A second look at prior trauma and the posttraumatic stress disorder effects of subsequent trauma: a prospective epidemiological study.
BACKGROUND
Previous studies showed increased probability of a posttraumatic stress disorder (PTSD) effect of trauma in persons who had experienced prior trauma. The evidence comes chiefly from retrospective data on earlier events, obtained from trauma-exposed persons with and without PTSD. A generally overlooked major limitation is the failure to assess the PTSD response to the prior trauma.


OBJECTIVE
To estimate the risk of PTSD after traumas experienced during follow-up periods in relation to respondents' prior traumatic events and PTSD.


METHODS
A cohort study of young adults interviewed initially in 1989, with repeated assessments during a 10-year follow-up.


METHODS
The sample was randomly selected from a large health maintenance organization in Southeast Michigan, representing the geographic area.


METHODS
The relative risk of PTSD precipitated by traumatic events occurring during follow-up periods in relation to prior exposure and PTSD that had occurred during preceding periods, estimated by general estimating equations (n = 990).


RESULTS
The conditional risk of PTSD during the follow-up periods was significantly higher among trauma-exposed persons who had experienced prior PTSD, relative to those with no prior trauma (odds ratio, 3.01; 95% confidence interval, 1.52-5.97). After adjustment for sex, race, education, and preexisting major depression and anxiety disorders, the estimates were only marginally revised. In contrast, the conditional risk of PTSD during follow-up among trauma-exposed persons who had experienced prior traumatic events but not PTSD was not significantly elevated, relative to trauma-exposed persons with no prior trauma. The difference between the 2 estimates was significant (P = .005).


CONCLUSIONS
Prior trauma increases the risk of PTSD after a subsequent trauma only among persons who developed PTSD in response to the prior trauma. The findings suggest that preexisting susceptibility to a pathological response to stressors may account for the PTSD response to the prior trauma and the subsequent trauma.
Breslau
Naomi
N
Department of Epidemiology, Michigan State University, College of Human Medicine, B645 West Fee Hall, East Lansing, MI 48824, USA. breslau@epi.msu.edu
Peterson
Edward L
EL
Schultz
Lonni R
LR
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008016:Life Change Events; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*