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.

Automated summary

The COVID-19 pandemic provides an unprecedented opportunity to study the trajectories of PTSD symptoms during prolonged social disruption and stress. A longitudinal study tracking trauma-exposed individuals in the US found four distinct trajectories of PTSD symptoms: resilient, recurring, recovering, and chronic. Early pandemic experiences, including emotional and physical health problems and positive changes, were significant predictors of trajectory membership, particularly distinguishing the resilient trajectory from the others. These findings highlight the need for targeted interventions to support individuals at higher risk for ongoing distress during the pandemic.