Prevalence, Severity and Predictors of Post - Traumatic Stress Disorder (PTSD) Among College Students: A DSM-5 Based Cross-Sectional Study

Post-traumatic stress disorder (PTSD) is a stress-related disorder with serious clinical symptoms; The daily activities of affected patients usually change; these changes are accompanied by a significantly reduced quality of life, excessive use of psychoactive substances, and other mental problems such as depression, anxiety, and phobias^[1]. That may develop after exposure to exceptionally threatening or horrifying events. PTSD can occur after a single traumatic event or from prolonged exposure to trauma, such as sexual abuse in childhood ^[2]. Post-traumatic stress disorder (PTSD) is a mental health condition that develops in some people who have experienced or witnessed a traumatic or frightening event, such as a natural disaster, a serious accident or assault, a terrorist attack or military combat, or those who have been threatened with death, sexual violence, or injury ^[3] intrusive memories of battlefields coupled with the loss of interests, loneliness, and arousal, which are similar to the PTSD diagnostic criteria used today^(6).. Subclasses of "internalizing disorders" identified within mood and anxiety disorders are evaluated^.[7] Depression is often divided into five subcategories, all of which share the characteristic symptoms of a persistent sense of melancholy, emptiness, or irritability, coupled with somatic, psychic, and cognitive changes that have a significant impact on an individual’s functionality and overall well-being ^[15]. For example, although the lifetime prevalence of PTSD in veterans of the Vietnam War is around 30 percent, about 50 percent of Vietnam veterans had some clinically significant symptoms of PTSD ^[8]. A recent epidemiologic survey indicates that approximately 16% of patients with PTSD have one other psychiatric diagnosis, 17% have two other psychiatric diagnoses, and nearly 50% have three or more additional psychiatric diagnoses. These data indicate that for individuals with PTSD, comorbidity with other psychiatric diagnoses is the rule rather than the exception^{. [11]} Based on data from the National Comorbidity Survey, about 60% of men and 50% of women are exposed to a traumatic event that can potentially result in the diagnosis of PTSD. Of these individuals, 8.2% of men and 20.4% of women develop PTSD.^[9] The estimated lifetime prevalence of PTSD among these Veterans was 30.9% for men and 26.9% for women. Of Vietnam theater Veterans, 15.2% of males and 8.1% of females were currently diagnosed with PTSD at the time the study was conducted ^[10]. It has been shown that traumatic situations, such as chronic stress, tend to decrease the density of glutamatergic synapses, as well as being associated with a decrease in gray matter, particularly. at the level of the prefrontal cortex ^(17). Hence, we analysed the impact of Traumatic experiences on Emotional, cognitive, and Social functioning in college students.

METHODOLOGY

The study was carried out at Pachamuthu College of Pharmacy, with a student survey, for a period of three months. Permission was obtained from the institution of our college. A systematic random sampling was applied. Informed consent was obtained from the student after the nature and purpose of the study were explained. The relevant demographic details were collected in a questionnaire format. Data were collected only from those students who were willing to participate in the study. During the first phase of study, PTSD was assessed and based on the traumatic event, was identified, and then after calculating the student score (low, moderate, high, and severe), marks were assigned based on DSM-5 criteria. Thus, the results were analyzed and documented.

RESULT     

A total of 530 participants were initially enrolled in the study. However, 57 participants were excluded due to non-willingness to continue and voluntary withdrawal from the study. Therefore, the final analysis included data from 473 participants. The mean age of the participants was 20 years. Among the analyzed participants, the majority were female (n = 328), while 145 participants were male. The mean Perceived Stress Scale (PSS) score of the participants was found to be 21.55, indicating an overall moderate level of perceived stress. Based on stress severity classification, only 3 participants were categorized as having mild stress, whereas 155 participants had moderate stress. A large proportion of participants (n = 313) experienced severe post-traumatic stress, and 2 participants were found to have very severe stress levels. The detailed demographic characteristics of the study participants are presented in Table:1.

TABLE 1: Demographic Details

Variables	Frequency	Percentage
Total participants recruited	530	100
Excluded participants	57	10.75
No. of participants analyzed	473	89.25
Mean Age	20	-
Gender Male	154	30.6
Female	328	69.3
Mean Stress Score (PSS)	21.55	-
No. Participants were presented  with different severity and PSS Score Mild (PSS Score 0 – 9)	3	0.63
Moderate (PSS Score 10 – 20)	155	32.77
Severe (PSS Score 21 – 30)	312	66.17
Very Severe (PSS Score 31 – 36)	2	0.42

 

Figure 1: Bar chart showing severity levels of perceived stress among participant

From the data, it was also found that Participants who were physically injured had significantly higher PTSD scores (Mean = 23.57, SD = 6.16) compared to those who were not physically injured (Mean = 20.62, SD = 5.36). This difference was statistically significant (t (471) = 5.31, p < 0.001). Participants whose school performance was affected reported significantly higher PTSD scores (Mean = 22.27, SD = 5.33) compared to those whose school performance was not affected (Mean = 19.86, SD = 6.45), and this difference was statistically significant (t (471) = 4.21, p < 0.001). Although participants whose daily activities were affected had higher PTSD scores (Mean = 22.26, SD = 6.41) compared to those whose daily activities were not affected (Mean = 21.34, SD = 5.57), this difference was not statistically significant (t (471) = 1.47, p = 0.143).

DISCUSSION

The present study evaluated the prevalence and determinants of perceived stress and post-traumatic stress among college-aged participants. The findings revealed that the overall mean PSS score was 21.55, indicating a moderate level of perceived stress among the participants. However, severity classification showed that the majority of participants experienced severe stress, highlighting a substantial psychological burden in this population. We then used latent transition analysis to understand the course of PTSD symptoms during this year of transition, and to explicate factors that may influence this course. Our findings revealed significant variability in PTSD symptom course over the first college year. ^[24] The hypothesis advanced in this study, that there is a significant correlation between psychological distress and academic adjustment in college students, was confirmed.^[21] The result came significantly positive between exam stress and psychological distress (r= 0.514, p < .01). The result also showed significant positive correlation between classroom stress and psychological distress (r= 0.457, p < .05). Further, the result showed significant positive relation between classroom stress and exam stress (r= 0.597, p < .001).^[22] . Moreover, the college environment can be challenging to navigate, resulting in additional stressors, including the experience of sexual assault. Additionally, the location of individuals within the social hierarchy further increases their chances of encountering stressors, as stressors vary according to one’s social status in society^.[23] Only one participant met criteria for PTSD diagnosis. Therefore, an accurate sample to represent the population was not given in this study^. This finding highlights the potential ^[25]. academic consequences of psychological distress and underscores the importance of early identification and intervention.

Overall, the findings of this study highlight the high prevalence of stress and PTSD symptoms among young adults and emphasize the significant role of gender, physical injury, and academic performance in influencing psychological outcomes.

CONCLUSION

Our study found a high prevalence of perceived stress and PTSD symptoms among participants. Female gender, physical injury, and affected academic performance were significantly associated with higher PTSD scores. These findings highlight the considerable psychological burden among young adults and emphasize the need for early screening and appropriate mental health support to improve student well-being.

REFERENCES

1. Düzeylerindeki PT. Altered neurotransmitter levels with post-traumatic stress disorder. Turk Neurosurg. 2014;24(6):844-8.
2. Bisson JI. Post-traumatic stress disorder. BMJ Clinical Evidence. 2010 Feb 3; 2010:1005.
3. Koenen KC, Ratanatharathorn A, Ng L, McLaughlin KA, Bromet EJ, Stein DJ, Karam EG, Ruscio AM, Benjet C, Scott K, Atwoli L. Posttraumatic stress disorder in the world mental health surveys. Psychological medicine. 2017 Oct;47(13):2260-74.
4. Sareen J. Posttraumatic stress disorder in adults: impact, comorbidity, risk factors, and treatment. The Canadian Journal of Psychiatry. 2014 Sep;59(9):460-7.
5. Mansour, M., Joseph, G.R., Joy, G.K., Khanal, S., Dasi reddy, R.R., Menon, A., Mason, I.B., Kataria, J., Patel, T. and Modi, S., 2023. Post-traumatic stress disorder: A narrative review of pharmacological and psychotherapeutic interventions. Cureus, 15.
6. Du J, Diao H, Zhou X, Zhang C, Chen Y, Gao Y, Wang Y. Post-traumatic stress disorder: a psychiatric disorder requiring urgent attention. Medical review. 2022 Jun 27;2(3):219- 43.
7. Friedman MJ, Resick PA, Bryant RA, Strain J, Horowitz M, Spiegel D. Classification of trauma and stressor‐related disorders in DSM‐5. Depression and anxiety. 2011 Sep;28(9):737-49.
8. Grinage BD. Diagnosis and management of post-traumatic stress disorder. American Family Physician. 2003 Dec 15;68(12):2401-9.
9. Yehuda R. Risk and resilience in posttraumatic stress disorder. Journal of Clinical Psychiatry. 2004 Jan 1;65: 29-36.
10. Gradus JL. Epidemiology of PTSD. National Center for PTSD (United States Department of Veterans Affairs). 2007.
11. Brady KT. Posttraumatic stress disorder and comorbidity: recognizing the many faces of PTSD. Journal of Clinical Psychiatry. 1997 Jan 1;58(9):12-5.
12. Miao XR, Chen QB, Wei K, Tao KM, Lu ZJ. Posttraumatic stress disorder: from diagnosis to prevention. Military Medical Research. 2018 Sep 28;5(1):32.
13. Jitender Sareen MD. Posttraumatic Stress Disorder in Adults: Impact, Comorbidity, Risk Factors, and Treatment. Canadian Journal of Psychiatry. 2014 Sep 1;59(9):460.
14. Voges MA, Romney DM. Risk and resiliency factors in posttraumatic stress disorder. Annals of General Hospital Psychiatry. 2003 May 1;2(1):4.
15. Ahmed SH, Zakai A, Zahid M, Jawad MY, Fu R, Chaiton M. Prevalence of post‐ traumatic stress disorder and depressive symptoms among civilians residing in armed conflict‐affected regions: a systematic review and meta‐analysis. General psychiatry. 2024 Jun;37(3): e101438.
16. Rasmusson AM, Pineles SL. Neurotransmitter, peptide, and steroid hormone abnormalities in PTSD: biological endophenotypes relevant to treatment. Current psychiatry reports. 2018 Jul;20(7):52.
17. Traina G, Tuszynski JA. The neurotransmission basis of post-traumatic stress disorders by the fear conditioning paradigm. International Journal of Molecular Sciences. 2023 Nov 15;24(22):16327.
18. Friedman MJ. Finalizing PTSD in DSM‐5: Getting here from there and where to go next. Journal of traumatic stress. 2013 Oct;26(5):548-56.
19. Pynoos RS. DSM-V PTSD Diagnostic Criteria for Children and Adolescents: A Developmental Perspective and Recommendations (vol 22, pg 391, 2009). Journal of Traumatic Stress. 2013 Feb 1;26(1):173-.
20. Downs DL, Hong A, North C. PTSD: A systematic approach to diagnosis and treatment. Current Psychiatry. 2018 Apr;17(4):35.
21. Miles D. Psychological distress and adjustment in college students. Rowan University; 2018.
22. Multani MK, Kaur N, Narula A. A Study on understanding Psychological Distress and Academic Stress among College Students. International Journal of Interdisciplinary Approaches in Psychology. 2024 Dec 8;2(12):290-9.
23. Tyler KA, Ray CM. PTSD symptoms among college students: linkages with familial risk, borderline personality, and sexual assault. Journal of child sexual abuse. 2024 Feb 17;33(2):127-45.
24. Read JP, Bachrach RL, Wright AG, Colder CR. PTSD symptom course during the first year of college. Psychological trauma: theory, research, practice, and policy. 2016 May;8(3):393.
25. Buscemi M. An exploratory investigation of the relationship between PTSD symptoms and substance abuse in undergraduate college students.
26. Wright WF, FAPA M. Trauma/PTSD and SUD.
27. Iribarren J, Prolo P, Neagos N, Chiappelli F. Post‐traumatic stress disorder: evidence‐based research for the third millennium. Evidence‐Based Complementary and Alternative Medicine. 2005;2(4):503-12.
28. Bryant RA. Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges. World psychiatry. 2019 Oct;18(3):259-69.
29. Perrotta G. Post-traumatic stress disorder: Definition, contexts, neural correlations and cognitive-behavioural therapy. Journal of Public Health and Nutrition. 2019 Jan 1.
30. Iribarren J, Prolo P, Neagos N, Chiappelli F. Post‐traumatic stress disorder: evidence‐based research for the third millennium. Evidence‐Based Complementary and Alternative Medicine. 2005;2(4):503-12.