Frequently Asked Questions

Initial PTSD status across the baseline and 1-month assessments was the strongest predictor of PTSD from 6 to 24 months. In the base model, youth with PTSD at 1 of the 2 initial assessments had 4 to 8 times the odds of later PTSD, including OR = 8.12 (95% CI, 5.40–12.23) at 6 months, while youth with PTSD at both initial assessments had 16 to 21 times the odds, including OR = 21.12 (95% CI, 13.85–32.23) at 6 months. The baseline model explained 8.4% of the variance in later PTSD, and the authors found that other baseline factors added only modest prognostic value beyond this repeated early diagnostic status.

Later PTSD was uncommon when youth were negative for PTSD at both baseline and 1 month. Among the 1,187 youth without PTSD at both initial assessments, subsequent PTSD prevalence was only 2.6% to 4.2% across follow-up. The authors concluded that the absence of PTSD across 2 early assessments may help identify a low-risk group for routine monitoring in trauma-referred settings.

PTSD prevalence declined early and then remained relatively stable after 6 months. Overall prevalence fell from 25.9% at baseline to 19.9% at 1 month and 13.3% at 6 months, then stayed between 9.6% and 13.0% through 24 months. The study visit term was not significant in the base model for youth without initial PTSD, which was consistent with the descriptive finding that prevalence changed little after 6 months.

Yes. A baseline anxiety or depressive disorder was associated with higher odds of PTSD from 6 to 24 months even after accounting for initial PTSD status. In the clinical characteristics model, the anxiety/depression composite was associated with later PTSD with OR = 2.15 (95% CI, 1.55–2.99). By contrast, the disruptive behavior/substance use composite was not a significant predictor in that model.

Intentional trauma predicted higher odds of later PTSD, whereas unintentional trauma and witnessed intentional trauma did not in these models. In Model 2a, intentional trauma was associated with later PTSD with OR = 2.53 (95% CI, 1.77–3.61). Trauma occurring 12 or more months before baseline also predicted higher odds of later PTSD, with OR = 1.91 (95% CI, 1.05–3.46).

When the authors used trauma categories paired with subjective distress during the event, the results were nearly the same. Intentional trauma with distress during the event predicted later PTSD with OR = 2.51 (95% CI, 1.77–3.56), while unintentional and witnessed intentional trauma with distress did not.

Higher perceived social support was protective for children and adolescents aged 8 to 17 years, but not for young adults aged 18 to 20 years. In the social-context model, the interaction between form type and perceived social support was significant (OR = 1.41, 95% CI, 1.05–1.88), indicating that the association differed by age group. For youth aged 8 to 17 years, higher support predicted lower odds of later PTSD (OR = 0.58, 95% CI, 0.39–0.88), whereas for ages 18 to 20 years it was not significant (OR = 0.80, 95% CI, 0.52–1.23).

Yes. Older age and female sex were associated with higher odds of PTSD from 6 to 24 months after accounting for initial PTSD status. Compared with children aged 8 to 12 years, adolescents aged 13 to 17 years had OR = 1.78 (95% CI, 1.31–2.41) and youth aged 18 to 20 years had OR = 2.71 (95% CI, 1.65–4.46). Female sex was also associated with higher risk, with OR = 1.78 (95% CI, 1.31–2.41). Race and ethnicity were not significant predictors in the demographic model.

Current psychiatric care and, more modestly, past psychiatric care were associated with higher odds of later PTSD. In the clinical characteristics model, current psychiatric care was associated with later PTSD with OR = 1.72 (95% CI, 1.29–2.28), and past psychiatric care was modestly associated with OR = 1.33 (95% CI, 1.00–1.77). The authors reported that these variables explained only a small additional amount of variance after initial PTSD status was already included.

This was a 2-year prospective longitudinal study of 1,728 trauma-exposed youth aged 8 to 20 years who completed at least 1 follow-up assessment. Participants were drawn from a statewide multisite Texas registry and were assessed with structured diagnostic interviews at baseline and again at 1, 6, 12, 18, and 24 months. Because the cohort included youth with and without PTSD and enrollment occurred at varying times since trauma, the findings are most directly relevant to prognosis after clinical evaluation in trauma-referred settings rather than to the full natural history of very early PTSD onset immediately after trauma.

The main limitations are attrition, recruitment from academic medical centers, limited information about very early posttrauma onset, reliance on youth report, and lack of detailed treatment data. Of 2,475 eligible youth, 1,728 (69.8%) had at least 1 follow-up and were included in analyses, so dropout could have biased estimates if it was related to symptom trajectory. The authors also noted that most participants enrolled more than 1 month after trauma, which limits conclusions about very early onset; treatment involvement was recorded, but receipt of specific trauma-focused psychotherapies was not; and measures relied on youth interview or self-report without collateral informant data.