PROSPECTIVE-STUDY OF POSTTRAUMATIC-STRESS-DISORDER AND DEPRESSION FOLLOWING TRAUMA

Objective: The purpose of this study was to prospectively evaluate the onset, overlap, and course of posttraumatic stress disorder (PTSD) an d major depression following traumatic events. Method: The occurrence of PTSD and major depression and the intensity of related symptoms wer e assessed in 211 trauma survivors recruited from a general hospital's emergency room. Psychometrics and structured clinical interview (the Structured Clinical Interview, for DSM-III-R and the Clinician-Adminis tered PTSD Scale) were administered 1 week, 1 month, and 4 months afte r the traumatic event. Heart rate was assessed upon arrival at the eme rgency room for subjects with minor physical injury. Twenty-three subj ects with PTSD and 35 matched comparison subjects were followed for 1 year. Results: Major depression and PTSD occurred early on after traum a; patients with these diagnoses had similar recovery rates: 63 surviv ors (29.9%) met criteria for PTSD at 1 month, and 37 (17.5%) had PTSD at 4 months. Forty subjects (19.0%) met criteria for major depression at 1 month, and 30 (14.2%) had major depression at 4 months. Comorbid depression occurred in 44.5% of PTSD patients at 1 month and in 43.2% at 4 months. Comorbidity was associated with greater symptom severity and lower levels of functioning. Survivors with PTSD had higher heart rate levels at the emergency room and reported more intrusive symptoms , exaggerated startle, and peri-traumatic dissociation than those with major depression. Prior depression was associated with a higher preva lence of major depression and with more reported symptoms. Conclusions : Major depression and PTSD are independent sequelae of traumatic even ts, have similar prognoses, and interact to increase distress and dysf unction. Both should be targeted by early treatment interventions and by neurobiological research.