The Role of Injury and Trauma-Related Variables in the Onset and Course of Symptoms of Posttraumatic Stress Disorder

  • Marit Sijbrandij
  • Iris M. Engelhard
  • Giel-Jan de Vries
  • Jan S. K. Luitse
  • Ingrid V. E. Carlier
  • Berthold P. R. Gersons
  • Miranda Olff


Posttraumatic stress disorder (PTSD) affects a minority of trauma-exposed persons and is associated with significant impairment. This longitudinal study examined risk factors for PTSD. We tested whether the presence of injuries resulting from trauma exposure predicted the course of PTSD symptoms. In addition, we tested whether gender, trauma type, perceived life threat, and peritraumatic dissociation predicted the onset of PTSD symptoms. 236 trauma-exposed civilians were assessed for PTSD symptoms with a structured interview at four occasions during 6 months posttrauma. Path analysis showed that a model in which the female gender, assault, perceived life threat, and peritraumatic dissociation predicted PTSD severity at 1 week, and injury predicted PTSD severity 8 weeks after the traumatic event showed the best fit. However, a similar model without injury showed comparable fit. It is concluded that injuries have a negligible effect on the course of PTSD.


Stress disorders Post-traumatic Acute reactions Risk factors Path analysis 



This study was supported by the Netherlands Organization for Health Research and Development (ZonMw), Grant no. 22000008 and Achmea Aid to Victims.

Conflict of interest

None declared.


  1. Andersen, T. E., Elklit, A., & Vase, L. (2011). The relationship between chronic whiplash-associated disorder and post-traumatic stress: Attachment-anxiety may be a vulnerability factor. European Journal of Psychotraumatology, 2.Google Scholar
  2. Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Archives of General Psychiatry, 55, 626–632.PubMedCrossRefGoogle Scholar
  3. Carlier, I. V., Lamberts, R. D., Van Uchelen, A. J., & Gersons, B. P. (1998). Clinical utility of a brief diagnostic test for posttraumatic stress disorder. Psychosomatic Medicine, 60, 42–47.PubMedGoogle Scholar
  4. Carty, J., O’Donnell, M., Evans, L., & Creamer, M. (2011). Predicting posttraumatic stress disorder symptoms and pain intensity following severe injury: The role of catastrophizing. European Journal of Psychotraumatology, 2. Doi:  10.3402/ejpt.v2i0.5652.
  5. Davidson, J. R., Malik, M. A., & Travers, J. (1997). Structured interview for PTSD (SIP): Psychometric validation for DSM-IV criteria. Depress Anxiety, 5, 127–129.PubMedCrossRefGoogle Scholar
  6. Ehlers, A., Mayou, R. A., & Bryant, B. (1998). Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Journal of Abnormal Psychology, 107, 508–519.PubMedCrossRefGoogle Scholar
  7. Engelhard, I. M., van Riji, M., Boullart, I., Ekhart, T. H., Spaanderman, M. E., van den Hout, M. A., et al. (2002). Posttraumatic stress disorder after pre-eclampsia: An exploratory study. General Hospital Psychiatry, 24, 260–264.PubMedCrossRefGoogle Scholar
  8. Engelhard, I. M., van den Hout, M. A., & Lommen, M. J. J. (2009). Individuals high in neuroticism are not more reactive to adverse events. Personality and Individual Differences, 47, 697–700.CrossRefGoogle Scholar
  9. Engelhard, I. M., van den Hout, M. A., & McNally, R. J. (2008). Memory consistency for traumatic events in Dutch soldiers deployed to Iraq. Memory, 16, 3–9.PubMedCrossRefGoogle Scholar
  10. Engelhard, I. M., van den Hout, M. A., & Schouten, E. G. (2006). Neuroticism and low educational level predict the risk of posttraumatic stress disorder in women after miscarriage or stillbirth. General Hospital Psychiatry, 28, 414–417.PubMedCrossRefGoogle Scholar
  11. Gabert-Quillen, C. A., Fallon, W., & Delahanty, D. L. (2011). PTSD after traumatic injury: An investigation of the impact of injury severity and peritraumatic moderators. Journal of Health Psychology, 16, 678–687.PubMedCrossRefGoogle Scholar
  12. Haagsma, J. A., Polinder, S., Olff, M., Toet, H., Bonsel, G. J., & van Beeck, E. F. (2012). Posttraumatic stress symptoms and health-related quality of life: A two-year follow-up study of injury treated at the emergency department. BMC Psychiatry, 12, 1.PubMedCrossRefGoogle Scholar
  13. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  14. Joy, D., Probert, R., Bisson, J. I., & Shepherd, J. P. (2000). Posttraumatic stress reactions after injury. Journal of Trauma, 48, 490–494.PubMedCrossRefGoogle Scholar
  15. Koren, D., Norman, D., Cohen, A., Berman, J., & Klein, E. M. (2005). Increased PTSD risk with combat-related injury: A matched comparison study of injured and uninjured soldiers experiencing the same combat events. American Journal of Psychiatry, 162, 276–282.PubMedCrossRefGoogle Scholar
  16. Marmar, C. R., Metzler, T. J., & Otte, C. (2004). The peritraumatic dissociative experiences questionnaire. In J.P.Wilson & T. M. Keane (Eds.), Assessing psychological trauma and PTSD (pp. 144–167). New York: Guildford Press.Google Scholar
  17. Marmar, C. R., Weiss, D. S., Metzler, T. J., & Delucchi, K. (1996). Characteristics of emergency services personnel related to peritraumatic dissociation during critical incident exposure. American Journal of Psychiatry, 153, 94–102.PubMedGoogle Scholar
  18. Michaels, A. J., Michaels, C. E., Zimmerman, M. A., Smith, J. S., Moon, C. H., & Peterson, C. (1999). Posttraumatic stress disorder in injured adults: Etiology by path analysis. Journal of Trauma, 47, 867–873.PubMedCrossRefGoogle Scholar
  19. Murray, J., Ehlers, A., & Mayou, R. A. (2002). Dissociation and post-traumatic stress disorder: Two prospective studies of road traffic accident survivors. British Journal of Psychiatry, 180, 363–368.PubMedCrossRefGoogle Scholar
  20. O’Donnell, M. L., Creamer, M., Bryant, R. A., Schnyder, U., & Shalev, A. (2003). Posttraumatic disorders following injury: An empirical and methodological review. Clinical Psychology Review, 23, 587–603.PubMedCrossRefGoogle Scholar
  21. O’Donnell, M. L., Elliott, P., Lau, W., & Creamer, M. (2006). PTSD symptom trajectories: From early to chronic response. Behaviour Research and Therapy, 45(3), 601–606.PubMedCrossRefGoogle Scholar
  22. Olff, M., Langeland, W., Draijer, N., & Gersons, B. P. (2007). Gender differences in posttraumatic stress disorder. Psychological Bulletin, 133, 183–204.PubMedCrossRefGoogle Scholar
  23. Panasetis, P., & Bryant, R. A. (2003). Peritraumatic versus persistent dissociation in acute stress disorder. Journal of Trauma Stress, 16, 563–566.CrossRefGoogle Scholar
  24. Rasmussen, A., Rosenfeld, B., Reeves, K., & Keller, A. S. (2007). The effects of torture-related injuries on long-term psychological distress in a Punjabi Sikh sample. Journal of Abnormal Psychology, 116, 734–740.PubMedCrossRefGoogle Scholar
  25. Roca, R. P., Spence, R. J., & Munster, A. M. (1992). Posttraumatic adaptation and distress among adult burn survivors. American Journal of Psychiatry, 149, 1234–1238.PubMedGoogle Scholar
  26. Schnyder, U., Moergeli, H., Klaghofer, R., & Buddeberg, C. (2001). Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. American Journal of Psychiatry, 158, 594–599.PubMedCrossRefGoogle Scholar
  27. Sijbrandij, M., Engelhard, I. M., Opmeer, B. C., van de, S. R., Carlier, I. V., Gersons, B. P., et al. (2012). The structure of peritraumatic dissociation: A cross validation in clinical and nonclinical samples. Journal of Trauma Stress, 25, 475–479.CrossRefGoogle Scholar
  28. Sijbrandij, M., Olff, M., Reitsma, J. B., Carlier, I. V., & Gersons, B. P. (2006). Emotional or educational debriefing after psychological trauma. Randomised controlled trial. British Journal of Psychiatry, 189, 150–155.PubMedCrossRefGoogle Scholar
  29. Stein, M. B., McQuaid, J. R., Pedrelli, P., Lenox, R., & McCahill, M. E. (2000). Posttraumatic stress disorder in the primary care medical setting. General Hospital Psychiatry, 22, 261–269.PubMedCrossRefGoogle Scholar
  30. Tedstone, J. E., & Tarrier, N. (2003). Posttraumatic stress disorder following medical illness and treatment. Clinical Psychology Review, 23, 409–448.PubMedCrossRefGoogle Scholar
  31. Udwin, O., Boyle, S., Yule, W., Bolton, D., & O’Ryan, D. (2000). Risk factors for long-term psychological effects of a disaster experienced in adolescence: Predictors of post traumatic stress disorder. Journal of Child Psychology and Psychiatry, 41, 969–979.PubMedCrossRefGoogle Scholar
  32. Van Loey, N. E., Maas, C. J., Faber, A. W., & Taal, L. A. (2003). Predictors of chronic posttraumatic stress symptoms following burn injury: Results of a longitudinal study. Journal of Trauma Stress, 16, 361–369.CrossRefGoogle Scholar
  33. van den Hout, M. A., & Engelhard, I. M. (2004). Pretrauma neuroticism, negative appraisals of intrusions, and severity of PTSD symptoms. Journal of Psychopathology and Behavioral Assessment, 26, 181–183.Google Scholar
  34. Walker, E. A., Katon, W., Russo, J., Ciechanowski, P., Newman, E., & Wagner, A. W. (2003). Health care costs associated with posttraumatic stress disorder symptoms in women. Archives of General Psychiatry, 60, 369–374.PubMedCrossRefGoogle Scholar
  35. Zatzick, D. (2003). Posttraumatic stress, functional impairment, and service utilization after injury: A public health approach. Seminars in clinical neuropsychiatry, 8, 149–157.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Marit Sijbrandij
    • 1
    • 2
    • 3
  • Iris M. Engelhard
    • 3
  • Giel-Jan de Vries
    • 4
  • Jan S. K. Luitse
    • 5
  • Ingrid V. E. Carlier
    • 6
  • Berthold P. R. Gersons
    • 4
  • Miranda Olff
    • 4
  1. 1.Department of Clinical PsychologyVU University AmsterdamAmsterdamThe Netherlands
  2. 2.EMGO Institute for Health and Care ResearchAmsterdamThe Netherlands
  3. 3.Department of Clinical and Health PsychologyUtrecht UniversityUtrechtThe Netherlands
  4. 4.Department of PsychiatryAcademic Medical Centre of the University of AmsterdamAmsterdamThe Netherlands
  5. 5.Department of Trauma SurgeryAcademic Medical Centre of the University of AmsterdamAmsterdamThe Netherlands
  6. 6.Department of PsychiatryLeiden University Medical CentreLeidenThe Netherlands

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