PurposeIn recent years, healthcare workers (HCWs) in Lebanon have encountered compounded traumatic exposures, including the Beirut Port blast, COVID-19, and an ongoing economic crisis, often preceded by early-life adversities such as adverse childhood experiences (ACEs). Understanding how these acute stressors interact with early adversities is crucial for assessing their long-term psychological impact. Accordingly, this study examines the extent to which these combined factors predict the development of full and subthreshold posttraumatic stress disorder (PTSD) over time.MethodsA cohort study was conducted following 296 HCWs from Saint George Hospital University Medical Center, with assessments at two timepoints: 6–7 months and 2–2.5 years after the Beirut Blast. PTSD symptoms were measured using the PCL-5, applying both full-threshold criteria and six definitions of subthreshold PTSD. Bivariable and multivariable analysis were conducted.ResultsAt 6–7 months, acute stressors (financial hardship, Beirut Blast, and COVID-19) were significantly associated with PTSD across most definitions. However, by 2–2.5 years, ACEs became the strongest and most consistent predictor of both full-threshold and subthreshold PTSD, while the impact of acute stressors diminished.ConclusionThe impact of acute trauma on the risk of PTSD fades over time, while early-life adversity has an enduring impact. The findings highlight the importance of including developmental trauma histories in PTSD assessments. In concordance with stress sensitization and neurobiological models, the results indicate a marked temporal shift, where the diminishing effects of acute stressors give way to the enduring role of early life adversity in shaping PTSD symptom trajectories.
Radically different