Predicting posttraumatic stress symptoms longitudinally in a representative sample of hospitalized injured adolescents.
OBJECTIVE
Adolescents constitute a high-risk population for traumatic physical injury, yet few longitudinal investigations have assessed the development of posttraumatic stress disorder (PTSD) symptoms over time in representative samples.


METHODS
Between July 2002 and August 2003, 108 randomly selected injured adolescent patients ages 12 to 18 and their parents were interviewed at baseline and again 2, 5, and 12 months postinjury. Initially, participants were screened for PTSD symptoms with the PTSD Reaction Index (PTSD-RI) and depressive symptoms with the Center for Epidemiologic Studies Depression Scale, as well as preinjury trauma. Random-coefficient regression was used to assess the association between baseline clinical, injury, and demographic characteristics and the development and maintenance of PTSD symptoms longitudinally.


RESULTS
Between 19% and 32% of adolescents screened positive for PTSD (i.e., had PTSD-RI scores of > or =38) during the course of the 12 months after the injury. Higher initial adolescent PTSD and depressive symptoms, higher emergency department heart rate, greater objective event severity, and greater parental preinjury trauma were significant independent predictors of higher adolescent PTSD symptoms.


CONCLUSIONS
For a substantive minority of hospitalized adolescents, high PTSD symptom levels persist during the 12 months after injury. Clinical characteristics readily identifiable after the acute injury predict the development of PTSD symptoms over time. Real-world clinical trials that test screening and intervention procedures for representative samples of at-risk youths are warranted.
Zatzick
Douglas F
DF
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles. Electronic address: dzatzick@u.washington.edu.
Grossman
David C
DC
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Russo
Joan
J
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Pynoos
Robert
R
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Berliner
Lucy
L
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Jurkovich
Gregory
G
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Sabin
Janice A
JA
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Katon
Wayne
W
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Ghesquiere
Angela
A
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
McCAULEY
Elizabeth
E
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
Rivara
Frederick P
FP
Drs. Zatzick, Russo, Katon, and McCauley and Ms. Ghesquiere are with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle; Drs. Zatzick, Grossman, Rivara, Sabin, and Jurkovich are with the Harborview Injury Prevention and Research Center, University of Washington School of Medicine; Drs. Berliner and Zatzick are with the National Child Traumatic Stress Network, Harborview Medical Center, Seattle; and Dr. Pynoos is with the National Child Traumatic Stress Network, University of California, Los Angeles.
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation*