Early risk factors and six month posttraumatic stress disorder symptom severity following trauma.

Background: Posttraumatic stress disorder (PTSD) is a significant public health concern associated with persistent psychological impairment following trauma exposure. Early identification of risk factors is critical for timely intervention and prevention of chronic symptoms.Objective: This study examined early post-trauma cognitive, emotional, trauma-related, and socioeconomic factors associated with PTSD symptom severity at six-month follow-up, with sleep quality and self-perceived pain as potential mediators.Method: A total of 178 adults were recruited from an emergency department and assessed approximately two weeks following trauma exposure. Partial least squares structural equation modeling (PLS-SEM) was used to evaluate cognitive attributions, trauma history, emotion responding and regulation, and socioeconomic factors as predictors of six-month PTSD symptom severity. PTSD symptom severity at two weeks post-trauma was included as a covariate to account for early symptom levels.Results: Maladaptive cognitive attributions demonstrated strong direct associations with later PTSD symptom severity and significant indirect associations through sleep quality and self-perceived pain. Trauma history showed a modest association with PTSD symptoms. Emotion responding and regulation was indirectly associated with PTSD symptom severity through sleep quality, suggesting a sleep-mediated pathway. Socioeconomic factors were not significantly associated with PTSD symptom severity. These effects were observed after accounting for PTSD symptom severity at two weeks post-trauma.Conclusions: Early maladaptive cognitive attributions and sleep disturbances represent key clinical targets for early post-trauma intervention. Addressing these factors promptly after trauma may help reduce the risk of chronic PTSD.