A predictive screening index for posttraumatic stress disorder and depression following traumatic injury.

Abstract

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling consequences of surviving severe injury. The majority of those who develop these problems are not identified or treated. The aim of this study was to develop and validate a screening instrument that identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized injury patients (n = 527) completed a pool of questions that represented 13 constructs of vulnerability. They were followed up at 12 months and assessed for PTSD and MDE. The resulting database was split into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample. Receiver-operating characteristic curves were then created. The resulting Posttraumatic Adjustment Scale had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.

Categorical and dimensional study of the predictive factors of the development of a psychotrauma in victims of car accidents

“…Indeed, factors occurring after the trauma, such as cognitive and emotional adaptation strategies, are involved in the development of PTSD and can modulate the effects of the peritraumatic events (Ehring et al, 2008;Jeavons, Horne, & Greenwood, 2000;O'Donnell et al, 2008;Donnell, Elliott, Wolfgang, & Creamer, 2007).…”

Diagnostic accuracy of the trauma screening questionnaire after the 2005 London bombings

“…Recently screening instruments have been developed that draw on a wider pool of items (e.g., O'Donnell et al, 2008;Winston, Kassam-Adams, Garcia-Espana, Ittenbach, & Cnaan, 2003). Symptom-based instruments have the advantage, however, that they may be applicable across a wider range of potentially traumatic events, and there is as yet no evidence that they are less effective at screening than more broadly based instruments.…”

Clinical Considerations for the Diagnosis of Major Depression After Moderate to Severe TBI

“…91 Surrogate markers for a history of psychiatric problems (eg, seeking professional help for emotional problems) or traumatic events (eg, assault, sexual abuse, combat duty) have been shown to be significant risk factors for depression in both the TBI and general populations. 58,79 Less education 14,16,90 and lower IQ scores 92 have been implicated in higher depression rates after TBI, but 2 studies using DSM MD criteria found no effects for education. 6,19 In the general population, no differences in lifetime prevalence of MD was found among levels of education, but persons with 0-11 years' education had higher 12-month MD rates (OR 1.9, CI 1.3-2.8).…”

“…25 Persons who reported irritability and anger soon after injury were at greater risk for developing post-TBI MD. 58 In the general population, impulse control disorders (16.6%, CI 13.0%-20.2%) were the second most common cooccurring disorder in persons with depression. 55 MD in the general population was a temporal antecedent of impulse control disorders in only 20.8% (CI 14.2%-27.3%) of cases.…”