What risk factors make PTSD symptoms last longer after a traumatic event?
After a traumatic event, some people recover quickly while others have PTSD symptoms that persist for months or years. Research has identified several factors that increase the risk of long-lasting symptoms. The strongest evidence points to being female, having a history of childhood adversity, experiencing an assault (versus an accident), and having severe depression symptoms soon after the trauma.
What the research says
A large individual participant data meta-analysis pooled data from five studies (2,571 participants) and found that female sex was associated with a 48% to 114% higher risk of persistent PTSD and major depressive disorder (MDD) 2. The same analysis showed that people whose index trauma was an accident (versus an assault or other event) had a 34% to 61% lower risk of persistent symptoms 2. Acute MDD symptom severity also predicted persistent PTSD, even after accounting for acute PTSD severity 2.
Early-life adversity, such as adverse childhood experiences (ACEs), appears to have a lasting impact. A cohort study of Lebanese healthcare workers found that while acute stressors (financial hardship, the Beirut blast, COVID-19) were linked to PTSD at 6-7 months, by 2-2.5 years ACEs became the strongest predictor of both full and subthreshold PTSD 5. This suggests that childhood trauma can make adults more vulnerable to long-term PTSD after later traumas.
Other risk factors identified in a 3-month follow-up study of hospitalized COVID-19 patients included female gender, younger age, and lower body mass index 10. A review of PTSD risk factors also highlights that prior trauma, lack of social support, and peritraumatic dissociation (feeling detached during the event) can contribute to chronic PTSD 9.
Genetic factors may also play a role. A large genome-wide study found that PTSD shares genetic risk with other internalizing disorders like anxiety and depression, and that disorder-specific genetic risk involves stress-responsive pathways 6. However, genetic testing is not yet used in routine clinical care to predict PTSD persistence.
What to ask your doctor
- Given my history and the type of trauma I experienced, what is my personal risk for long-lasting PTSD symptoms?
- Should I be screened for depression or other conditions soon after a trauma, since acute depression symptoms can predict persistent PTSD?
- If I have a history of childhood adversity, are there specific treatments or monitoring strategies that might help prevent chronic PTSD?
- What early interventions are available to reduce the chance that my symptoms become long-term?
This question is drawn from common patient questions about Psychiatry and answered using cited medical research. We do not provide individualized advice.