Natural history

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Amongst the many different types of accident, children or adolescents who were passengers in a car appear more likely to develop PTSD compared with those riding a bicycle or who were pedestrians at the time.(42) About 72 per cent of children involved in car accidents had high PTSD symptoms at 6 weeks post-accident, compared with around 30 per cent of bicyclists or pedestrians. Car passengers also reported more severe symptoms, supporting previous findings that the level of exposure to personal danger correlates with the severity of PTSD symptoms.(43) Although cars are associated with the greater risk, all types of accident are associated with a significantly raised rate of PTSD in children.

Symptoms that are unresolved by 6 weeks and higher premorbid levels of anxiety or depression are both associated with a somewhat increased risk for chronic PTSD. Premorbid levels of hyperactivity or behavioural symptoms do not appear to be associated with either acute or chronic PTSD symptoms.(42) High levels of comorbid anxious and depressive syndromes are reported from most studies, but it is unclear to what extent this influences the risk for a chronic disorder. It seems likely that, for some children, PTSD is superimposed on an already existing emotional disorder. In such cases chronic PTSD may only be part of a continuum of a more widespread persistent emotional illness.

In most studies, girls appear to be more susceptible than boys, and less able children are more badly affected than the more able. The gender difference relates to both acute and chronic forms of the disorder and is generally independent of age. The concurrent experience of death or severe injury to a parent increases the risk to the child. (44)

There are few longer-term studies and none on accidents around the home or school. In a 7-year follow-up of the sinking of the Jupiter, adolescent survivors, who are now in their twenties, were reassessed for PTSD and other psychopathologies.(444 and 46) Of the sample, 50 per cent had presented with PTSD in the first 6 months after the accident and 25 per cent still met criteria 7 years later. Long-term cases had high rates of comorbid anxiety and depression syndromes and, although the numbers are small, showed a rate of suicide attempts threefold higher than controls.

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