Prior Sexual Violence, PTSD Symptoms, and Recovery Trajectories After New Trauma.

Abstract

IMPORTANCE: Prior work demonstrates that earlier trauma exposure increases the risk of posttraumatic stress disorder (PTSD) after a subsequent trauma, and cross-sectional work has also identified sexual violence (SV) as the form of traumatic stressor with the greatest conditional risk for PTSD. However, little work explores these findings longitudinally with a comparison group with no history of SV. OBJECTIVE: To examine the differences in PTSD symptoms after a new incident of trauma exposure in survivors with and without an earlier history of SV. DESIGN, SETTING, AND PARTICIPANTS: In this case-control study, data from a longitudinal cohort sample of patients enrolled in the Advancing Understanding of Recovery After Trauma (AURORA) study were examined. Participants were admitted to emergency departments due to a traumatic injury (primarily motor vehicle crash), and they were followed up for 1 year after emergency department (ED) admission. They were recruited within 72 hours of ED admission and then assessed at 5 time points (2 weeks, 8 weeks, 3 months, 6 months, 12 months) after their injury. Participants were a diverse and heterogeneous sample of individuals admitted to EDs across the US. Study data were evaluated from January 2025 to March 2026. EXPOSURE: Earlier history of SV as assessed at ED admission using the Childhood Trauma Questionnaire and the Life Events Checklist. MAIN OUTCOMES AND MEASURES: Symptoms of PTSD as assessed by the PTSD Checklist for DSM-5. RESULTS: The study sample included 2423 individuals (mean [SD] age, 36 [13] years; 1566 female [64.6%]), 1270 whom (52%) reported an earlier history of SV. At every time point, participants with a history of SV demonstrated significantly elevated symptoms of PTSD (β = 4.62; 95% CI, 3.09-6.21; P < .001) compared with those without a history of SV, even after controlling for earlier nonsexual trauma exposure. Within the group with prior SV, the PTSD symptoms that remained the highest across time points were hypervigilance symptoms (criterion E), although negative alterations in cognition and mood (criterion D) were the symptom cluster that recovered most slowly. CONCLUSIONS AND RELEVANCE: Results of this case-control study indicate that having a history of SV was associated with elevated symptoms of PTSD and slower symptom recovery after a subsequent nonsexual trauma. These results raise important considerations for clinicians, regardless of whether or not they self-identify as working specifically with survivors of SV.