Precise risk factors for PTSD are very difficult to establish. In broad terms they can be divided into two parts. First is exposure to trauma(s), which is the first criterion of PTSD. The second factor is not to do with exposure to trauma, but personal circumstance, aspects of the trauma and the post trauma conditions.
Some factors in the first category that increase risk for PTSD include (The National Institute of Mental Health 2018):
- Living through dangerous events and traumas
- Getting hurt
- Seeing another person hurt, or seeing a dead body
- Childhood trauma
- Feeling horror, helplessness, or extreme fear
Factors in the second category are much more complicated, and as mentioned this category is further divided into personal factors, factors within the trauma and post trauma factors. ( go to summary and list below)
Brewin, Andrews and Valentine (2000) completed a meta-analysis of 14 risk factors for posttraumatic stress disorder in trauma-exposed adults. They examined 77 articles that had a combined sample sizes ranging to over 11,000 people. They established 14 factors. Similarly, Ozer et al., 2003 examined 68 studies in their meta-analysis of predictors of posttraumatic stress disorder and symptoms in adults. They outlined 7 predictors. Di Gangi et al., 2013 completed a systematic review of 54 prospective, longitudinal studies of PTSD published between 1991 and 2013. Inclusion criteria required that all individuals were assessed both before and after an index trauma. They described six categories of pre-trauma predictor variables. Sareen et al., 2014 in their review of the literature listed many of the items listed by others, and included heart rate, as a post risk factor, however this was found in some studies (Zatzick, 2005), but not others (Ehring, 2008).
Unfortunately, it is not as simple as “here is the list of risk factors”. Outlined below are three studies, and the risk factors they list. However, it is important to consider how strong these predictors are. Brewin et al., 2000 found that factors such as gender, age at trauma, and race predicted PTSD in some populations but not in others. In addition, they found that education, previous trauma, and general childhood adversity predicted PTSD more consistently, but this varied depending on the population and study type. Other factors such as psychiatric history, reported childhood abuse, and family psychiatric history had more consistent predictive effects. The strongest group of predictive factors were those that were operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress.
Similarly, Ozer et al., 2003 reported that the strongest predictor in their study was peritraumatic dissociation, however as a predictor its effect size was only moderate. They also described that, peritraumatic emotional response was the second strongest predictor in their study. DiGangi et al., 2013 suggested that their results indicated that many variables, previously considered outcomes of trauma, are pre-trauma risk factors.
Summary
Some of the significant factors seem to be lack of social support, prior trauma and pre-existing mental health problems. Reactions during the trauma, coping responses and severity of trauma also appear as factors, and probably interact with each other.
Risk factors from three studies
| Brewin et al., (2000) | Ozer et al., (2003) | DiGangi et al. (2013) |
| 1. Other previous trauma |
2. Psychiatric history
3. Family psychiatric history
4. Lack of social support
5. Trauma severity
6. Low intelligence
7. Gender (female)
8. Younger age
9. Low SES
10. Lack of education
11. Race (minority status)
12. Childhood abuse
13. Other adverse childhood experiences
14. Life stress1. Prior trauma
2. Prior psychological adjustment
3. Family history of psychopathology
4. Posttrauma social support
5. Perceived life threat during the trauma
6. Peritraumatic emotional responses (fear, helplessness, horror, guilt, and shame)
7. Peritraumatic dissociation1. Psychopathology
2. Social ecological factors
3. Cognitive abilities
4. Coping and response styles
5. Personality factors
6. Psychophysiological factors
And Food for thought…
Hansen, et. al. (2014) found that the strongest common risk factor for post bank robbery victims developing ASD and PTSD was negative cognitions about self.
References
Brewin, C. R., Andrews, B., & Valentine, J. D. (2000). Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. Journal of Consulting and Clinical Psychology, 68(5), 748-766. doi:10.1037/0022-006X.68.5.748
DiGangi, J. A., Gomez, D., Mendoza, L., Jason, L. A., Keys, C. B., & Koenen, K. C. (2013). Pretrauma risk factors for posttraumatic stress disorder: A systematic review of the literature. Clinical Psychology Review, 33(6), 728-744. doi:https://doi.org/10.1016/j.cpr.2013.05.002
Ehring, T., Ehlers, A., Cleare, A. J., & Glucksman, E. (2008). Do acute psychological and psychobiological responses to trauma predict subsequent symptom severities of PTSD and depression? Psychiatry Research, 161(1), 67-75. doi:https://doi.org/10.1016/j.psychres.2007.08.014
Hansen, M., Armour, C., Wittmann, L., Elklit, A., & Shevlin, M. (2014). Is there a common pathway to developing ASD and PTSD symptoms? Journal of Anxiety Disorders, 28(8), 865-872. doi:https://doi.org/10.1016/j.janxdis.2014.09.019
National Institute of Mental Health (2016). Post-Traumatic Stress Disorder. Retrieved March 25, 2018, from https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml
Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: A meta-analysis. Psychological Bulletin, 129(1), 52-73. doi:10.1037/0033-2909.129.1.52
Sareen, J. (2014). Posttraumatic Stress Disorder in Adults: Impact, Comorbidity, Risk Factors, and Treatment. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 59(9), 460-467.
Zatzick, D. F., Russo, J., Pitman, R. K., Rivara, F., Jurkovich, G., & Roy-Byrne, P. (2005). Reevaluating the association between emergency department heart rate and the development of posttraumatic stress disorder: A public health approach. Biological Psychiatry, 57(1), 91-95. doi:https://doi.org/10.1016/j.biopsych.2004.10.005
