Pre-event psychiatric states predict trajectories of post-traumatic stress symptoms during the COVID-19 pandemic

Recent time-dependent analyses of stress-related disorders have identified heterogeneity of trajectories and their modifying factors. While psychiatric patients are vulnerable to stress events, it is unclear how psychiatric conditions in the general population modulate subsequent stress responses. Using our longitudinal online survey from before the COVID-19 pandemic to post-pandemic follow-ups (n = 3815 Japanese adults), here we identified four trajectories of post-traumatic stress symptoms (PTSS) a latent growth mixture model; resilient, chronic, mild chronic, and early response. The depression/anxiety were identified as specific risk factors for the early-response trajectory. In contrast, general psychiatric burden and social withdrawal were identified as common risk/protective factors. Further, we estimated "baseline" PTSS to determine the predictability of the PTSS prognosis from pre-pandemic states. The chronic group showed significantly higher baseline PTSS scores than the mild-chronic and early-response groups, both of which were significantly higher than the resilient group. We concluded that prior psychiatric conditions significantly affect the PTSS trajectory. These results suggest that prior psychiatric conditions may be considered for the prevention and treatment of maladaptive stress responses. ### Competing Interest Statement The sponsor, KDDI, reviewed the design, the collection, and the analysis. The funder had no role in the conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. ### Funding Statement This research was supported by a KDDI collaborative research contract. This work was also supported by AMED under Grant Number JP20dm0307008. The sponsor, KDDI, reviewed the design, the collection, and the analysis. The funder had no role in the conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committees of the Advanced Telecommunications Research Institute International (ATR) gave ethical approval for the original and follow-up research designs (approval No. 21-195 for the original study & 21-749 for the follow-up study). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The main summary statistical data that support the findings of this study are available in the Supplementary Data. Owing to company cohort data sharing restrictions, individual-level data cannot be publicly posted. However, data are available from the authors upon request and with permission of KDDI Corporation.