Wednesday, June 6, 2018

Response trajectories to major life stressors and potential trauma are resilience, recovery, chronic stress, and delayed response. Both trait and state factors are associated with trajectory, so individuals on maladaptive trajectories may be identifiable prospectively or soon following stress exposure

Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Isaac R. Galatzer-Levy, Sandy H. Huang, George A. Bonanno. Clinical Psychology Review, https://doi.org/10.1016/j.cpr.2018.05.008

Highlights
•    A review of n=54 studies demonstrates that resilience is the modal response to major life stressors and potential trauma.
•    Across events, individuals cluster into common trajectories of stress response at relatively stable rates including resilience, recovery, chronic stress, and delayed response. The stability of these patterns across events, degree of stress exposure, and populations indicates that they may represent phenotypic human stress responses.
•    Despite the stability of trajectories, there is evidence that both trait and state factors are associated with trajectory membership, indicating that individuals on maladaptive trajectories may be identifiable either prospectively or soon following stress exposure, and that trajectory membership may be malleable by interventions that target state-level predictors of risk.
•    Trajectory models provide a robust methodology to identify and study clinically relevant responses to stress and potential trauma, and to identify characteristics, predictors, and their potential treatment targets.

Abstract: Given the rapid proliferation of trajectory-based approaches to study clinical consequences to stress and potentially traumatic events (PTEs), there is a need to evaluate emerging findings. This review examined convergence/divergences across 54 studies in the nature and prevalence of response trajectories, and determined potential sources of bias to improve future research. Of the 67 cases that emerged from the 54 studies, the most consistently observed trajectories following PTEs were resilience (observed in: n = 63 cases), recovery (n = 49), chronic (n = 47), and delayed onset (n = 22). The resilience trajectory was the modal response across studies (average of 65.7% across populations, 95% CI [0.616, 0.698]), followed in prevalence by recovery (20.8% [0.162, 0.258]), chronicity (10.6%, [0.086, 0.127]), and delayed onset (8.9% [0.053, 0.133]). Sources of heterogeneity in estimates primarily resulted from substantive population differences rather than bias, which was observed when prospective data is lacking. Overall, prototypical trajectories have been identified across independent studies in relatively consistent proportions, with resilience being the modal response to adversity. Thus, trajectory models robustly identify clinically relevant patterns of response to potential trauma, and are important for studying determinants, consequences, and modifiers of course following potential trauma.

Keywords: Aversive event; Depression; Heterogeneity; Latent growth mixture modeling; PTSD; Stress; Trajectory