A comparison of posttraumatic stress disorder in veterans with and without spinal cord injury. Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma Predicting posttraumatic stress symptoms from pretraumatic risk factors: a 2-year prospective follow-up study in firefighters. Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals. Posttraumatic stress disorder after injury: does admission to intensive care unit increase risk? Symptoms of traumatic stress in mothers of children victims of a motor vehicle accident. Corticotrophin-Releasing Hormone Type 1 Receptor Gene (CRHR1) Variants Predict Posttraumatic Stress Disorder Onset and Course in Pediatric Injury Patients Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims Prospective evaluation of parent distress following pediatric burns and identification of risk factors for young child and parent posttraumatic stress disorder. Long-term posttraumatic stress disorder persists after major trauma in adolescents: new data on risk factors and functional outcome. Prospective study of posttraumatic stress disorder and depression following trauma. Acute stress response and posttraumatic stress disorder in traffic accident victims: a one-year prospective, follow-up study. A multisite analysis of the fluctuating course of posttraumatic stress disorder. Posttraumatic stress disorder and suicide attempts in a community sample of urban american young adults. Similar factors predict disability and posttraumatic stress disorder trajectories after whiplash injury Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity. Posttraumatic stress disorder in abused and neglected children grown up. Postintensive care unit psychological burden in patients with chronic obstructive pulmonary disease and informal caregivers: A multicenter study Association between posttraumatic stress and depressive symptoms and functional outcomes in adolescents followed up longitudinally after injury hospitalization. The impact of PTSD on pain experience in persons with HIV/AIDS Looking beyond the physical injury: posttraumatic stress disorder in children and parents after pediatric traffic injury. Altered cortisol awakening response in posttraumatic stress disorder A pilot randomized controlled trial assessing secondary prevention of traumatic stress integrated into pediatric trauma care.
The authors assessed effects of  paraplegic and quadriplegic spinal cord injuries ( SCIs )  on posttraumatic stress disorder ( PTSD ) by comparing severity and prevalence of PTSD in these groups to a sample of controls who experienced traumatic injuries other than SCI . The authors found that veterans with quadriplegia reported significantly less severe current PTSD symptoms than controls who were not significantly different from veterans with paraplegia . These results suggest that sustaining a quadriplegic SCI decreases risk of current PTSD , whereas sustaining a paraplegic SCI is associated with greater risk of PTSD , although the risk is no greater than that incurred from experiencing the trauma itself BACKGROUND This study investigated the efficacy of propranolol prescribed shortly after trauma exposure in the prevention of  posttraumatic stress disorder ( PTSD ) symptoms and diagnosis . METHODS Eleven patients received 40 mg of propranolol 3 times daily for 7 days , followed by a taper period of 8 - 12 days . They were compared with eight patients who refused propranolol but agreed to participate in the study . Though nonr and omized , the two groups did not differ on demographics , exposure characteristics , physical injury severity , or peritraumatic emotional responses . RESULTS Posttraumatic stress disorder rates were higher in the group who refused propranolol ( 3/8 ) compared with those who received the medication ( 1/11 ) , as were the levels of PTSD symptoms ( U = 85 , p = .037 ) . CONCLUSIONS Our results are consistent with earlier findings and suggest that propranolol may be useful for mitigating PTSD symptoms or perhaps even preventing the development of PTSD OBJECTIVE Most studies focusing on risk factors for posttraumatic stress disorder ( PTSD ) have used retrospective study design s. Only a small number of studies have prospect ively examined risk factors in the immediate aftermath of trauma exposure in predicting PTSD symptoms . The purpose of this study was to identify predictive risk factors for posttraumatic stress symptoms and comorbid psychopathological symptoms present during the time before exposure to traumatic stress in a high-risk population . METHOD Forty-three professional firefighters were assessed immediately after basic training  ( baseline ) and at 6 , 9 , 12 , and 24 months after entry into firefighter service .  Subjects were screened for psychopathological symptoms , including symptoms of PTSD , depression , and anxiety . Subjects were also characterized with regard to personality traits such as self-efficacy , hostility , and alexithymia . Neuroendocrine activity was assessed by examination of awakening and diurnal salivary cortisol profiles and 24-hour urinary catecholamine excretion . Multiple linear regression analysis was used to analyze posttraumatic stress symptoms at 24-month follow-up as a function of pretraumatic characteristics . RESULTS A high level of hostility and a low level of self-efficacy at baseline accounted for 42 % of the variance in posttraumatic stress symptoms after 2 years . Subjects who had both risk factors at baseline showed a significant increase in measures of PTSD symptoms , depression , anxiety , general psychological morbidity , global symptom severity , and alexithymia during the 2-year period . Biological characteristics were not predictive of the development of psychopathological symptoms . CONCLUSIONS These results suggest that specific personality traits may constitute markers of vulnerability to the development of psychopathological symptoms after trauma exposure . Early identification of preexisting risk factors is needed to provide effective prevention and intervention for individuals who are at risk of developing trauma-related disorders Two studies of assault victims examined the roles of ( a ) disorganized trauma memories in the development of posttraumatic stress disorder ( PTSD ) , ( b ) peritraumatic cognitive processing in the development of problematic memories and PTSD , and ( c ) ongoing dissociation and negative appraisal s of memories in maintaining symptomatology . In the cross-sectional study ( n = 81 ) , comparisons of current , past , and no-PTSD groups suggested that peritraumatic cognitive processing is related to the development of disorganized memories and PTSD . Ongoing dissociation and negative appraisal s served to maintain PTSD symptoms . The prospect i ve study ( n = 73 ) replicated these findings longitudinally .  Cognitive and memory assessment s completed within 12-weeks postassault predicted 6-month symptoms . Assault severity measures explained 22 % of symptom variance ; measures of cognitive processing , memory disorganization , and appraisal s increased prediction accuracy to 71 % BACKGROUND This study aim ed to index the prevalence of posttraumatic stress disorder ( PTSD ) after injury requiring intensive care unit ( ICU ) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission . METHODS A two-group ( those admitted to the ICU vs. those not admitted to ICU ) , prospect i ve , cohort study of 829 r and omly selected injury patients from five major trauma hospitals across Australia . We collected information on factors that may increase risk for PTSD including demographic variables ( gender , age , income , education , and marital status ) , preinjury mental health status ( prior trauma , psychiatric history , and prior social support ) , and injury characteristics ( mild traumatic brain injury , injury severity , length of hospital admission , discharge destination , pain , and perceived threat ) . PTSD was measured at 12 months by structured clinical interview .  RESULTS ICU patients were significantly more likely to have PTSD at 12 months than trauma controls ( 17 % vs. 7 % ) . Stepwise logistic regressions showed that an ICU admission significantly contributed to the development of PTSD after controlling for demographic , preinjury mental health status , and injury characteristic variables . CONCLUSIONS Injury patients are three times more likely to develop later PTSD if they have an ICU admission . Given we controlled for many risk variables , it seems that an ICU admission itself may contribute to the development of PTSD . Mental health services such as screening and early intervention may be particularly useful for this population BACKGROUND Motor vehicle accidents ( MVAs ) are the main cause of Posttraumatic stress disorder ( PTSD ) in industrialized countries . This includes the frequently occurring but understudied situation of parents learning that their children were injured . However , unlike in other types of trauma survivors , little is known about the predictors of PTSD symptoms in mothers whose child has suffered an MVA . METHODS A group of 72 mothers and 28 fathers were prospect ively assessed for peritraumatic distress , peritraumatic dissociation , and PTSD symptoms 1 and 5 weeks after their child had suffered an MVA . RESULTS Levels of peritraumatic distress and dissociation were comparable to other trauma victims , 18 % of the mothers were considered to be suffering from probable PTSD . In mothers , significant positive correlations were found between PTSD symptoms and peritraumatic distress ( r=.34 ) and dissociation ( r=.37 ) , whereas mothers ' PTSD symptoms were associated with decreased peritraumatic dissociation in fathers ( r=-.37 ) . Even after controlling for covictim/witness status , peritraumatic distress was a predictor of mothers ' PTSD symptoms , explaining 14 % of the variance . CONCLUSIONS Peritraumatic response and PTSD symptoms should be routinely assessed among parents whose child has experienced a traumatic event Posttraumatic stress disorder ( PTSD ) is a common and disabling anxiety disorder that may occur in the aftermath of exposure to potentially traumatic life events . PTSD is moderately heritable , but few specific molecular variants accounting for this heritability have been identified . Genes regulating the hypothalamic-pituitary-adrenal ( HPA ) axis , such as corticotrophin-releasing hormone type 1 receptor gene ( CRHR1 ) , have been implicated in traumatic-stress related phenotypes but have yet to be studied in relation to PTSD . The present study sought to examine the relation between 9 single nucleotide polymorphisms ( SNPs ) in the CRHR1 gene and posttraumatic stress symptoms in a prospect i ve study of pediatric injury patients ( n = 103 ) who were first assessed in the acute aftermath of their injury at the hospital . Results indicated that multiple SNPs were associated with acute symptoms at a univariate level , and after correction for multiple testing , rs12944712 was significantly related to acute PTSD symptoms . Longitudinal latent growth curve analyses suggest that rs12944712 is also related to both acute symptom level and trajectory of symptoms over time . The present study adds support for the role of CRHR1 in the stress response following potentially traumatic event exposure in youth . It should be noted that the sample size in this study was small , and therefore statistical power was low ; following , results from this study should be considered preliminary . Although results are not definitive , the findings from this study warrant future replication studies on how variation in this gene relates to response to traumatic event exposure in youth BACKGROUND This study was design ed to examine the relationship between urinary hormone levels collected upon admission to the trauma unit following a motor vehicle accident and posttraumatic stress disorder symptomatology 1 month later . METHODS Fifteen-hour urine sample s were collected from 63 male and 36 female motor vehicle accident victims and were used to assess levels of catecholamines and cortisol reflecting peritraumatic and acute-phase posttraumatic levels . Presence of posttraumatic stress disorder symptomatology was assessed 1 month after the accident . RESULTS Motor vehicle accident victims subsequently diagnosed with acute posttraumatic stress disorder excreted significantly lower levels of cortisol in 15-hour urines collected upon admission to the hospital . In addition , urinary levels of cortisol predicted a significant percentage of the variance in intrusive and avoidant thoughts 1 month after the accident . CONCLUSIONS The results of our study suggest that initial cortisol levels in the immediate aftermath of a traumatic event contribute , in part , to subsequent symptoms of posttraumatic stress disorder OBJECTIVE Early childhood is a high-risk time for exposure to potentially traumatic medical events . We have previously reported that 10 % of young children continue to have posttraumatic stress disorder ( PTSD ) 6 months after burn injury . This study aim ed to 1 ) document the prevalence and prospect i ve change in parental psychological distress over 6 months following their child 's burn injury and 2 ) identify risk factors for posttraumatic stress symptoms ( PTSS ) in young children and their parents . METHODS Participants were 120 parents of 1 - 6-year-old children with unintentional burn injuries . Data were collected within 2 weeks , 1 month , and 6 months of burn injury using developmentally sensitive diagnostic interviews and question naires . RESULTS Within the first month , ∼ 25 % of parents had a probable PTSD diagnosis , and moderate to extremely severe levels of depression , anxiety , and stress . Distress levels decreased significantly over time ; however , 5 % of parents still had probable PTSD at 6 months . Hierarchical multiple regression and path analyses indicated that parent posttraumatic stress reactions contributed significantly to the development and maintenance of child PTSS . Other risk factors for child PTSS included premorbid emotional and behavioral difficulties and larger burn size . Risk factors identified for parent PTSS included prior trauma history , acute distress , greater number of child invasive procedures , guilt , and child PTSS . CONCLUSIONS The findings from this study suggest that parents ' responses to a traumatic event may play a particularly important role in a young child 's psychological recovery . However , further research is needed to confirm the direction of the relationship between child and parent distress . This study identified variables that could be incorporated into screening tools or targeted by early intervention protocol s to prevent the development of persistent child and parent PTSS following medical trauma BACKGROUND Little is known about long-term psychological outcomes after major trauma in adolescents , a leading cause of death and preventable morbidity in this age group . A prospect i ve epidemiologic study was conducted to examine quality of life ( QoL ) and posttraumatic stress disorder ( PTSD ) outcomes in injured adolescents . The specific objectives of the present report are to describe long-term PTSD and to identify risk factors for long-term PTSD and the impact of PTSD on QoL. METHODS Between April 26 , 1999 , and November 13 , 2002 , 401 eligible trauma patients aged 12 to 19 years triaged to five participating trauma center hospitals in a regionalized trauma system were enrolled in the study . The admission criteria for patients were as follows : age 12 to 19 years and injury diagnoses excluding severe traumatic brain injury or spinal cord injury . PTSD was diagnosed with the Impact of Events Scale-Revised ; scores of 24 + were used to diagnose PTSD . QoL after trauma was measured using the Quality of Well-Being scale , a sensitive and well-vali date d functional index ( range : 0 = death to 1.000 = optimum functioning ) . Patient outcomes were assessed at discharge and at 3 , 6 , 12 , 18 , and 24 months after discharge . RESULTS The rate of long-term PTSD was 27 % , with high rates over the follow-up period . Risk factors for long-term PTSD were perceived threat to life ( odds ratio [ OR ] , 2.2 ; p < 0.001 . ) ; death of a family member at the scene ( OR , 4.7 ; p < 0.001 ) ; no control over injury event ( OR , 1.7 ; p < 0.05 ) , and violence-related injury ( OR , 2.2 ; p < 0.05 ) . PTSD in adolescents was significantly and strongly associated with female gender , older age , low socioeconomic status , drug and alcohol abuse , and other adolescent behavioral problems . Long-term PTSD was also associated with marked and significant QoL deficits throughout the 24-month follow-up interval . CONCLUSION High rates of long-term PTSD persist after major trauma in adolescents . Injury events such as perceived threat to life and control over the event are strongly associated with PTSD risk . Prolonged PTSD severely impacts QoL outcomes . Early identification and treatment of risk factors for long-term PTSD will be important to improve outcomes in injured adolescents OBJECTIVE The purpose of this study was to prospect ively evaluate the onset , overlap , and course of posttraumatic stress disorder ( PTSD ) and major depression following traumatic events . METHOD The occurrence of PTSD and major depression and the intensity of related symptoms were assessed in 211 trauma survivors recruited from a general hospital 's emergency room .  Psychometrics and structured clinical interview ( the Structured Clinical Interview for DSM-III-R and the Clinician-Administered PTSD Scale ) were administered 1 week , 1 month , and 4 months after the traumatic event .  Heart rate  was assessed upon arrival at the emergency room for subjects with physical injury . Twenty-three subjects with PTSD and 35 matched comparison subjects were followed for 1 year . RESULTS Major depression and PTSD occurred early on after trauma ; patients with these diagnoses had similar recovery rates : 63 survivors ( 29.9 % ) met criteria for PTSD at 1 month , and 37 ( 17.5 % ) had PTSD at 4 months . Forty subjects ( 19.0 % ) met criteria for major depression at 1 month , and 30 ( 14.2 % ) had major depression at 4 months . Comorbid depression occurred in 44.5 % of PTSD patients at 1 month and in 43.2 % at 4 months . Comorbidity was associated with greater symptom severity and lower levels of functioning . Survivors with PTSD had higher heart rate levels at the emergency room and reported more intrusive symptoms , exaggerated startle , and peritraumatic dissociation than those with major depression . Prior depression was associated with a higher prevalence of major depression and with more reported symptoms . CONCLUSIONS Major depression and PTSD are independent sequelae of traumatic events , have similar prognoses , and interact to increase distress and dysfunction . Both should be targeted by early treatment interventions and by neurobiological research OBJECTIVE This study was design ed to assess the natural course of posttraumatic symptoms formation , as well as the degree to which acute stress reactions predict later posttraumatic stress disorder ( PTSD ) in injured traffic accident victims . METHOD A prospect i ve , 1-year follow-up study was carried out on 74 injured traffic accident victims and a comparison group of 19 patients who were hospitalized for elective orthopedic surgery . Participants were interviewed within the first week following the accident , and follow-up interviews were performed 1 , 3 , 6 , and 12 months after the accident . At 12 months , a structured clinical interview was administered to determine a formal DSM-III-R diagnosis of PTSD . RESULTS Twenty-four ( 32 % ) of the 74 traffic accident victims , but none of the 19 comparison subjects , met DSM-III-R criteria for PTSD at 1 year . Traffic accident victims who developed PTSD had higher levels of premorbid and comorbid psychopathology . Levels of posttraumatic symptoms were significantly higher from the outset in the subjects who developed PTSD and worsened progressively over the first 3 months , in contrast to subjects without PTSD , who manifested gradual amelioration of symptoms during this time . Existence of posttraumatic symptoms immediately after the accident was a better predictor of later PTSD than was accident or injury severity . CONCLUSIONS In this study , a significant portion of injured traffic accident victims manifested PTSD 1 year after the event . The development of PTSD at 1 year can be predicted as early as 1 week after the accident on the basis of the existence and severity of early PTSD-related symptoms . However , the first 3 months following the accident appear to be the critical period for the development of PTSD IMPORTANCE Delayed-onset posttraumatic stress disorder ( PTSD ) accounts for approximately 25 % of PTSD cases . Current models do not adequately explain the delayed increases in PTSD symptoms after trauma exposure . OBJECTIVE To test the roles of initial psychiatric reactions , mild traumatic brain injury ( MTBI ) , and ongoing stressors on delayed-onset PTSD . DESIGN , SETTING , AND PARTICIPANTS In this prospect i ve cohort study , patients were selected from recent admissions to 4 major trauma hospitals across Australia . A total of 1084 traumatically injured patients were assessed during hospital admission from April 1 , 2004 , through February 28 , 2006 , and 785 ( 72.4 % ) were followed up at 3 , 12 , and 24 months after injury . MAIN OUTCOME AND MEASURE Severity of PTSD was determined at each assessment with the  Clinician-Administered PTSD Scale .  RESULTS Of those who met PTSD criteria at 24 months , 44.1 % reported no PTSD at 3 months and 55.9 % had subsyndromal or full PTSD . In those who displayed subsyndromal or full PTSD at 3 months , PTSD severity at 24 months was predicted by prior psychiatric disorder , initial PTSD symptom severity , and type of injury . In those who displayed no PTSD at 3 months , PTSD severity at 24 months was predicted by initial PTSD symptom severity , MTBI , length of hospitalization , and the number of stressful events experienced between 3 and 24 months . CONCLUSIONS AND RELEVANCE These data highlight the complex trajectories of PTSD symptoms over time . This study also points to the roles of ongoing stress and MTBI in delayed cases of PTSD and suggests the potential of ongoing stress to compound initial stress reactions and lead to a delayed increase in PTSD symptom severity . This study also provides initial evidence that MTBI increases the risk of delayed PTSD symptoms , particularly in those with no acute symptoms CONTEXT Previous research has shown that exposure to traumatic events , especially sexual trauma during childhood , is associated with an increased risk of attempted suicide . However , no information is available as to whether the increased risk of attempted suicide is related primarily to posttraumatic stress disorder ( PTSD ) following traumatic experiences or applies also to persons who experienced trauma but did not develop PTSD . OBJECTIVE We examine the association between exposure to traumatic events with and without result ing PTSD and the risk of a subsequent suicide attempt in a community sample of urban young adults . DESIGN A cohort study followed young adults who had participated in a r and omized trial of all first- grade students entering 19 public schools . SETTING Baltimore , Maryl and , an urban setting . PARTICIPANTS A total of 1698 young adults ( mean age , 21 ; 47 % male ; 71 % African American ) who represented 75 % of the original cohort of 2311 persons . MAIN OUTCOME MEASURE Relative risk of a subsequent suicide attempt associated with PTSD and with exposure to assaultive and non-assaultive traumas ( no PTSD ) , as estimated using discrete time survival analysis . RESULTS Posttraumatic stress disorder was associated with increased risk of a subsequent suicide attempt . The PTSD-suicide attempt association was robust , even after adjustment for a prior major depressive episode , alcohol abuse or dependence , and drug abuse or dependence ( adjusted relative risk , 2.7 ; 95 % confidence interval , 1.3 - 5.5 ; P < .01 ) . In contrast , exposure to traumatic events without PTSD was not associated with an increased risk of attempted suicide . CONCLUSIONS Posttraumatic stress disorder is an independent predictor of attempted suicide . Exposure to traumatic events without PTSD is not associated with a later suicide attempt & NA ; Distinct developmental trajectories for neck disability and posttraumatic stress disorder ( PTSD ) symptoms after whiplash injury have recently been identified . This study aim ed to identify baseline predictors of membership to these trajectories and to explore their dual development . In a prospect i ve study , 155 individuals with whiplash were assessed at < 1 month , 3 , 6 , and 12 months postinjury . Outcomes at each time point were assessed according to the Neck Disability Index and the Posttraumatic Stress Diagnostic Scale . Baseline predictor variables were age , gender , initial pain ( based on a visual analogue scale [ VAS ] ) , pressure pain thresholds ( PPT ) , cold pain thresholds ( CPT ) , and sympathetic vasoconstrictor responses . Group‐based trajectory analytical techniques were used to parameterise the optimal trajectories and to identify baseline predictors . A dual trajectory analysis was used to explore probabilities of conditional and joint trajectory group membership . CPT ⩾ 13 ° C ( OR = 26.320 , 95 % CI = 4.981–139.09 ) , initial pain level ( VAS ) ( OR = 4.3 , 95 % CI = 4.98–139.1 ) , and age ( OR = 1.109 , 95 % CI = 1.043–1.180 ) predicted a chronic/severe disability trajectory . The same baseline factors also predicted chronic moderate/severe PTSD ( CPT ⩾ 13 ° C , OR = 9.7 , 95%CI = 2.22–42.44 ; initial pain level [ VAS ] : OR = 2.13 , 95 % CI = 1.43–3.17 ; age : OR = 1.07 , 95 % CI = 1.01–1.14 ) . There was good correspondence of trajectory group for both disability and PTSD . These findings support the proposal of links between the development of chronic neck related disability and PTSD after whiplash injury . Developmental trajectories of disability and posttraumatic stress disorder ( PTSD ) after whiplash injury are mostly in synchrony , and similar factors predict their membership . This suggests links between the development of chronic neck pain‐related disability and PTSD BACKGROUND Psychiatric history has been suggested to have an impact on long-term adjustment in burn survivors . A rigorous , prospect i ve , longitudinal approach was used to study psychiatric history in a population -based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder ( PTSD ) at a 12-month follow-up . METHODS Seventy-three consecutive patients admitted to the Uppsala Burn Unit were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition for psychiatric disorders , of whom 64 were also assessed after 12 months . RESULTS Forty-eight patients ( 66 % ) presented with at least one lifetime psychiatric diagnosis ; major depression ( 41 % ) , alcohol abuse or dependence ( 32 % ) , simple phobia ( 16 % ) , and panic disorder ( 16 % ) were most prevalent . At 12-months postburn , 10 patients ( 16 % ) met criteria for major depression , 6 ( 9 % ) for PTSD , and 11 ( 17 % ) for subsyndromal PTSD . Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months , whereas those with lifetime affective disorder , substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD . CONCLUSIONS Two-thirds of burn survivors exhibit a history of lifetime psychiatric disorders . Those with a psychiatric history have a higher risk of postburn psychiatric problems OBJECTIVE The purpose of this study was to describe the extent to which childhood abuse and neglect increase a person 's risk for subsequent  posttraumatic stress disorder ( PTSD ) and to determine whether the relationship to PTSD persists despite controls for family , individual , and lifestyle characteristics associated with both childhood victimization and PTSD . METHOD Victims of substantiated child abuse and neglect from 1967 to 1971 in a Midwestern metropolitan county area were matched on the basis of age , race , sex , and approximate family socioeconomic class with a group of nonabused and nonneglected children and followed prospect ively into young adulthood . Subjects ( N = 1,196 ) were located and administered a 2-hour interview that included the National Institute of Mental Health Diagnostic Interview Schedule to assess PTSD . RESULTS Childhood victimization was associated with increased risk for lifetime and current PTSD . Slightly more than a third of the childhood victims of sexual abuse ( 37.5 % ) , 32.7 % of those physically abused , and 30.6 % of victims of childhood neglect met DSM-III-R criteria for lifetime PTSD . The relationship between childhood victimization and number of PTSD symptoms persisted despite the introduction of covariates associated with risk for both . CONCLUSIONS Victims of child abuse ( sexual and physical ) and neglect are at increased risk for developing PTSD , but childhood victimization is not a sufficient condition . Family , individual , and lifestyle variables also place individuals at risk and contribute to the symptoms of PTSD Objective : To determine the prevalence and risk factors of symptoms of anxiety , depression , and posttraumatic stress disorder-related symptoms in patients with chronic obstructive pulmonary disease and their relatives after an intensive care unit stay . Design : Prospect i ve multicenter study . Setting : Nineteen French intensive care units . Subjects : One hundred twenty-six patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and 102 relatives . Intervention : None . Measurements and Main Results : Patients and relatives were interviewed at intensive care unit discharge and 90 days later to assess symptoms of anxiety and depression using Hospital Anxiety and Depression Scale ( HADS ) and posttraumatic stress disorder-related symptoms using the Impact of Event Scale ( IES ) . At intensive care unit discharge , 90 % of patients recollected traumatic psychological events in the intensive care unit . At day 90 , we were able to conduct telephone interviews with 53 patients and 47 relatives . Hospital Anxiety and Depression Scale scores indicated symptoms of anxiety and depression in 52 % and 45.5 % of patients at intensive care unit discharge and in 28.3 % and 18.9 % on day 90 , respectively . Corresponding prevalence in relatives were 72.2 % and 25.7 % at intensive care unit discharge and 40.4 % and 14.9 % on day 90 , respectively . The Impact of Event Scale indicated posttraumatic stress disorder-related symptoms in 20.7 % of patients and 29.8 % of relatives on day 90 . Peritraumatic dissociation assessed using the Peritraumatic Dissociative Experiences Question naire was independently associated with posttraumatic stress disorder-related symptoms in the patients and relatives . Previous intensive care unit experience and re collection of bothersome noise in the intensive care unit predicted posttraumatic stress disorder-related symptoms in the patients . Conclusions : Psychiatric symptoms were found to be common in a group of 126 patients with chronic obstructive pulmonary disease who survived an intensive care unit stay and their relatives at intensive care unit discharge and 90 days later . Peritraumatic dissociation at intensive care unit discharge was found to independently predict posttraumatic stress disorder-related symptoms in this sample of patients and relatives OBJECTIVE To assess the association between early posttraumatic stress disorder ( PTSD ) and depressive symptoms and functional and quality -of-life outcomes  among injured youth . DESIGN Prospect i ve cohort study . SETTING Combined pediatric-adult level I trauma center . PARTICIPANTS R and omly sample d adolescent injury survivors aged 12 to 18 years ( N = 108 ) were recruited from surgical inpatient units . MAIN EXPOSURES Posttraumatic stress disorder and depressive symptom levels in the days and weeks immediately following injury . We also collected relevant adolescent demographic , injury , and clinical characteristics . MAIN OUTCOME MEASURE Multiple domains of adolescent functional impairment were assessed with the 87-item Child Health Question naire ( CHQ-87 )  at 2 , 5 , and 12 months after injury . RESULTS The investigation attained greater than 80 % adolescent follow-up at each assessment after injury . Mixed-model regression was used to assess the association between baseline levels of PTSD and depressive symptoms and subsequent functional outcomes longitudinally . High baseline PTSD symptom levels were associated with significant impairments in CHQ-87 Role/Social Behavioral , Role/Social Physical , Bodily Pain , General Behavior , Mental Health , and General Health Perceptions subscales . High baseline depressive symptoms were associated with significant impairments in CHQ-87 Physical Function , Role/Social Emotional , Bodily Pain , Mental Health , Self-esteem , and Family Cohesion subscales . CONCLUSIONS Early PTSD and depressive symptoms are associated with a broad spectrum of adolescent functional impairment during the year after physical injury . Coordinated investigative and policy efforts that refine mental health screening and intervention procedures have the potential to improve the functioning and well-being of injured youth treated in the acute care medical setting & NA ; Pain is a common and pervasive symptom for persons infected with the human immunodeficiency virus ( HIV ) . Individuals with persistent pain are known to be at heightened risk for posttraumatic stress disorder ( PTSD ) , an anxiety disorder that manifests itself following exposure to a traumatic event . Moreover , research suggests that patients with persistent pain who develop PTSD often experience greater pain intensity and pain‐related disability than those who do not develop PTSD . The purpose of this study was to assess the relation of PTSD to pain intensity and pain‐related interference in HIV‐infected persons suffering from persistent pain . Study participants included 145 ambulatory persons living with HIV/AIDS ( PWHAs ) who were enrolled in a r and omized clinical trial assessing the impact of a pain communication intervention .  Participants completed a series of self‐report measures including the Stressful Life Events Checklist ( SLE ) , the Posttraumatic Stress Disorder Checklist‐Civilian ( PCL‐C ) , the Mental Health Inventory ( MHI ) , and the Brief Pain Inventory ( BPI ) . On average , participants reported being exposed to 6.3 different types of trauma over the course of their lifetime , of which receiving an HIV diagnosis was rated as being among the most stressful . Over half ( 53.8 % ) merited a PTSD diagnosis according to the PCL‐C. Those with PTSD reported having significantly higher pain intensity and greater pain‐related interference in performance of daily activities ( i.e. , working , sleeping , walking ability and general activity ) , and affect ( i.e. , mood , relations with other people , enjoyment of life ) over time than those who did not meet the diagnostic criteria . Possible explanations for these findings are discussed along with implication s for clinical care BACKGROUND Traffic crashes are the leading health threat to children in the United States , result ing in nearly 1 million injuries annually . The psychological consequences of these injuries are primarily unknown . The aims of this study were to estimate the prevalence of posttraumatic stress disorder ( PTSD ) in traffic-injured children and their parents and to identify risk factors for PTSD development . METHODS A prospect i ve cohort study of traffic-injured children between 3 and 18 years of age was conducted at a level 1 Pediatric Trauma Center . The children were enrolled as part of an ongoing surveillance system of traffic-related injuries . Presence and severity of PTSD were determined in the children and their parents through a vali date d diagnostic question naire 7 to 12 months after child injury . RESULTS Twenty-five percent of the children and 15 % of the parents suffered diagnostic PTSD , but only 46 % of the parents of affected children sought help of any form ( including from friends ) for their child and only 20 % of affected parents sought help for themselves . Child PTSD was associated with older child age and parent PTSD . Parent PTSD was associated with younger child age , child PTSD , and parent witnessing the event . Injury severity was not predictive of PTSD . CONCLUSIONS PTSD in children and their parents is a common , yet overlooked , consequence of pediatric traffic-related injury with prevalence rates similar to those found in children exposed to violence . Physicians managing the pediatric trauma patient , regardless of injury severity or whether the injury was intentional , should screen for PTSD and refer for treatment where appropriate An altered function of the hypothalamic-pituitary-adrenal axis is assumed to be characteristic for Posttraumatic Stress Disorder ( PTSD ) , although there is inconsistent empirical evidence . Only few studies examined the awakening cortisol response and a daytime profile in PTSD .  Salivary cortisol levels were measured at seven intervals from awakening until 8 PM in trauma-exposed subjects with ( N=29 ) and without PTSD ( N=19 ) and in 15 non-exposed controls . While the three groups did not differ with respect to their first cortisol level immediately after awakening , the expected cortisol increase to awakening 15 - 60 min later was significantly lower in PTSD patients compared to non-PTSD subjects and healthy controls . This effect remained stable when trauma-exposed subjects with comorbid major depression were excluded from the analysis . A significant negative correlation between the overall cortisol secretion ( AUC(G ) ) and overall PTSD symptomatology and hyper-arousal symptoms was found . The findings are discussed in light of the hypothesis of a counterregulation of hyper-arousal symptoms and chronic stress in PTSD Medical setting s provide opportunities for secondary prevention of traumatic stress and other sequelae of pediatric injury . This pilot r and omized trial evaluated the delivery and effectiveness of a targeted preventive intervention based on best practice recommendations and integrated within acute medical care .  Hospitalized injured children were screened for risk of developing posttraumatic stress disorder ( PTSD ) . Those at risk ( N = 85 ) were r and omized to the intervention  ( n = 46 ) or usual care ( n = 39 ) . The preventive intervention did not reduce PTSD or depression severity or increase health-related quality of life , compared to usual care . Both groups improved over time , but 6 months postinjury approximately 10 % of each group still met criteria for PTSD , suggesting room for improvement in comprehensive pediatric injury care
Conclusion : Combinations of peri- and post-injury factors appear to be influential in the development of PTSD among persons with SCI .
Objectives : To summarise quantitatively the available evidence relating to pretraumatic , peritraumatic and posttraumatic characteristics that may increase or decrease the risk of developing posttraumatic stress disorder ( PTSD ) following spinal cord injury ( SCI ) .