Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland.
Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland.
Psychiatry Res. 2018 Feb;260:262-271. doi: 10.1016/j.psychres.2017.11.068. Epub 2017 Dec 2.
Epidemiological data on the chronicity of posttraumatic stress disorder (PTSD) symptoms in relation to trauma type and underlying pathways are rare. The current study explored how PTSD symptoms change over time across different trauma types and examined mediators of their persistence. A trauma-exposed community sample, whereof approximately one quarter met diagnostic criteria for PTSD, provided retrospective data on the duration of PTSD symptoms. Those who remitted and those who had not at the time of assessment were compared regarding worst trauma, symptom severity, comorbidity, demographic and treatment-seeking variables. Time to remission was estimated using Cox proportional hazard models including candidate predictors of remission. A mediated survival analysis was used to explore indirect pathways that explain trauma-specific differences in remission times. Both the full sample and PTSD subgroup were analyzed separately. Overall, lower socio-economic status, lifetime and childhood sexual trauma, symptom severity, comorbid depression and past treatment were associated with non- and longer remissions. PTSD avoidance symptoms and comorbid depression were found to mediate longer remission times after lifetime or childhood sexual trauma. Our findings provide insight into the mechanisms and complicating factors of remission from PTSD symptoms after trauma, which might have important implications for therapeutic interventions.
创伤后应激障碍（PTSD）症状慢性化的流行病学数据与创伤类型和潜在途径有关，但很少见。本研究探讨了不同创伤类型下 PTSD 症状随时间的变化，并检验了其持续存在的中介因素。一个暴露于创伤的社区样本中，大约四分之一的人符合 PTSD 的诊断标准，提供了 PTSD 症状持续时间的回顾性数据。对评估时已缓解和未缓解的人进行了比较，比较内容包括最严重的创伤、症状严重程度、合并症、人口统计学和寻求治疗的变量。使用 Cox 比例风险模型估计缓解时间，该模型包括缓解的候选预测因素。使用中介生存分析来探索解释缓解时间创伤特异性差异的间接途径。分别对全样本和 PTSD 亚组进行了分析。总体而言，较低的社会经济地位、终身和儿童期性创伤、症状严重程度、合并抑郁和过去的治疗与非缓解和缓解时间较长有关。发现 PTSD 回避症状和合并抑郁是导致终身或儿童期性创伤后缓解时间延长的中介因素。我们的研究结果提供了对创伤后 PTSD 症状缓解的机制和复杂因素的深入了解，这可能对治疗干预具有重要意义。
