Prevalence and psychometric screening for the detection of major depressive disorder and post-traumatic stress disorder in adults injured in a motor vehicle crash who are engaged in compensation

Abstract

BackgroundPhysical injury and psychological disorder following a motor vehicle crash (MVC) is a public health concern. The objective of this research was to determine rates of major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) in adults with MVC-related injury engaged in compensation, and to determine the capacity (e.g. sensitivity and specificity) of two psychometric scales for estimating the presence of MDD and PTSD.MethodsParticipants included 109 adults with MVC-related injury engaged in compensation during 2015 to 2017, in Sydney, Australia. The mean time from MVC to baseline assessment was 11 weeks. Comprehensive assessment was conducted at baseline, and the Depression Anxiety Stress Scales (DASS-21) and the Impact of Event Scale-Revised (IES-R) were administered to determine probable MDD and PTSD. An online psychiatric interview, based on Diagnostic and Statistical Manual for Mental Disorders (DSM-5), was used to diagnose actual MDD and PTSD, acknowledged as gold standard diagnostic criteria. One-way multivariate analyses of variance established criterion validity of the DASS-21 and IES-R, and sensitivity and specificity analyses were conducted to determine the most sensitive cut-off points for detecting probable MDD and PTSD.ResultsSubstantial rates of MDD (53.2%) and PTSD (19.3%) were found. The DASS-21 and IES-R were shown to have excellent criterion validity for detecting MDD and PTSD in injured participants. A range of cut-off points were investigated and shown to have acceptable sensitivity and specificity for detecting MDD and PTSD in an injured population engaged in compensation. The preferred cut-off points based on this study are: to detect MDD, a DASS-21 total score of 30 and/or a DASS-21 depression score of 10; to detect PTSD, IES-R scores of 33–40 and/or a DASS-21 anxiety score of 7–8.ConclusionsMajor psychological disorder is prevalent following a MVC. Results suggest the DASS-21 and IES-R are suitable for use in clinical/compensation settings to detect probable MDD and PTSD soon after a MVC in physically injured people engaged in compensation. These results provide positive direction in the public health arena for improving mental health outcomes.Trial RegistrationClinical Trials registration number: ANZCTR - ACTRN12615000326594 (9th April 2015).

Changing patterns in the prevalence of posttraumatic stress disorder, major depressive episode and generalized anxiety disorder over 24 months following a road traffic crash: Results from the UQ SuPPORT study

“…We also examined whether the identification of subclinical PTSD could identify participants at risk of future psychological disorders. Although our sample size was small (n = 13), we found that early subclinical PTSD was similar to clinical PTSD in terms of its relationship to having any Research has reported that premorbid psychiatric problems is associated with poor post-injury outcomes [38][39][40]. In the current study, 25% of respondents reported a history of psychological diagnosis, which is similar to the 12-month prevalence of psychological disorders in the Australian general population [41].…”

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study

“…Traumatic injury can be a significant precipitating event for developing posttraumatic stress disorder (PTSD; e.g. [4][5][6][7],), which, in its chronic form, is tenacious and debilitating [8,9], and which early cognitive behavioral interventions may efficiently mitigate [10][11][12][13].…”

Outcomes after traffic injury: mental health comorbidity and relationship with pain interference

“…These results strongly confirm that people sustaining minor-to-moderate traffic injury face high risks of mental distress and pain -related interference with various activities of daily living. After four weeks post-injury, over 80% reported their pain interfered with daily functioning, over 30% had clinically elevated PTS symptoms and almost 30% had clinically elevated DM, reflecting a high probability of meeting diagnostic criteria for PTSD and MDD disorders respectively [21]. As expected, these rates reduced with time, however, at 12 months post-injury over 40% continued to report that pain was limiting their daily functioning and many still reported elevated depressive mood and/or traumatic stress symptoms (i.e.…”

“…Post-injury rates of mental disorder have been reported in the range of 30%-50%. [5,14,20,21] Individual course and relationships over time between multiple problems are best captured by personcentred analysis, such as growth mixture models. [11,22] A few studies have now examined trajectories of mental health following injury [18,[23][24][25][26][27].…”

“…Based on available norms, a total mean score of ≥4.5 (i.e. ≥33 of the total score of 88) represents clinically elevated PTS, that is, a probable PTSD diagnosis[21,53].Depressive mood (DM) symptoms. The 7-item depression subscale of the Depression Anxiety Stress Scale-21 (DASS-21) was used to assess the presence of DM symptoms at 1, 6 and 12-months post-injury via phone interviews.…”