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Published February 2023 | Published + Supplemental Material
Journal Article Open

Posttraumatic stress disorder symptom trajectories in a 16-month COVID-19 pandemic period


COVID-19 pandemic presents an unheralded opportunity to better understand trajectories of posttraumatic stress disorder (PTSD) symptoms across a prolonged period of social disruption and stress. We tracked PTSD symptoms among trauma-exposed individuals in the United States and sought to identify population-based variability in PTSD symptom trajectories and understand what, if any, early pandemic experiences predicted membership in one trajectory versus others. As part of a longitudinal study of U.S. residents during the pandemic, participants who reported at least one potentially traumatic experience in their lifetime (N = 1,206) at Wave 1 (April 2020) were included in the current study. PTSD symptoms were assessed using the PCL-5 at four time points extending to July 2021. Latent growth mixture modeling was used to identify heterogeneous symptom trajectories. Trajectory membership was regressed on experiences from the early stage of the pandemic as measured using the Epidemic-Pandemic Impacts Inventory in a model that controlled for variables with documented associations to PTSD trajectories, including age, sex, income, and trauma history. Four trajectories were identified, categorized as resilient (73.0%), recurring (13.3%), recovering (8.3%), and chronic (5.5%). Emotional and physical health problems and positive changes associated with the early phase of the pandemic were each significant predictors of trajectory membership over and above all other variables in the model. Predictors primarily differentiated the resilient trajectory from each of the other three trajectories. Distinct PTSD symptom trajectories during the COVID-19 pandemic suggest a need for targeted efforts to help individuals at most risk for ongoing distress.

Additional Information

© 2022 International Society for Traumatic Stress Studies. This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency. This work was supported by grants from the National Institute of Mental Health (2P50MH094258), Caltech Chen Neuroscience Institute, Caltech Merkin Institute, Oscar M. Ruebhausen Fund at Yale Law School, Rutgers Center of Alcohol & Substance Use Studies, John Templeton Foundation, and Kay Family Foundation at Chapman University. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the funding agencies. We have no known conflicts of interest to disclose. COVID‐Dynamic team members associated with this work are as follows: Amber Hopkins, Dehua Liang, Uri Maoz, and Tessa Rusch. A detailed characterization of each author's contribution can be found in Supplementary Table S3. This article reported on prespecified aims, hypotheses, and analytic plans (https://osf.io/phwf2/) from a preregistered broader study, the COVID‐Dynamic Project. Within the COVID‐Dynamic Project in the Open Science F repository, the Introduction to the COVID Dynamic Dataset component (https://osf.io/kex8y/) contains all assessment instruments (https://osf.io/nhm2v/) and the full COVID‐Dynamic data dictionary (https://osf.io/z8k2t/). The component specific to the current manuscript (https://osf.io/hy3aq/) contains a project‐specific dataset, data dictionary, analysis code, and output. This article has earned an Open Materials badge for making publicly available the components of the research methodology needed to reproduce the reported procedure and analysis. All materials are available at https://osf.io/9vgzj/.

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Additional details

October 9, 2023
October 24, 2023