Roberson III, Richard B (2015-08). Resilience Following Trauma: Evidence from a Level 1 Trauma Center. Doctoral Dissertation.
The purpose of this study was to examine longitudinally the trajectories of depression and post-traumatic stress disorder (PTSD) in individuals who survived a potentially traumatic event (PTE) and were admitted to a Level 1 trauma center and explore covariate prediction of classes using mild traumatic brain injury (TBI) status, demographic, and health related quality of life variables. Data were analyzed using latent growth mixture modeling. Participants consists of patients consecutively admitted to a Level 1 trauma center that were approached to complete assessments while hospitalized and then at three, six and 12 months post-discharge. The Patient Health Questionnaire-8 (PHQ-8) and the Primary Care Posttraumatic Stress Disorder Screen (PC-PTSD) were used in the present study to identify the classes of adjustment. The sample (n = 406) was predominantly male, European-American, and high school or less educated. The results indicated that a five-class model was the best fit for the depression data, which included a resilient, a delayed, a recovering, a chronic, and a chronic-worsening class. A three-class model was the best fit for the PTSD data, which included a resilient, a chronic, and a stable, moderately distressed class. Lower pain interference and greater psychological well-being while hospitalized was associated with significantly decreased odds of being in a non-resilient class compared to the resilient class. The resilient class reported the fewest symptoms of depression and PTSD and reported the lowest levels of pain interference and greater psychological well-being than the other classes. In conclusion, a five-class model of depression and a three-class model of PTSD best described the data. The results indicate that most survivors following a PTE experienced minor and transient symptoms of depression and PTSD (i.e., resiliency). This pattern provides additional evidence that resiliency may be the most likely outcome following a PTE. In addition, greater psychological well-being and less pain interference soon after a trauma may be protective factors against the development of depression and PTSD following a PTE. Mild TBI, cause of injury, education, or gender did not predict class membership. Despite surviving a PTE, a large percentage of the sample reported low levels of distress. Clinical and research implications of the results are offered.