Predictors of the long-term course of comorbid PTSD: A naturalistic prospective study

• Published in: International journal of psychiatry in clinical practice 2013-08, Vol.17 (3), p.232-237
• Main Authors: Pérez Benítez, Carlos I., Zlotnick, Caron, Dyck, Ingrid, Stout, Robert, Angert, Erica, Weisberg, Risa, Keller, Martin
• Format: Article
• Language: English
• Subjects: Adult; Agoraphobia - epidemiology; Agoraphobia - psychology; Anxiety Disorders - epidemiology; Anxiety Disorders - psychology; Comorbidity; Depressive Disorder, Major - epidemiology; Depressive Disorder, Major - psychology; Disease Progression; Female; Follow-Up Studies; Humans; Male; Middle Aged; New England - epidemiology; Panic Disorder - epidemiology; Panic Disorder - psychology; Phobic Disorders - epidemiology; Phobic Disorders - psychology; Prospective Studies; Recurrence; Risk Factors; Social Behavior; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - psychology
• ISSN: 1365-1501; 1471-1788
• DOI: 10.3109/13651501.2012.667113

Abstract Objectives. The study examined the long-term course of posttraumatic stress disorder (PTSD) by analyzing rates of recurrence and the predictive value of comorbid psychiatric disorders and psychosocial functioning. Methods. This study is based on diagnostic assessments administered at intake and subsequent follow-up interviews over a period of 15 years in a sample of 90 anxiety-disordered patients with comorbid PTSD who participated in the Harvard Brown Anxiety Research project (HARP). Kaplan–Meier life table analysis revealed a 0.20 probability of full remission during the 15 years of follow-up. Results. Latent growth model (LGM) analysis revealed that the number of trauma exposures was a predictor of a worse course of PTSD but only during some intervals of the 15-year follow-up. Subjects with full social phobia were more likely to experience worsening of PTSD over time in comparison with subjects with less severe social phobia. Role functioning in the areas of household and employment was a significant predictor of a declining course of PTSD. Conclusions. These findings revealed the dynamic nature of the predictive value of traumatic experiences, the deleterious effect of social phobia and the long term effect of psychosocial functioning on the course of PTSD. Implications for treatment planning and development of interventions for PTSD are discussed.