Use of serial smartphone-based assessments to characterize diverse neuropsychiatric symptom trajectories in a large trauma survivor cohort

• Type of Material: Article
• Authors: Kerry Ressler, Emory University; Francesca L Beaudoin, Brown University; Xinming An, University of North Carolina at Chapel Hill; Archana Basu, Harvard University; Yinyao Ji, University of North Carolina at Chapel Hill; Mochuan Liu, University of North Carolina at Chapel Hill; Ronald C Kessler, Harvard Medical School; Robert F Doughtery, Mindstrong Health; Donglin Zeng, University of North Carolina at Chapel Hill; Kenneth A Bollen, University of North Carolina at Chapel Hill; Stacey L House, Washington University; Jennifer Stevens, Emory University; Thomas C Neylan, University of California San Francisco; Gari Clifford, Emory University; Tanja Jovanovic, Emory University; Sarah D Linnstaedt, University of North Carolina at Chapel Hill; Laura T Germine, McLean Hospital, Belmont; Scott L Rauch, McLean Hospital, Belmont; John P Haran, University of Massachusetts; Alan B Storrow, Vanderbilt University; Christopher Lewandowski, Henry Ford Health System, Detroit; Paul I Musey Jr, Indiana University School of Medicine; Pyhllis L Hendry, University of Florida at Jacksonville; Sophia Sheikh, University of Florida at Jacksonville; Christopher W Jones, Rowan University; Brittany E Punches, University of Cincinnati; Michael C Kurz, University of Alabama; Robert A Swor, Oakland University; Vishnu P Murty, Temple University; Meghan E McGrath, Boston Medical Center; Lauren Hudak, Emory University; Jose L Pascual, University of Pennsylvania, Philadelphia; Elizabeth M Datner, Einstein Healthcare Network; Anna M Chang, Jefferson University Hospitals; Claire Pearson, Wayne State University; David A Peak, Massachusetts General Hospital; Roland C Merchant, Brigham & Womens Hospital; Robert M Domeier, St Joseph Mercy Hosp; Niels K Rathlev, University of Massachusetts; Brian J O'Neil, Wayne State University; Paulina Sergot, University of Texas Health; Leon D Sanchez, Beth Israel Deaconess Medical Center; Steven E Bruce, University of Missouri - St. Louis; Justin T Baker, Mindstrong Health; Jutta Joormann, Yale University; Mark W Miller, VA Boston Healthcare System; Robert H Pietrzak, VA Connecticut Healthcare System; Deannna M Barch, Washington University; Diego A Pizzagalli, Harvard Medical School; John F Sheridan, OSU Wexner Medical Center; Jordan W Smoller, Massachusetts General Hospital; Steven E Harte, University of Michigan, Ann Arbor; James M Elliott, University of Sydney, St Leonards; Karestan C Koenen, Harvard University; Samuel A McLean, University of North Carolina at Chapel Hill
• Language: English
• Date: 2023-01-07
• Publisher: SPRINGERNATURE
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1038/s41398-022-02289-y
• Title of Journal or Parent Work: TRANSLATIONAL PSYCHIATRY
• Volume: 13
• Issue: 1
• Start Page: 4
• End Page: 4
• Keywords: ASSOCIATION; PREDICTORS; MOTOR-VEHICLE COLLISION; Science & Technology; SLEEP; VETERANS; NECK PAIN; Psychiatry; POSTTRAUMATIC-STRESS-DISORDER; Life Sciences & Biomedicine; RESPONSES; PERSISTENT PAIN; ANXIETY SENSITIVITY
• Research Categories: Health Sciences, Mental Health; Health Sciences, Epidemiology

Abstract

The authors sought to characterize adverse posttraumatic neuropsychiatric sequelae (APNS) symptom trajectories across ten symptom domains (pain, depression, sleep, nightmares, avoidance, re-experiencing, anxiety, hyperarousal, somatic, and mental/fatigue symptoms) in a large, diverse, understudied sample of motor vehicle collision (MVC) survivors. More than two thousand MVC survivors were enrolled in the emergency department (ED) and completed a rotating battery of brief smartphone-based surveys over a 2-month period. Measurement models developed from survey item responses were used in latent growth curve/mixture modeling to characterize homogeneous symptom trajectories. Associations between individual trajectories and pre-trauma and peritraumatic characteristics and traditional outcomes were compared, along with associations within and between trajectories. APNS across all ten symptom domains were common in the first two months after trauma. Many risk factors and associations with high symptom burden trajectories were shared across domains. Both across and within traditional diagnostic boundaries, APNS trajectory intercepts, and slopes were substantially correlated. Across all domains, symptom severity in the immediate aftermath of trauma (trajectory intercepts) had the greatest influence on the outcome. An interactive data visualization tool was developed to allow readers to explore relationships of interest between individual characteristics, symptom trajectories, and traditional outcomes (http://itr.med.unc.edu/aurora/parcoord/). Individuals presenting to the ED after MVC commonly experience a broad constellation of adverse posttraumatic symptoms. Many risk factors for diverse APNS are shared. Individuals diagnosed with a single traditional outcome should be screened for others. The utility of multidimensional categorizations that characterize individuals across traditional diagnostic domains should be explored.