Understanding Onset, Dynamic Transitions, and Associated Inequality Risk Factors for Adverse Posttraumatic Neuropsychiatric Sequelae After Trauma Exposure
Abstract
Objective
Methods
Results
Conclusions
STUDY AIMS
METHODS
Study Participants
Variables
APNS symptom domains
Equity‐relevant characteristics (i.e., covariates)
Statistical Analyses
RESULTS
Variables | n (%) or mean ± standard deviation |
---|---|
Age, years | 35.6 ± 13.07 |
Gender (n = 2555) | |
Males | 964 (37.7%) |
Females | 1591 (62.3%) |
Race (n = 2545) | |
Whites | 859 (33.8%) |
Non‐whites | 1686 (66.2%) |
Education (n = 2556) | |
Less than a high school degree | 304 (11.9%) |
A high school degree or higher | 2252 (88.1%) |
Total family income (n = 2264) | |
≤ $75,000 | 1956 (86.4%) |
> $75,000 | 308 (13.6%) |
Childhood traumaa (range: 0‐44; n = 2183) | 9.5 ± 9.78 |
Area deprivationb (range: 0‐100; n = 2471) | 64.8 ± 27.58 |
Latent status | |||
---|---|---|---|
Low‐symptom status | Moderate‐symptom status | Severe‐symptom status | |
Symptom indicator means (range of means)a | |||
Pain (0–10) | 2.52 ± 0.16 | 5.48 ± 0.08 | 6.96 ± 0.10 |
Sleep discontinuity and nightmares (0–4) | 0.67 ± 0.02 | 1.46 ± 0.04 | 2.54 ± 0.06 |
Avoidance and re‐experience (0–4) | 0.78 ± 0.03 | 1.89 ± 0.05 | 2.82 ± 0.05 |
Depression, anxiety, and hyperarousal (0–4) | 0.68 ± 0.02 | 1.64 ± 0.05 | 2.72 ± 0.06 |
Somatic symptoms and mental fatigue (0–10) | 2.35 ± 0.08 | 4.62 ± 0.10 | 6.85 ± 0.11 |
Latent status membership prevalence | |||
Time 1 (baseline) | 18.6% (n = 475) | 56.3% (n = 1439) | 25.1% (n = 643) |
Time 2 (1 month) | 42.0% (n = 1074) | 38.2% (n = 977) | 19.8% (n = 506) |
Time 3 (2 months) | 46.8% (n = 1197) | 35.3% (n = 902) | 17.9% (n = 458) |
Transition probabilities (rows for baseline, columns for 1 month) | |||
Low‐symptom status | 1.000 | 0.000 | 0.000 |
Moderate‐symptom status | 0.416 | 0.565 | 0.019 |
Severe‐symptom status | 0.001 | 0.256 | 0.743 |
Transition probabilities (rows for 1 month, columns for 2 months) | |||
Low‐symptom status | 1.000 | 0.000 | 0.000 |
Moderate‐symptom status | 0.126 | 0.874 | 0.000 |
Severe‐symptom status | 0.000 | 0.093 | 0.907 |
OR (95% CI) | AOR (95% CI) | |
---|---|---|
Low‐symptom status (vs. severe‐symptom status) | ||
Females (vs. males) | 0.32* (0.24, 0.42) | 0.37* (0.27, 0.52) |
Non‐whites (vs. whites) | 0.55* (0.42, 0.73) | 0.69* (0.47, 0.99) |
Less than a high school degree (vs. a high school degree or higher) | 0.46* (0.29, 0.71) | 0.75 (0.44, 1.28) |
Total family income ≤ $75,000 (vs. total family income > $75,000) | 0.18* (0.11, 0.29) | 0.32* (0.19, 0.54) |
Childhood trauma | 0.32* (0.25, 0.41) | 0.35* (0.27, 0.46) |
Area deprivation | 0.73* (0.63, 0.83) | 0.94 (0.78, 1.13) |
Moderate‐symptom status (vs. severe‐symptom status) | ||
Females (vs. males) | 0.65* (0.52, 0.83) | 0.10* (0.55, 0.93) |
Non‐whites (vs. whites) | 0.94 (0.75, 1.18) | 1.12 (0.85, 1.48) |
Less than a high school degree (vs. a high school degree or higher) | 0.63* (0.46, 0.86) | 0.67* (0.46, 0.97) |
Total family income ≤ $75,000 (vs. total family income > $75,000) | 0.33* (0.21, 0.51) | 0.42* (0.26, 0.69) |
Childhood trauma | 0.63* (0.57, 0.70) | 0.64* (0.61, 0.76) |
Area deprivation | 0.83* (0.74, 0.94) | 0.91 (0.79, 1.04) |
OR (95% CI) | AOR (95% CI) | |
---|---|---|
Estimates from baseline to 1 month | ||
Severe‐symptom status to moderate‐symptom status (vs. staying in severe‐symptom status) | ||
Females (vs. males) | 1.30 (0.72,2.34) | 1.14 (0.62, 2.11) |
Non‐whites (vs. whites) | 0.42* (0.25, 0.69) | 0.43* (0.25, 0.73) |
Less than a high school degree (vs. a high school degree or higher) | 0.54 (0.23, 1.27) | 0.84 (0.37, 1.95) |
Total family income ≤ $75,000 (vs. total family income > $75,000) | 0.93 (0.32, 2.63) | 1.22 (0.43, 3.42) |
Childhood trauma | 0.77* (0.63, 0.94) | 0.75* (0.60, 0.92) |
Area deprivation | 0.76* (0.60, 0.97) | 0.81 (0.61, 1.07) |
Moderate‐symptom status to low‐symptom status (vs. staying in moderate‐symptom status) | ||
Females (vs. males) | 0.76 (0.56, 1.02) | 0.69* (0.49, 0.98) |
Non‐whites (vs. whites) | 0.54* (0.40, 0.72) | 0.74 (0.52, 1.06) |
Less than a high school degree (vs. a high school degree or higher) | 0.52* (0.32, 0.84) | 0.69 (0.38, 1.27) |
Total family income ≤ $75,000 (vs. total family income > $75,000) | 0.58* (0.38, 0.89) | 0.86 (0.53, 1.39) |
Childhood trauma | 0.65* (0.55, 0.78) | 0.68* (0.57, 0.82) |
Area deprivation | 0.76* (0.67, 0.88) | 0.89 (0.75, 1.06) |
Estimates from 1 month to 2 months | ||
Severe‐symptom status to moderate‐symptom status (vs. staying in severe‐symptom status) | ||
Females (vs. males) | 13.47† (0.03, 5332.65) | 8.20† (0.05, 759.38) |
Non‐whites (vs. whites) | 1.28 (0.28, 5.79) | 0.87 (0.20, 3.75) |
Less than a high school degree (vs. a high school degree or higher) | 0.32 (0.02, 4.16) | 0.00† (0.00, 0.00) |
Total family income ≤ $75,000 (vs. total family income > $75,000) | 1.10† (0.04, 33.93) | 0.87 (0.08, 9.84) |
Childhood trauma | 0.81 (0.51, 1.27) | 0.64 (0.38, 1.05) |
Area deprivation | 0.84 (0.50, 1.39) | 1.03 (0.55, 1.92) |
Moderate‐symptom status to low‐symptom status (vs. staying in moderate‐symptom status) | ||
Females (vs. males) | 1.32 (0.63, 2.80) | 1.55 (0.59, 4.06) |
Non‐whites (vs. whites) | 0.76 (0.38, 1.50) | 0.85 (0.36, 1.98) |
Less than a high school degree (vs. a high school degree or higher) | 0.28 (0.04, 1.83) | 0.11 (0.00, 87.77) |
Total family income ≤ $75,000 (vs. total family income > $75,000) | 0.31* (0.13, 0.72) | 0.35* (0.14, 0.87) |
Childhood trauma | 0.81 (0.55, 1.21) | 0.81 (0.52, 1.26) |
Area deprivation | 0.97 (0.72, 1.31) | 1.04 (0.71, 1.54) |
DISCUSSION
Limitations
Clinical Implications
CONCLUSIONS
Footnotes
Supplementary Material
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