Category: PTSD

Symposium

Depression Profiles and Their Trajectory Across PTSD Treatment

Friday, November 17
3:30 PM - 5:00 PM
Location: Sapphire Ballroom B, Level 4, Sapphire Level

Keywords: Depression | PTSD Posttraumatic Stress Disorder | Prolonged Exposure
Presentation Type: Symposium

Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD commonly co-occur (Rytwinski et al., 2013). It is highly unlikely that this association universally reflects true comorbidity, that is, separate etiologic entities underlying the respective symptoms and may instead be a marker of severity (e.g., Au et al., 2013; Zoellner et al., 2014).  Depression consistently improves with PTSD treatment (Ronconi et al., 2015), though less is known about varying depression profiles.  In this study of 200 men and women with PTSD, we examined pre-treatment latent associations between PTSD and depression symptoms and how these profiles related to change over the course of 10-week treatment using prolonged exposure (PE) or sertraline.  At pre-treatment, a three-class LPA model best fit the data, with a general pattern of high (43%), moderate (25%), and low severity (32%), with the high and low classes differing across negative affect, rumination, and lack of positive affect (ps < .05).  The slope of PTSD symptom change from pre- to post-treatment was larger for the high severity compared to the low severity class, F = 6.09, p = .048, despite a lower likelihood of being PTSD diagnosis free at post-treatment, χ2 (2, N = 155) = 12.5, p = .002.  Related, the majority of the high severity class transitioned to a responder class (62%) with slightly lower rates compared to the rest of the sample (75%), χ2 (1, N = 200) = 3.56, p = .06, and no moderation effect for treatment type, χ2 (1, N = 200) = 4.1, ns.  Class membership was not related to the presence of MDD at 24-month follow-up nor was it related to a relapse in MDD at that time.  This study adds to the growing literature pointing to the presence of both PTSD and depression as a marker of severity (e.g., Contractor et al., 2015) and pointing to the nuanced perspective that, despite making more gains than others, these individuals have further to go to be diagnosis free.  It remains unclear whether individuals with both severe PTSD and depression may be more vulnerable to longer-term reoccurrence of PTSD or depression, though this evidence argues against the hypothesis.  

Lori A. Zoellner

Professor
University of Washington

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