ACUTE STRESS DISORDER, SUBSEQUENT POSTTRAUMATIC-STRESS-DISORDER AND DEPRESSION AFTER A SERIES OF TYPHOONS

From August to November 1992, five typhoons struck the U.S. Pacific is land territory of Guam. Three hundred and twenty subjects exposed to a ll five typhoons participated in a population survey measuring their a cute stress symptoms and subsequent diagnoses of posttraumatic stress disorder (PTSD) and depression. A 23-item scale approximating the new DSM-IV diagnosis of acute stress disorder (ASD) was used to classify s ubjects into three groups based on their symptoms one week after the f irst typhoon: (I) probable ASD, (2) an early traumatic stress response (ETSR) of fear intrusion, avoidance, and arousal, without dissociatio n, and (3) no acute diagnosis. A multi-dimensional measure of PTSD and the Zung Self-Rating Depression Scale were used to assess PTSD and de pression 8 months after the first storm. The point prevalence of ASD a t one week was 7.2%. An additional 15% of subjects had ETSR. Subjects with probable ASD at one week had significantly increased rates of PTS D and somewhat higher rates of depression at 8 months than those witho ut ASD. In contrast, subjects with ETSR at one week did not have a poo rer outcome than those with no acute diagnosis. These findings suggest that ASD is prognostically important, but also indicate that all acut e stress symptoms do not have the same discriminative value. lit this study, the acute dissociative symptoms of emotional numbing and dereal ization differentiated highly symptomatic subjects at risk for subsequ ent psychopathology (ASD) from others who were highly symptomatic at o ne week, but then had a more benign, posttraumatic course (ETSR). (C) 1996 Wiley-Liss, Inc.