{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T16:27:54Z","timestamp":1786724874945,"version":"build-2736575974"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Long-term persistence of posttraumatic stress reactions (PTSRs) is a major public health challenge, yet early prognostic markers for decadal outcomes remain poorly characterized. Specifically, the importance of early symptom fluctuations compared with initial cross-sectional severity is not well understood.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether early postdisaster symptom dynamics within 1 year are associated with persistent, clinically meaningful PTSRs 15 years after the 2011 Great East Japan Earthquake (GEJE).<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This 15-year prospective longitudinal cohort study (2011-2025) included residents of Shichigahama, Miyagi, Japan, aged 20 years or older, who experienced disaster-certified housing destruction after the GEJE.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Early symptom dynamics (2011-2012) based on Impact of Event Scale\u2013Revised (IES-R) scores and classified as (1) high-escalating (IES-R score \u226525 and increasing), (2) high-improving (IES-R score \u226525 and nonincreasing), and (3) nonpersistent early (IES-R score &amp;lt;25 at either wave).<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcomes were persistent, clinically meaningful PTSRs (IES-R score \u226525) at 15 years. Multivariable logistic regression with 40-fold multiple imputation was used to estimate adjusted odds ratios (aORs).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Among 1291 participants (685 women [53.1%]; mean [SD] age, 53.9 [16.6] years), group-based trajectory modeling of IES-R scores (2011-2025) identified 5 distinct PTSR patterns. At 15 years, 14.7% of participants (190 participants) had clinically meaningful PTSRs. Symptom escalation was most frequent during the first-to-second year interval compared with all subsequent periods. This trend remained consistent even under stringent escalation criteria (&amp;gt;5-point increase). The high-escalating pattern was the one most associated with 15-year persistence (aOR, 5.31; 95% CI, 3.85-7.32). The prognostic model incorporating early dynamics demonstrated improved discrimination (area under the curve [AUC], 0.756; 95% CI, 0.717-0.763) compared with models using baseline symptom severity alone (AUC, 0.608; 95% CI, 0.600-0.612) or delayed single-point assessments (AUC, 0.726; 95% CI, 0.663-0.738).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this 15-year cohort study of GEJE survivors, symptom escalation during the first-to-second year interval was identified as the most prevalent pattern and was a factor associated with long-term persistent PTSRs. Because early symptom dynamics offer superior prognostic accuracy compared with single-point assessments, these findings support a serial screening approach during the immediate postdisaster period to optimize risk stratification and early intervention strategies.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.29441","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T15:30:19Z","timestamp":1786721419000},"page":"e2629441","source":"Crossref","is-referenced-by-count":0,"title":["Posttraumatic Stress Dynamics and 15-Year Persistence in Great East Japan Earthquake Survivors"],"prefix":"10.1001","volume":"9","author":[{"given":"Xue","family":"Li","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Graduate School of Medicine, Tohoku University, Miyagi, Japan"},{"name":"Department of Regional Alliance for Promoting Liaison Psychiatry, Tohoku University Graduate School of Medicine, Miyagi, 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