after ED admission, or delayed PE (n = 35) starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample.

Main outcome measure: Latent trajectories of PTSD symptoms; effects of CBT on these trajectories.

Results: THREE TRAJECTORIES WERE IDENTIFIED: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes.

Conclusions: The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.

Show MeSH
Related in: MedlinePlus