Unmasking deep-rooted trauma: long-term effects of childhood adversities on posttraumatic stress disorder in healthcare workers facing acute multi-trauma.

Purpose: In 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. Methods: A 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. Results: At 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. Conclusion: The 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.