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Trajectory of post-traumatic stress following traumatic injury: 6-year follow-up

  • Richard A. Bryant (a1), Angela Nickerson (a2), Mark Creamer (a3), Meaghan O'Donnell (a3), David Forbes (a3), Isaac Galatzer-Levy (a4), Alexander C. McFarlane (a5) and Derrick Silove (a6)...



Traumatic injuries affect millions of patients each year, and resulting post-traumatic stress disorder (PTSD) significantly contributes to subsequent impairment.


To map the distinctive long-term trajectories of PTSD responses over 6 years by using latent growth mixture modelling.


Randomly selected injury patients (n = 1084) admitted to four hospitals around Australia were assessed in hospital, and at 3, 12, 24 and 72 months. Lifetime psychiatric history and current PTSD severity and functioning were assessed.


Five trajectories of PTSD response were noted across the 6 years: (a) chronic (4%), (b) recovery (6%), (c) worsening/recovery (8%), (d) worsening (10%) and (e) resilient (73%). A poorer trajectory was predicted by female gender, recent life stressors, presence of mild traumatic brain injury and admission to intensive care unit.


These findings demonstrate the long-term PTSD effects that can occur following traumatic injury. The different trajectories highlight that monitoring a subset of patients over time is probably a more accurate means of identifying PTSD rather than relying on factors that can be assessed during hospital admission.


Corresponding author

Richard Bryant, School of Psychology, University of New South Wales, New South Wales 2052, Australia. Email:


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1 Murray, CJ, Lopez, AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997; 349: 1498–504.
2 Bryant, RA, Creamer, M, O'Donnell, M, Silove, D, Clark, CR, McFarlane, AC. The psychiatric sequelae of traumatic injury. Am J Psychiatry 2010; 167: 312–20.
3 Zatzick, DF, Rivara, FP, Nathens, AB, Jurkovich, GJ, Wang, J, Fan, M-Y, et al. A nationwide US study of post-traumatic stress after hospitalization for physical injury. Psychol Med 2007; 37: 1469–80.
4 Stein, MB, Walker, JR, Hazen, AL, Forde, DR. Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 1997; 154: 1114–9.
5 Muthén, B. Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In Handbook of Quantitative Methodology for the Social Sciences (ed Kaplan, D): 345–68. Sage, 2004.
6 Norris, FH, Tracy, M, Galea, S. Looking for resilience: understanding the longitudinal trajectories of responses to stress. Soc Sci Med 2009; 68: 2190–8.
7 Pietrzak, RH, Van Ness, PH, Fried, TR, Galea, S, Norris, FH. Trajectories of posttraumatic stress symptomatology in older persons affected by a large-magnitude disaster. J Psychiatr Res 2013; 47: 520–6.
8 Bonanno, GA, Mancini, AD, Horton, JL, Powell, TM, Leardmann, CA, Boyko, EJ, et al. Trajectories of trauma symptoms and resilience in deployed U.S. military service members: prospective cohort study. Br J Psychiatry 2012; 200: 317–23.
9 deRoon-Cassini, TA, Mancini, AD, Rusch, MD, Bonanno, GA. Psychopathology and resilience following traumatic injury: a latent growth mixture model analysis. Rehabil Psychol 2010; 55: 111.
10 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM-IV). APA, 1994.
11 Carroll, LJ, Cassidy, JD, Holm, L, Kraus, J, Coronado, VG. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. J Rehabil Med 2004; 36: 113–25.
12 Baker, SP, O'Neil, B, Haddon, W, Long, WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187–96.
13 Blake, DD, Weathers, FW, Nagy, LM, Kaloupek, DG, Charney, DS, Keane, TM. Clinician-Administered PTSD Scale for DSM-IV. National Center For Posttraumatic Stress Disorder, 1998.
14 Weathers, FW, Keane, TM, Davidson, J. Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety 2001; 13: 132–56.
15 Aziz, M, Kenford, S. Comparability of telephone and face-to-face interviews in assessing patients with posttraumatic stress disorder. J Psychiatr Pract 2004; 10: 307–13.
16 Sheehan, DV, Lecrubier, Y, Harnett-Sheehan, K, Amorim, P, Janavs, J, Weiller, E, et al. The Mini International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview. J Clin Psychiatry 1998; 59 (suppl 20): 2233.
17 World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. WHO, 1992.
18 Harper, A, Power, M. Development of the World Health Organization WHOQOLBREF quality of life assessment. Psychol Med 1998; 28: 551–8.
19 Hawthorne, G, Herrman, H, Murphy, B. Interpreting the WHOQOL-Brèf: preliminary population norms and effect sizes. Soc Indicat Res 2006; 77: 3759.
20 Brugha, T, Bebbington, P, Tennant, C, Hurry, J. The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med 1985; 15: 189–94.
21 Muthén, LK, & Muthén, BO. Mplus User's Guide. Muthén, & Muthén, 1998–2011.
22 Brewin, CR, Andrews, B, Valentine, JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 2000; 68: 748–66.
23 Zlotnick, C, Franklin, CL, Zimmerman, M. Does “subthreshold” posttraumatic stress disorder have any clinical relevance? Compr Psychiatry 2002; 43: 413–9.
24 Bonanno, GA, Kennedy, P, Galatzer-Levy, IR, Lude, P, Elfstrom, ML. Trajectories of resilience, depression, and anxiety following spinal cord injury. Rehabil Psychol 2012; 57: 236–47.
25 Bryant, RA. Early predictors of posttraumatic stress disorder. Biol Psychiatry 2003; 53: 789–95.
26 Rauch, SL, Shin, LM, Phelps, EA. Neurocircuitry models of posttraumatic stress disorder and extinction: human neuroimaging research-past, present, and future. Biol Psychiatry 2006; 60: 376–82.
27 Bryant, RA. Disentangling mild traumatic brain injury and stress reactions. N Engl J Med 2008; 358: 525–7.
28 Smid, GE, van der Velden, PG, Lensvelt-Mulders, GJ, Knipscheer, JW, Gersons, BP, Kleber, RJ. Stress sensitization following a disaster: a prospective study. Psychol Med 2012; 42: 1675–86.
29 Norrholm, SD, Jovanovic, T, Vervliet, B, Myers, KM, Davis, M, Rothbaum, BO, et al. Conditioned fear extinction and reinstatement in a human fear-potentiated startle paradigm. Learn Mem 2006; 13: 681–5.
30 Post, RM, Weiss, SRB, Smith, MA. Sensitization and kindling. Implications for the evolving neural substrates of post-traumatic stress disorder. In Neurobiological and Clinical Consequences of Stress: from Normal Adaptation to PTSD (ed Friedman, MJ, Charney, DS and Deutch, AY): 203–24. Lipincott-Raven, 1995.
31 Hobfoll, SE, Tracy, M, Galea, S. The impact of resource loss and traumatic growth on probable PTSD and depression following terrorist attacks. J Traum Stress 2006; 19: 867–78.
32 McFarlane, AC. The long-term costs of traumatic stress: intertwined physical and psychological consequences. World Psychiatry 2010; 9: 310.
33 Breslau, N, Davis, GC, Andreski, P. Risk factors for PTSD-related traumatic events: a prospective analysis. Am J Psychiatry 1995; 152: 529–35.
34 Shalev, AY, Peri, T, Brandes, D, Freedman, S, Orr, SP, Pitman, RK. Auditory startle response in trauma survivors with posttraumatic stress disorder: A prospective study. Am J Psychiatry 2000; 157: 255–61.
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Trajectory of post-traumatic stress following traumatic injury: 6-year follow-up

  • Richard A. Bryant (a1), Angela Nickerson (a2), Mark Creamer (a3), Meaghan O'Donnell (a3), David Forbes (a3), Isaac Galatzer-Levy (a4), Alexander C. McFarlane (a5) and Derrick Silove (a6)...
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