PREDICTORS OF PTSD IN INJURED TRAUMA SURVIVORS - A PROSPECTIVE-STUDY

Objective: The aim of this study was to prospectively examine the rela tionship between immediate and short-term responses to a trauma and th e subsequent development of posttraumatic stress disorder (PTSD). Meth od: All patients consecutively admitted to a general hospital were scr eened for the presence of physical injury due to a traumatic event. Fi fty-one eligible subjects were assessed 1 week and 6 months after the trauma. The initial assessment included measures of event severity, pe ritraumatic dissociation, and symptoms of intrusion, avoidance, depres sion, and anxiety. The follow-up assessments added the PTSD module of the Structured Clinical Interview for DSM-III-R-Non-Patient Version an d the civilian trauma version of the Mississippi Scale for Combat-Rela ted Posttraumatic Stress Disorder. Results: Thirteen subjects (25.5%) met PTSD diagnostic criteria at follow-up. Subjects who developed PTSD had higher levels of peritraumatic dissociation and more severe depre ssion anxiety, and intrusive symptoms at the 1-week assessment. Peritr aumatic dissociation predicted a diagnosis of PTSD after 6 months over and above the contribution of other variables and explained 29.4% of variance of PTSD symptom intensity. Initial scores on the Impact of Ev ent Scale predicted PTSD status with 92.3% sensitivity and 34.2% speci ficity. Symptoms of avoidance that were initially very mild intensifie d in the subjects who developed PTSD. Conclusions: Peritraumatic disso ciation is strongly associated with the later development of PTSD. Ear ly dissociation and PTSD symptoms can help the clinician identify subj ects at higher risk for developing PTSD.