{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:56:05Z","timestamp":1787507765611,"version":"build-2736575974"},"reference-count":77,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T00:00:00Z","timestamp":1747612800000},"content-version":"unspecified","delay-in-days":138,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000125","name":"National Institute for Occupational Safety and Health","doi-asserted-by":"publisher","award":["R21OH012614"],"award-info":[{"award-number":["R21OH012614"]}],"id":[{"id":"10.13039\/100000125","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S0033291725000686_sec1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Posttraumatic stress disorder (PTSD) is often chronic and impairing. Mechanisms that maintain symptoms remain poorly understood because of heterogenous presentation. We parsed this heterogeneity by examining how individual differences in stress-symptom dynamics relate to the long-term maintenance of PTSD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725000686_sec2\" sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We studied 7,308 trauma-exposed World Trade Center responders who self-reported PTSD symptoms and stressful life events at annual monitoring visits for up to 20\u00a0years (average\u00a0=\u00a08.8 visits; [range\u00a0=\u00a04\u201316]). We used multilevel structural equation models to separate the stable and time-varying components of symptoms and stressors. At the within-person level, we modeled stress reactivity by cross-lagged associations between stress and future symptoms, stress generation by cross-lagged associations between symptoms and future stress, and autoregressive effects represented symptom persistence and stress persistence. The clinical utility of the stress-symptom dynamics was evaluated by associations with PTSD chronicity and mental health care use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725000686_sec3\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Stress reactivity, stress generation, and symptom persistence were significant on average (bs\u00a0=\u00a00.03\u20130.16). There were significant individual differences in the strength of each dynamic (interquartile ranges\u00a0=\u00a00.06\u20130.12). Correlations among within-person processes showed some dynamics are intertwined (e.g. more reactive people also generate stress in a vicious cycle) and others represent distinct phenotypes (e.g. people are reactive or have persistent symptoms). Initial trauma severity amplified some dynamics. People in the top deciles of most dynamics had clinically significant symptom levels across the monitoring period and their health care cost 6\u201317\u00d7 more per year than people at median levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0033291725000686_sec4\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Individual differences in stress-symptom dynamics contribute to the chronicity and clinical burden of PTSD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s0033291725000686","type":"journal-article","created":{"date-parts":[[2025,5,19]],"date-time":"2025-05-19T03:50:58Z","timestamp":1747626658000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":2,"title":["Stress dynamics that maintain posttraumatic stress disorder across 20\u00a0years"],"prefix":"10.1017","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8883-5963","authenticated-orcid":false,"given":"Whitney R.","family":"Ringwald","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Feltman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean A.P.","family":"Cloutson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Mann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilo","family":"Ruggero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelyn","family":"Bromet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Luft","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Kotov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2025,5,19]]},"reference":[{"key":"S0033291725000686_r62","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291711002765"},{"key":"S0033291725000686_r14","doi-asserted-by":"publisher","DOI":"10.3402\/ejpt.v6.27344"},{"key":"S0033291725000686_r54","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2015.01.003"},{"key":"S0033291725000686_r55","doi-asserted-by":"publisher","DOI":"10.1521\/jscp.2016.35.9.705"},{"key":"S0033291725000686_r20","doi-asserted-by":"publisher","DOI":"10.1002\/jts.20327"},{"key":"S0033291725000686_r34","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0000000000000581"},{"key":"S0033291725000686_r38","volume-title":"Stress, appraisal, and coping","author":"Lazarus","year":"1984"},{"key":"S0033291725000686_r35","doi-asserted-by":"publisher","DOI":"10.1002\/jts.20406"},{"key":"S0033291725000686_r74","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2021.101998"},{"key":"S0033291725000686_r76","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2014.11.010"},{"key":"S0033291725000686_r42","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2015.0803"},{"key":"S0033291725000686_r86","doi-asserted-by":"publisher","DOI":"10.1016\/j.copsyc.2016.12.005"},{"key":"S0033291725000686_r6","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291716002026"},{"key":"S0033291725000686_r5","doi-asserted-by":"publisher","DOI":"10.1037\/0022-006X.68.5.748"},{"key":"S0033291725000686_r39","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291717001143"},{"key":"S0033291725000686_r56","doi-asserted-by":"publisher","DOI":"10.1037\/met0000062"},{"key":"S0033291725000686_r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2015.06.008"},{"key":"S0033291725000686_r72","unstructured":"U.S. Census Bureau. 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