Biological and psychological predictors of posttraumatic stress disorder onset and chronicity. A one-year prospective study

C Gandubert, J Scali, M-L Ancelin, I Carrière, A-M Dupuy, G Bagnolini, K Ritchie, M Sebanne, L Martrille, E Baccino, A Hermès, J Attal, I Chaudieu, C Gandubert, J Scali, M-L Ancelin, I Carrière, A-M Dupuy, G Bagnolini, K Ritchie, M Sebanne, L Martrille, E Baccino, A Hermès, J Attal, I Chaudieu

Abstract

Background: Few studies have prospectively examined risk factors for posttraumatic stress disorder (PTSD) in the aftermath of a traumatic exposure. The aim of this study is to identify the concurrent influence of psychological and biological diatheses on PTSD onset and maintenance, taking into account socio-demographic factors and psychiatric antecedents.

Methods: A total of 123 civilians (61.8% of women) recruited in emergency units, were assessed using validated instruments during the first week and then at 1, 4, and 12 months post-trauma. Baseline assessment included evaluation of the psychological diathesis (i.e. psychiatric history and peritraumatic distress and dissociation), and the biological diathesis [i.e. cortisol, norepinephrine, epinephrine, c-reactive protein, total cholesterol, HDL cholesterol, glycosylated haemoglobin, waist-to-hip ratio (WHR), body mass index, diastolic and systolic blood pressure (SBP), and heart rate].

Results: Multivariate logistic regression analyses demonstrated both psychological and biological diatheses to be independent risk factors for PTSD. Peritraumatic distress and dissociation predicted onset (1-month) and mid-term PTSD (4-months), respectively. PTSD risk was associated positively with SBP and negatively with WHR, throughout the follow-up. In addition, a higher level of 12 h-overnight urinary norepinephrine independently predicted mid-term PTSD (4-months).

Conclusions: This prospective study shows that peritraumatic psychological and biological markers are independent predictors of PTSD onset with specificities according to the stage of PTSD development; the psychological diathesis, i.e. peritraumatic distress and dissociation, being a better predictor of short-term dysfunction whereas biological diathesis was also predictive of development and maintenance of PTSD.

Keywords: Cortisol; Norepinephrine; PTSD; Peritraumatic reaction; Waist-to-hip-ratio.

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