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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

  • Sarah R. Lowe (a1), Andrew Ratanatharathorn (a2), Betty S. Lai (a3), Willem van der Mei (a4), Anna C. Barbano (a5), Richard A. Bryant (a6) (a7), Douglas L. Delahanty (a8), Yutaka J. Matsuoka (a9), Miranda Olff (a10) (a11), Ulrich Schnyder (a12), Eugene Laska (a13), Karestan C. Koenen (a14), Arieh Y. Shalev (a15) and Ronald C. Kessler (a16)...



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.


Corresponding author

Author for correspondence: Sarah R. Lowe, E-mail:


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

  • Sarah R. Lowe (a1), Andrew Ratanatharathorn (a2), Betty S. Lai (a3), Willem van der Mei (a4), Anna C. Barbano (a5), Richard A. Bryant (a6) (a7), Douglas L. Delahanty (a8), Yutaka J. Matsuoka (a9), Miranda Olff (a10) (a11), Ulrich Schnyder (a12), Eugene Laska (a13), Karestan C. Koenen (a14), Arieh Y. Shalev (a15) and Ronald C. Kessler (a16)...


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