Mental Health History Increases PTSD Risk

Individuals undergoing mental health treatment prior to exposure to a traumatic event are twice as likely to experience post traumatic stress disorder (PTSD) within 12 months.

In a study funded by National Institutes of Health (NIH) and the Pennsylvania Department of Health, Geisinger Center for Health Research senior investigator Joseph Boscarino, PhD, MPH examined risk factors for poor health outcomes immediately following the traumatic event and two years later in more than 2,000 adult victims of the World Trade Center disaster. This study was published in the December, 2008 issue of the International Journal of Emergency Mental Health.

Low self esteem, negative life events and lack of a support network greatly increase the likelihood of PTSD, the study showed.

Those most resilient to mental health problems following this traumatic event were male, older, with higher self esteem and a strong support network. Generally these individuals had no history of mental health issues prior to the traumatic event and less exposure to long-term and short-term trauma and stress. While the intensity of trauma was a significant PTSD risk factor during the first 12 months post exposure, at a two-year check it appeared no longer significant.

PTSD can set in immediately or months after a traumatic event. According to Dr. Boscarino, the condition often occurs when someone has experienced a life threatening event that evokes fear or a feeling of helplessness. Symptoms of the condition can include anxiety, flashbacks and an emotional numbness.

Consistent with earlier findings, the study suggests that brief psychological interventions immediately following the event can prevent long term mental health issues. Also effective is informal support from families, friends and spiritual communities. Interestingly, extensive psychological therapy appears to delay recovery.

“This study is likely to fuel debate about how best to treat PTSD and whether conventional post-disaster treatments are warranted and for whom,” noted Dr. Boscarino.

While PTSD symptoms immediately following a traumatic event appear more commonly in younger persons, women, those with low self esteem, and those with a history of depression, delayed PTSD is more common among Hispanics non-native born persons, females, those with low self esteem and/or exposed to negative life events. In general, African Americans were found to have a lower incidence of PTSD.

In addition, the study suggests that following a traumatic event the risk of problem drinking and alcohol abuse is also commonly associated with a history of mental health issues.

Dr. Boscarino’s research at Geisinger is currently examining both the risk and protective factors for PTSD, as well as optimal treatments for this condition, including a better understanding of the genetic basis of this disorder. “Armed with genetic information,” Dr. Boscarino noted, “we hope someday we can identify those at the highest risk, as well as which treatments would be the most effective.