Association Among Trauma History Characteristics, PTSD Symptoms Trajectory, and Disability Level after Injury Among Adult Injury Patients in Kenya

Introduction: Prior trauma has been consistently found to be associated with PTSD, but the extent of association and attribution to subsequent disability varied, with limited studies conducted in urban low-income contexts. Limited research has been available on understanding the role of prior trauma and the longitudinal burden of PTSD symptoms from common types of injuries after traumatic injury and the associated disability level in low- and middle-income settings. This longitudinal study examines the trajectory of PTSD symptoms among adult injury patients up to seven months after hospitalization and the association with trauma history characteristics and associated disability level.

Methods: Adult injury patients (n=476) admitted to Kenyatta National Hospital in Nairobi, Kenya, were interviewed in hospital in person, and at 1, 2-3, and 4-7 months after hospital discharge through phone interviews. Post-traumatic stress disorder symptoms were assessed at each follow-up and trauma history was assessed in the hospital. The level of disability was assessed at each follow-up interview.

Latent growth curve analysis was conducted to estimate the trajectories of PTSD symptoms 4 to 7 months after hospital discharge. Risk factors and trauma history characteristics were preliminarily assessed using R3Step and subsequently included in multivariate logistic regression using manual BCH methods.

Results: Two trajectories of PTSD symptoms were found between 1-month post-hospitalization and four to seven months after hospital discharge: persistently elevated PTSD symptoms (9%), and low PTSD symptoms (91%). The cumulative number of potentially traumatic events experienced remained moderately associated with the elevated trajectory after controlling for in-hospital depressive symptoms. Having previously witnessed killings or serious injuries was associated with elevated PTSD symptoms trajectory class, controlling for other risk factors and direct association with disability level at 4 to 7 months. Being female, having elevated depressive symptoms during hospitalization and having no household savings nor assets were associated with elevated PTSD symptoms trajectory.

Conclusions: Our study found elevated PTSD symptoms persisted several months after hospital discharge, which was associated with a significantly higher level of disability after controlling for injury and demographic characteristics. Specific trauma characteristics should be examined when assessing trauma history exposure to identify populations at risk for early interventions. Mechanisms of pathological association between witnessing trauma and elevated PTSD symptoms warrant future investigations to prevent the development of PTSD.