Preditores de resiliência ao transtorno de estresse pós-traumático: uma metanálise

Abstract

In contrast to majority of psychiatric disorders, post-traumatic stress disorder (PTSD) has defined necessary causal factor, despite not sufficient: exposure to a potential traumatic event (PTE). Consequently to this event, the individual develops three symptom clusters: reexperience, avoidance/ emotional numbing and arousal. One of the most relevant findings of epidemiological research on PTSD is that despite most individuals are exposed to traumatic event some moment on their lives, only a few of them will develop the disorder. Thus, the majority of individuals are resilient. Resilience refers to the positive adaptation ability within the context of adversity. A systematic review and metanalysis were conducted on longitudinal studies that investigated predictors of PTSD resilience. Absence of PTSD was considered a proxy of resilience. Database searches on Medline, PILOTS (Published International Literature on Traumatic Stress) and ISI (Institute for Scientific Information) returned a huge number of studies. Hence, post hoc, it was decided to focus predictor variables on social support (SS), personality, self esteem and potential stressful life events (PSLE). Only twenty articles fulfilled eligibility criteria. Thirteen of them evaluated social support, nine evaluated personality and two evaluated PSLE. None of the studies that investigated self esteem was eligible. Sixteen of twenty included studies were based on general population. Most studies measured risk factors after PTE occurrence. Although some of them attempted to catch pre-event exposure information, due to retrospective nature of this measure, potential trauma effect cannot be neglected. In addition, it was observed large heterogeneity between researches, restricting the number of studies included in metanalysis. Neuroticism was the unique personality dimension evaluated in more than one study. Combined measures comprising these studies revealed that higher positive SS is significant associated with PTSD resilience whereas neuroticism decreases resilience chance. The two studies that investigated PSLE could not be combined. One of them was inconclusive while the other yielded significant association between lower PSLE and resilience. It should be highlighted that combined measures should be appraised with caution due to large heterogeneity between studies. Due to evaluated constructs complexity it is expected that we come upon large heterogeneity in factors appraisal methods. However, the lack of operational method pattern reduces results comparability.