PTSD plus depression are comorbid conditions but depression can occur independently in the acute aftermath of trauma

摘要

This study examines the longitudinal course and risk factors of depressive and post-traumatic stress disorder (PTSD) symptoms in a group of 363 injury survivors admitted to a trauma centre. All participants received a comprehensive evaluation while in hospital and were interviewed by telephone three and 12 months after their initial assessment. Three hundred and one participated in evaluations at all three points. Seventy four per cent had been in motor vehicle accidents and 56% had incurred mild traumatic brain injury. Because this study is centred on accidental trauma victims, the findings cannot be generalised to survivors of rape, assault, terrorism, warfare, or natural and man-made disasters. In such traumas other factors may influence the risks for, and course of, psychiatric conditions. The study provides a very thoughtful and precise examination of psychiatric symptoms in trauma survivors across time. Importantly, it included examination of those with subsyndromal conditions as well as those who met full criteria for a psychiatric condition. Sixty nine per cent of patients remained free of either a full or subsyndromal diagnosis across time and 49% of those with a condition (full or subsyndromal) at three months no longer had a diagnosis at 12 months. While a majority of those with PTSD, or PTSD and depression at three months continued to have a psychiatric disorder at 12 months, 92% of those with depression alone at three months had no diagnosis at 12 months.The study also presents an analysis supporting the theory that PTSD alone and PTSD with depression may be the result of a mutual set of patient and trauma characteristics, while depression alone is perhaps mediated by other factors.When assessing trauma victims, it is important to recognise that most will do well with the passage of time. Those with depression alone have an excellent prognosis and should respond to routine clinical practices. Those with symptoms of PTSD alone or PTSD and depression have a more guarded course, with the majority meeting criteria for one or another condition at 12 months.