Depression independent of PTSD in the acute aftermath of trauma
Sept. 1, 2004
Psychiatry Matters

Depressive symptoms appear to be integral to post-traumatic stress disorder (PTSD), following traumatic exposure, but depression may also exist as a separate and independent entity, with its own course of recovery and a good prognosis, reveal investigators.

"PTSD and major depression occur frequently following traumatic exposure, both as separate disorders and concurrently," observe Meaghan O'Donnell (Australian Centre for Posttraumatic Mental Health, Victoria, Australia) and colleagues.

They therefore sought to determine whether PTSD and depression that occur as a consequence of trauma are separate disorders, or part of a single general traumatic stress makeup.

Using the Clinician-Administered PTSD scale for DSM-IV and the Structured Clinical Interview for DSM-IV, the researchers assessed depressive and PTSD symptoms in 363 injury survivors just prior to discharge from hospital and again, 3 and 12 months post-discharge.

In the aftermath of trauma, the majority of psychopathology was best conceptualized as a general traumatic stress, with PTSD and comorbid PTSD and depression indistinguishable, and sharing the same predictive factors.

"The data suggest that depressive symptoms are often integral to PTSD and that to separate depression out as a distinct disorder when it occurs with PTSD is a somewhat arbitrary distinction," the researchers report in the American Journal of Psychiatry.

However, there was also evidence to suggest that, in the first few months following trauma, depression may exist as a separate and independent entity, with its own unique set of predictors and its own course of recovery.

A good prognosis for this depression was suggested, because, by 12 months post-trauma, the psychopathology becomes less well differentiated, and it is no longer possible to identify a unique construct of depression.

Given their good prognosis, patients with depression in the absence of PTSD may "be best managed with close monitoring through primary care providers rather than with intensive specialist interventions," O'Donnell and team say.

"On the other hand, individuals presenting at 3 months with clear PTSD symptoms, whether or not depression is also present, may warrant more specialist interventions to modify what is otherwise likely to be a chronic course."

Am J Psychiatry 2004; 161: 1390-1396