Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents

Abstract

The present study aimed to utilize a Receiver Operating Characteristic (ROC) approach in order to improve clinical decision-making for adolescents at risk for the development of psychopathology in the aftermath of a natural disaster. Specifically we assessed theoretically-driven individual, interpersonal, and event-related vulnerability factors to determine which indices were most accurate in forecasting PTSD. Furthermore, we aimed to translate these etiological findings by identifying clinical cut-off recommendations for relevant vulnerability factors. Our study consisted of structured phone-based clinical interviews with 2,000 adolescent-parent dyads living within a 5-mile radius of tornados that devastated Joplin, MO, and northern Alabama in Spring 2011. Demographics, tornado incident characteristics, prior trauma, mental health, and family support and conflict were assessed. A subset of youth completed two behavioral assessment tasks online to assess distress tolerance and risk taking behavior. ROC analyses indicated four variables that significantly improved PTSD diagnostic efficiency: Lifetime depression (AUC=.90), trauma history (AUC=.76), social support (AUC=.70), and family conflict (AUC=.72). Youth were 2–3 times more likely to have PTSD if they had elevated scores on any of these variables. Of note, event-related characteristics (e.g., property damage) were not related to PTSD diagnostic status. The present study adds to the literature by making specific recommendations for empirically-based, efficient disaster-related PTSD assessment for adolescents following a natural disaster. Implications for practice and future trauma-related developmental psychopathology research are discussed.

Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study

“…Previous researchers speculate that effects of psychiatric comorbidity on doctor-patient communication might play a role [14], and psychological or social factors associated with PTSD as either risk factors or symptoms might influence how timely and successfully a patient responds to symptoms of illness, influencing their clinical course [47,52,53].…”

The relationship between social support and posttraumatic stress symptoms among youth exposed to a natural disaster

“…At the same time, social support may be an important protective factor that buffers children from experiencing significant symptoms of distress (Jieling & Xinchun, 2017; Ma et al, 2011). Inadequate social support is a significant risk factor for PTSS in response to multiple types of disasters, including floods, tornados, hurricanes, earthquakes, fires, and man-made disasters (Bokszczanin, 2008, 2012; Danielson et al, 2017; La Greca et al, 2013). This is an important association among adults as well, as demonstrated by a meta-analysis of risk factors for Posttraumatic Stress Disorder among adults, which found lack of social support to have stronger effects than pre-trauma factors on Posttraumatic Stress Disorder (Brewin, Andrews, & Valentine, 2000).…”

Effects of extreme weather events on child mood and behavior

“…18 Though associations between general trauma and adolescent substance abuse have been more firmly established, 20 several reports have implicated EWE-specific trauma as a risk factor for substance abuse. [21][22][23] Childhood disaster exposure is also associated with attachment security. 20,24 A study of children affected by the 1983 Ash Wednesday bushfires in Australia is illustrative.…”

“…7 Likewise, presence of parents at the time of a disaster was identified as protective with respect to adolescent substance abuse in a study of the Spring of 2011 tornadoes in the United States. 21 The impact on childhood learning is an additional and important consideration in the aftermath of an EWE. Diminished academic performance has been observed in EWE-affected children and appears to be correlated with the degree/severity of exposure and resultant emotional distress.…”