title: A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury.
abstract: BACKGROUND
  Psychologic problems are common after burns, and symptoms of posttraumatic stress disorder (PTSD) are some of the most prevalent. Risk factors for PTSD have been identified, but little is known about the onset and course of these symptoms. The objective was to investigate whether there are different PTSD symptom trajectories after burns.
  
  
  METHODS
  Ninety-five adults with burns were enrolled in a prospective study from in-hospital treatment until 12 months after burn. Symptoms of PTSD were assessed with the Impact of Event Scale-Revised and scores at 3, 6, and 12 months after the burn were used in a cluster analysis to detect trajectories. The trajectories were compared regarding known risk factors for PTSD using non-parametric analysis of variance.
  
  
  RESULTS
  Four clusters were identified: (1) resilient, with low levels of PTSD symptoms that decreased over time; (2) recovery, with high levels of symptoms that gradually decreased; (3) delayed, with moderate symptoms that increased over time; and (4) chronic, with high levels of symptoms over time. The trajectories differed regarding several risk factors for PTSD including life events, premorbid psychiatric morbidity, personality traits, avoidant coping, in-hospital psychologic symptoms, and social support. The resilient trajectory consistently had fewer of the risk factors and differed the most from the chronic trajectory.
  
  
  CONCLUSIONS
  There are subgroups among patients with burns that have different patterns of PTSD symptom development. These findings may have implications for clinical practice, such as the timing of assessment and the management of patients who present with these symptoms.
authors.affiliation: Department of Neuroscience, Psychiatry, Uppsala University, University Hospital, Uppsala, Sweden. josefin.sveen@neuro.uu.se
authors.forename: Josefin
authors.initials: J
authors.lastname: Sveen
authors.forename: Lisa
authors.initials: L
authors.lastname: Ekselius
authors.forename: Bengt
authors.initials: B
authors.lastname: Gerdin
authors.forename: Mimmie
authors.initials: M
authors.lastname: Willebrand
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D002056:Burns / Q000150:complications* / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D016000:Cluster Analysis; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D013548:Sweden; D013997:Time Factors; D055815:Young Adult