Alegre, Alyssa Joyce; (2024) Identifying trajectories of Post-Traumatic Stress Disorder symptom change during Cognitive Behavioural Therapy and examining their associations with sociodemographic characteristics. Doctoral thesis (D.Clin.Psy), UCL (University College London).

Text Alyssa Joyce_Alegre_Thesis_final_volume1_Alegre.pdf - Submitted Version Access restricted to UCL open access staff until 1 November 2026. Download (1MB)

Abstract

Background: Most people are exposed to some form of traumatic event across their lifetime. Yet despite this, not everyone goes on to develop post-traumatic stress disorder (PTSD). Identifying trajectories of post-traumatic stress (PTS) symptom severity following traumatic events, and the characteristics associated with these different responses might help inform interventions to support poor prognoses. Aims: This systematic review had three key aims: (1) to identify differential symptom trajectories of PTS following a traumatic event in the literature; (2) to estimate the prevalence of these trajectories; and (3) to assess factors that may be associated with the identified trajectories. Methods: A systematic search of electronic literature bases (PsycInfo, EMBASE, Medline, PTSDPubs, Web of Science) was conducted in November 2023 to identify studies which used growth modelling approaches to assess symptoms of PTS following a traumatic event. A random effects meta-analysis of proportions, and meta-regressions were conducted to estimate the prevalence of these trajectories and their associated predictors. Results: 51 studies met the inclusion criteria for this review. The most consistently observed trajectory following a traumatic event was Resilient (70%[95%CI=0.64; 0.75]); followed by Improving (22%[95%CI=0.15; 0.31]); Deteriorating (9.3%[95%CI=0.07; 0.12]) and Chronic (9.3%[95%CI=0.073; 0.11]). Additional trajectories were also found, including 10 trajectories which could be classed as ‘Persistent’ and 7 ‘Other’ trajectories which were uncommon in the literature. Country of study was a significant predictor of the Resilient and Improving trajectory; mean sample age was a significant predictor of Chronic trajectories; and Type of Modelling technique a significant predictor of the Deteriorating trajectory. Conclusions: Overall, most people tend to follow a resilient trajectory following a traumatic event, indicated by consistently low PTS symptoms. However, a smaller proportion of people will experience chronic or deteriorating symptoms. It may be helpful for services to be mindful of these different trajectories when assessing PTS reactions, and to consider earlier prevention to reduce the risk of those falling into the chronic or deteriorating trajectories.

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