The developmental mental-disorder histories of adults with posttraumatic stress disorder: a prospective longitudinal birth cohort study

Abstract

Clinical and epidemiologic studies have established that posttraumatic stress disorder (PTSD) is highly comorbid with other mental disorders. However, such studies have largely relied on adults' retrospective reports to ascertain comorbidity. The authors examined the developmental mental health histories of adults with PTSD using data on mental disorders assessed across the first 3 decades of life among members of the longitudinal Dunedin Multidisciplinary Health and Development Study; 100% of those diagnosed with past-year PTSD and 93.5% of those with lifetime PTSD at age 26 had met criteria for another mental disorder between ages 11 and 21. Most other mental disorders had first onsets by age 15. Of new cases of PTSD arising between ages 26 and 32, 96% had a prior mental disorder and 77% had been diagnosed by age 15. These data suggest PTSD almost always develops in the context of other mental disorders. Research on the etiology of PTSD may benefit from taking lifetime developmental patterns of comorbidity into consideration. Juvenile mental-disorder histories may help indicate which individuals are most likely to develop PTSD in populations at high risk of trauma exposure.

Figure 1

Prevalence (percentages) of first diagnosis of psychiatric disorders at ages 11 to 15 among those assessed for posttraumatic stress disorder at age 26. Asterisk indicates p < .05 based on the statistical significance of the adjusted odds ratio of the association between lifetime posttraumatic stress disorder (PTSD) diagnosis among the trauma exposed at 26 years of age and disorders at 11 to 15 years of age; ^indicates p < .05 based on the statistical significance of the adjusted odds ratio of the association between current PTSD at 26 years of age and disorders at 11 to 15 years of age. Trauma, no PTSD = reference group for all analyses; ADHD = attention-deficit/hyperactivity disorder.

Figure 2

Prevalence (percentages) of first diagnosis of psychiatric disorders at ages 11 to 15 among cases of posttraumatic stress disorder (PTSD) with first onset between 26 and 32. Asterisk indicates p < .05 based on the statistical significance of the adjusted odds ratio of the association between new PTSD diagnosis and disorders at 11 to 15 years of age. Participants who experienced a trauma between 26 and 32 years of age and never met diagnostic criteria for PTSD comprise the reference group for the analysis. Trauma, no PTSD = reference group for all analyses; ADHD = attention-deficit/hyperactivity disorder.