Early-life adversities predict PTSD in Lebanese healthcare workers after acute stressors
Photo by Abdulai Sayni / Unsplash
Key Takeaway
Note that early-life adversities become the strongest PTSD predictor over time in this cohort.
This cohort study included 296 healthcare workers from Saint George Hospital University Medical Center in Lebanon. Participants were assessed regarding exposure to acute stressors, including financial hardship, the Beirut Blast, and COVID-19, as well as early-life adversities (adverse childhood experiences or ACEs). The primary outcome was the development of full and subthreshold PTSD.
At 6 to 7 months post-Blast, acute stressors were significantly associated with PTSD across most definitions. However, the study did not report specific absolute numbers, effect sizes, or p-values for these associations. Safety data, adverse events, and discontinuations were not reported in the available evidence.
By 2 to 2.5 years after the event, the impact of acute stressors on PTSD diminished. During this later follow-up period, early-life adversities became the strongest and most consistent predictor of PTSD development. The study did not report specific statistical measures for this shift in predictive strength.
Key limitations include the lack of reported absolute numbers, effect sizes, and p-values, which restricts the precision of the quantitative findings. Additionally, safety and tolerability data were not reported. The study design is observational; therefore, causal language regarding the relationship between exposures and outcomes is not supported by the data. The practice relevance highlights the importance of including developmental trauma histories in PTSD assessments for this population.
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View Original Abstract ↓
PurposeIn recent years, healthcare workers (HCWs) in Lebanon have encountered compounded traumatic exposures, including the Beirut Port blast, COVID-19, and an ongoing economic crisis, often preceded by early-life adversities such as adverse childhood experiences (ACEs). Understanding how these acute stressors interact with early adversities is crucial for assessing their long-term psychological impact. Accordingly, this study examines the extent to which these combined factors predict the development of full and subthreshold posttraumatic stress disorder (PTSD) over time.MethodsA cohort study was conducted following 296 HCWs from Saint George Hospital University Medical Center, with assessments at two timepoints: 6–7 months and 2–2.5 years after the Beirut Blast. PTSD symptoms were measured using the PCL-5, applying both full-threshold criteria and six definitions of subthreshold PTSD. Bivariable and multivariable analysis were conducted.ResultsAt 6–7 months, acute stressors (financial hardship, Beirut Blast, and COVID-19) were significantly associated with PTSD across most definitions. However, by 2–2.5 years, ACEs became the strongest and most consistent predictor of both full-threshold and subthreshold PTSD, while the impact of acute stressors diminished.ConclusionThe impact of acute trauma on the risk of PTSD fades over time, while early-life adversity has an enduring impact. The findings highlight the importance of including developmental trauma histories in PTSD assessments. In concordance with stress sensitization and neurobiological models, the results indicate a marked temporal shift, where the diminishing effects of acute stressors give way to the enduring role of early life adversity in shaping PTSD symptom trajectories.
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