IPD meta-analysis identifies risk factors for persistent PTSD and MDD after trauma

Photo by Justin Morgan / Unsplash

Depression and anxiety Published May 6, 2026 Medically reviewed May 11, 2026 Study authors: Ratanatharathorn Andrew, Bryant Richard A, Kessler Ronald C, Keyes Katherine M, Matsuoka Yutaka, Olf… PubMed ↗ DOI ↗ By Dr. Ji-eun Park, MD · Brain, Mind & Pain

Key Takeaway

Consider that female sex and acute symptom severity are associated with persistent PTSD and MDD after trauma.

This is an individual participant data meta-analysis of five prospective studies involving 2,571 participants from emergency room and critical care unit settings. The review synthesized risk factors for acute (0-60 days) and persistent (122-456 days) posttraumatic stress disorder and major depressive disorder after trauma.

Key findings include that female sex was associated with increased risk for both conditions (OR range: 1.48-2.14). Individuals who experienced an accident versus an assault or other traumatic event were at reduced risk (OR range: 0.39-0.66). For persistent PTSD, acute MDD symptom severity was associated (OR: 1.17; 95% CI: 1.08, 1.27) and remained significant after including acute PTSD symptom severity (OR: 1.14; 95% CI: 1.01, 1.29). Reexperiencing symptoms were also associated (OR: 1.18; 95% CI: 1.02, 1.36).

For persistent MDD, acute PTSD symptom severity was associated (OR: 1.15; 95% CI: 1.03, 1.28), as was acute MDD symptom severity (OR: 1.13; 95% CI: 1.00, 1.26).

The authors note limitations, including that absolute numbers and p-values were not reported for many outcomes. The evidence is observational, so causal conclusions are not supported. Practice relevance was not reported.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJan 2026

PMID42088032

View Original Abstract ↓

BACKGROUND: Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) are common sequelae to trauma. Identifying individuals at risk for persistent symptomology allows for targeted interventions. METHODS: We conducted an individual participant data meta-analysis (IPD-MA) by pooling data from five prospective emergency room and critical care unit studies ( participants = 2571) to examine risk factors for PTSD and MDD. We derived harmonized measures of PTSD and MDD in the acute period (0-60 days) following a traumatic event and in the follow-up persistent period (122-456 days). Multinomial logistic regression was used to estimate associations between seven risk factors for acute and persistent MDD and PTSD. Logistic models examined the association between acute symptoms and persistence of PTSD and MDD. RESULTS: Female sex (odds ratio [OR] range: 1.48-2.14) was associated with increased risk for acute and persistent MDD and PTSD while individuals who experienced an accident versus an assault or other traumatic event as the index trauma were at reduced risk (OR range: 0.39-0.66). Acute MDD symptom severity was associated with persistent PTSD (OR: 1.17; 95% CI: 1.08, 1.27) and remained significant after inclusion of acute PTSD symptom severity (OR: 1.14; 95% CI: 1.01, 1.29). In an analysis of PTSD symptom clusters, reexperiencing symptoms (OR: 1.18; 95% CI: 1.02, 1.36) and MDD symptom severity were associated with persistent PTSD. In models of persistent MDD, acute PTSD symptom severity was associated with persistence (OR: 1.15; 95% CI: 1.03, 1.28), but neither overall symptom severity nor cluster symptom severities were associated with persistence after inclusion of acute MDD symptom severity (OR: 1.13; 95% CI: 1.00, 1.26). CONCLUSION: Early symptoms of MDD and reexperiencing were associated with the persistence of psychopathology indicating that depressive rumination may play a role in the maintenance of MDD and PTSD.