title: The Evolution of Post-Traumatic Stress Disorder following Moderate-to-Severe Traumatic Brain Injury.
abstract: Increasing evidence indicates that post-traumatic stress disorder (PTSD) may develop following traumatic brain injury (TBI), despite most patients having no conscious memory of their accident. This prospective study examined the frequency, timing of onset, symptom profile, and trajectory of PTSD and its psychiatric comorbidities during the first 4 years following moderate-to-severe TBI. Participants were 85 individuals (78.8% male) with moderate or severe TBI recruited following admission to acute rehabilitation between 2005 and 2010. Using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Disorders (SCID-I), participants were evaluated for pre- and post-injury PTSD soon after injury and reassessed at 6 months, 12 months, 2 years, 3 years, and 4 years post-injury. Over the first 4 years post-injury, 17.6% developed injury-related PTSD, none of whom had PTSD prior to injury. PTSD onset peaked between 6 and 12 months post-injury. The majority of PTSD cases (66.7%) had a delayed-onset, which for a third was preceded by subsyndromal symptoms in the first 6 months post-injury. PTSD frequency increased over the first year post-injury, remained stable during the second year, and gradually declined thereafter. The majority of subjects with PTSD experienced a chronic symptom course and all developed one or more than one comorbid psychiatric disorder, with mood, other anxiety, and substance-use disorders being the most common. Despite event-related amnesia, post-traumatic stress symptoms, including vivid re-experiencing phenomena, may develop following moderate-to-severe TBI. Onset is typically delayed and symptoms may persist for several years post-injury.
authors.affiliation: 1 School of Psychological Sciences, Monash University , Melbourne Australia .|2 Monash-Epworth Rehabilitation Research Centre, Epworth Hospital , Melbourne, Australia .
authors.forename: Yvette
authors.initials: Y
authors.lastname: Alway
authors.affiliation: 1 School of Psychological Sciences, Monash University , Melbourne Australia .|2 Monash-Epworth Rehabilitation Research Centre, Epworth Hospital , Melbourne, Australia .|3 National Trauma Research Institute , Melbourne, Australia .
authors.forename: Kate Rachel
authors.initials: KR
authors.lastname: Gould
authors.affiliation: 1 School of Psychological Sciences, Monash University , Melbourne Australia .|2 Monash-Epworth Rehabilitation Research Centre, Epworth Hospital , Melbourne, Australia .
authors.forename: Adam
authors.initials: A
authors.lastname: McKay
authors.affiliation: 2 Monash-Epworth Rehabilitation Research Centre, Epworth Hospital , Melbourne, Australia .
authors.forename: Lisa
authors.initials: L
authors.lastname: Johnston
authors.affiliation: 1 School of Psychological Sciences, Monash University , Melbourne Australia .|2 Monash-Epworth Rehabilitation Research Centre, Epworth Hospital , Melbourne, Australia .|3 National Trauma Research Institute , Melbourne, Australia .
authors.forename: Jennie
authors.initials: J
authors.lastname: Ponsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D000070642:Brain Injuries, Traumatic / Q000150:complications* / Q000175:diagnosis / Q000523:psychology*; D015331:Cohort Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000209:etiology / Q000523:psychology; D013997:Time Factors; D055815:Young Adult
keywords: anxiety disorder; post-traumatic stress disorder; psychiatric disorder; traumatic brain injury