Longitudinal analysis of latent classes of psychopathology and patterns of class migration in survivors of severe injury.
OBJECTIVE
Little research to date has explored the typologies of psychopathology following trauma, beyond development of particular diagnoses such as posttraumatic stress disorder (PTSD). The objective of this study was to determine the longitudinal patterns of these typologies, especially the movement of persons across clusters of psychopathology.


METHODS
In this 6-year longitudinal study, 1,167 hospitalized severe injury patients who were recruited between April 2004-February 2006 were analyzed, with repeated measures at baseline, 3 months, 12 months, and 72 months after injury. All patients met the DSM-IV criterion A1 for PTSD. Structured clinical interviews were used to assess psychiatric disorders at each follow-up point. Latent class analysis and latent transition analysis were applied to assess clusters of individuals determined by psychopathology. The Mini International Neuropsychiatric Interview (MINI) and Clinician-Administered PTSD Scale (CAPS) were employed to complete diagnoses.


RESULTS
Four latent classes were identified at each time point: (1) Alcohol/Depression class (3 months, 2.1%; 12 months, 1.3%; and 72 months, 1.1%), (2) Alcohol class (3 months, 3.3%; 12 months, 3.7%; and 72 months, 5.4%), (3) PTSD/Depression class (3 months, 10.3%; 12 months, 11.5%; and 72 months, 6.4%), and (4) No Disorder class (3 months, 84.2%; 12 months, 83.5%; and 72 months, 87.1%). Latent transition analyses conducted across the 2 transition points (12 months and 72 months) found consistently high levels of stability in the No Disorder class (90.9%, 93.0%, respectively) but lower and reducing levels of consistency in the PTSD/Depression class (81.3%, 46.6%), the Alcohol/Depression class (59.7%, 21.5%), and the Alcohol class (61.0%, 36.5%), demonstrating high levels of between-class migration.


CONCLUSIONS
Despite the array of psychiatric disorders that may develop following severe injury, a 4-class model best described the data with excellent classification certainty. The high levels of migration across classes indicate a complex pattern of psychopathology expression over time. The findings have considerable implications for tailoring multifocused interventions to class type, as well as flexible stepped care models, and for the potential development and delivery of transdiagnostic interventions targeting underlying mechanisms.
Australian Centre for Posttraumatic Mental Health, Department of Psychiatry, The University of Melbourne, Level 3, Alan Gilbert Building, 161 Barry St, Carlton VIC 3053, Australia dforbes@unimelb.edu.au.
David
D
Forbes
Angela
A
Nickerson
Nathan
N
Alkemade
Richard A
RA
Bryant
Mark
M
Creamer
Derrick
D
Silove
Alexander C
AC
McFarlane
Miranda
M
Van Hooff
Susan L
SL
Fletcher
Meaghan
M
O'Donnell
D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis / Q000523:psychology*; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales; D011599:Psychopathology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D017741:Survivors / Q000523:psychology*; D014947:Wounds and Injuries / Q000150:complications* / Q000523:psychology*; D055815:Young Adult