Who Develops Acute Stress Disorder after Accidental Injuries?

Abstract

Background: Acute stress disorder (ASD) is still a much discussed diagnosis, and research on predictors of ASD is sparse. The aim of this study was to assess the prevalence of ASD in a random sample of accident victims and to investigate the associations between different independent variables and ASD symptomatology with the objective to find a regression model best explaining the variance in ASD symptom level. Methods: We collected a randomized sample of hospitalized accident victims (n = 323). ASD was assessed using the Peritraumatic Dissociative Experiences Questionnaire and the Clinician-Administered Posttraumatic Stress Disorder Scale. Correlations and multiple regression analyses were computed with four groups of variables. This yielded the variables entered into a final multiple regression analysis. Results: Thirteen patients (4.0%) met all criteria for a diagnosis of ASD. Thirty-two patients (9.9%) met the criteria for a diagnosis of subsyndromal ASD. Thirty-eight percent of the variance in ASD symptom level was explained with a regression model including stay at the intensive care unit, preexisting psychiatric disorder, sense of coherence, sense of death threat, appraisal of accident severity, preventability of the accident by others, pain and appraisal of coping ability regarding physical recovery. Conclusions: This study furthers the discussion about the requirements for the ASD diagnosis. It also points to the importance of not only assessing objective accident-related variables in the aftermath of an accident but also of giving more consideration to the subjective experience and appraisal of the accident in the prevention of ASD.

Coping with Serious Accidental Injury: A One-Year Follow-Up Study

“…The high SOC scores in the LSG correspond to the concept of the SOC as an indicator for an individual’s capacity to adequately respond to a stressor by means of appropriate and diverse coping strategies and is in accordance with the literature [3, 41]. Patients scoring high on the SOC can probably accept their situation better than those with low SOC scores.…”

“…We have reported that the patients’ appraisal of the severity of their accident, and of their ability to cope with the accident, made a substantial contribution to their time off work due to the accident, independent of the objective severity of the injuries [45]. This finding is consistent with results of another sample of accident victims [3], and highlights the importance of subjective factors in the pathogenesis of posttraumatic disturbances. Malt [6] stated that it is the personal meaning and the implication of the injury, rather than external threats that are crucial for the ongoing appraisals and thus ultimately for coping.…”

“…While the development of posttraumatic stress symptoms does not necessarily correlate with objective measures of injury severity [1, 2], the patient’s subjective appraisal of an accident and its sequelae appears to be an important outcome predictor [3]. Individual risk factors play an important role and are well investigated [4], while protective factors and resilience are less researched.…”

Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: A longitudinal study

“…Since no validated assessment tool for ASD was available at the time of this study, ASD symptoms were assessed using a combination of items from the CAPS and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) (Fuglsang et al 2002). The PDEQ rater version (Marmar et al 1997) is a 10-item interview for the assessment of peritraumatic dissociation.…”

Comorbidity in posttraumatic stress disorder: a structural equation modelling approach

“…By this procedure an ASD score was obtained with a maximum range from 0 to 17 which showed a satisfactory internal consistency [Cronbach's alpha =.68; for further details see 35].…”