title: Trajectories of posttraumatic stress symptomatology in older persons affected by a large-magnitude disaster.
abstract: This study examined the nature and determinants of longitudinal trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms in older persons affected by a large-magnitude disaster. Two hundred six adults age 60 or older (mean = 69, range = 60-92) who resided in the Galveston Bay area when Hurricane Ike struck in September 2008 completed telephone interviews an average of 3-, 6-, and 15-months after this disaster. Latent growth mixture modeling was employed to identify predominant trajectories of disaster-related PTSD symptoms over time; and pre-, peri-, and post-disaster determinants of these trajectories were then examined. A 3-class solution optimally characterized PTSD symptom trajectories, with the majority (78.7%) of the sample having low/no PTSD symptoms over all assessments (i.e., resistant); 16.0% having chronically elevated symptoms (i.e., chronic); and 5.3% having a delayed onset course of symptoms (i.e., delayed-onset). Lower education, greater severity of Hurricane Ike exposure (i.e., Ike-related physical illness or injury and high level of community destruction), and greater number of traumatic and stressful life events after Hurricane Ike, particularly financial problems, were associated with a chronic PTSD trajectory. Greater number of traumatic and stressful life events, particularly financial problems after Hurricane Ike, was also associated with a delayed-onset trajectory. These findings suggest that there are heterogeneous trajectories of disaster-related PTSD symptoms in older adults and that these trajectories have common and unique determinants. They also underscore the importance of prevention efforts designed to mitigate the deleterious effects of post-disaster stressors, most notably financial distress, in older persons affected by disasters.
authors.affiliation: National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, West Haven, CT 06516, USA. robert.pietrzak@yale.edu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Pietrzak
authors.forename: Peter H
authors.initials: PH
authors.lastname: Van Ness
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: Fran H
authors.initials: FH
authors.lastname: Norris
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D055867:Cyclonic Storms / Q000191:economics / Q000706:statistics & numerical data*; D004190:Disasters / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000191:economics / Q000453:epidemiology / Q000523:psychology*; D013781:Texas / Q000453:epidemiology