Abstract
Objective: Most youth recover after traumatic events, but some develop chronic posttraumatic stress disorder (PTSD). This study examined predictors of PTSD in a large, diverse cohort of trauma-exposed youth followed prospectively for 2 years.
Methods: Participants were 1,728 trauma-exposed youth (ages 8–20 years; 60% female) enrolled between 2020 and 2025 in the Texas Childhood Trauma Research Network. Diagnosis of PTSD was determined using the Clinician-Administered PTSD Scale for DSM-5, Child/Adolescent Version administered at baseline, 1, 6, 12, 18, and 24 months. Baseline and 1-month PTSD were combined to account for cases in which PTSD could not be diagnosed because assessments occurred within 30 days of trauma exposure. Additional baseline predictors included clinical, trauma-related, social, and demographic factors. Generalized estimating equations modeled PTSD diagnosis and symptoms from 6 to 24 months.
Results: The prevalence of PTSD declined from 26% at baseline to 13% at 6 months, then stabilized, with few new diagnoses during prospective follow-up among youth without PTSD at baseline or 1 month (<5%). Diagnostic status at baseline or 1 month was the strongest predictor of subsequent diagnosis. Several other factors showed smaller but statistically significant associations, including anxiety or depression, psychiatric care history, intentional trauma, trauma ≥12 months before baseline, female sex, and older age. Race, ethnicity, and bullying were not significant predictors, while social support showed a small association only for children and adolescents.
Conclusion: Diagnostic status at baseline and 1-month follow-up distinguished higher-and lower-risk trajectories for PTSD over 2 years, even among those with severe or temporally distant trauma.
J Clin Psychiatry 2026;87(3):26m16318
Author affiliations are listed at the end of this article.
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