New Analytic Model to Better Identify Those at Risk of PTSD

Summary: Researchers have developed a new model that can predict the likelihood of a person developing PTSD after a shocking event.

Source: NYU Langone.

New findings from an international research team led by psychiatrists at NYU School of Medicine show that a newly-developed analytic model can predict soon after a shocking or scary event – and with significant accuracy — the likelihood of someone developing Post-Traumatic Stress Disorder (PTSD).

Patients in the study — who had experienced trauma ranging from traffic and workplace accidents to assaults and terrorist attacks — were initially evaluated using the Clinician-Administered PTSD Scale for DSM-IV (CAPS), considered the “gold standard” for assessing PTSD. All study participants had a CAPS interview within 60 days of their traumatic event and a follow-up interview four to 15 months later.

The researchers took these CAPS scores and then further analyzed them using the Brier Score, a measurement developed in the 1950s, as well as other validation methods to estimate of each individual’s risk of developing PTSD nine to 15 months later. They found that this approach could, indeed, predict chronic PTSD with high confidence and compute, with similar accuracy, additional risk associated with other factors such as sex, lower education or a lifetime experience of interpersonal trauma.

Specifically, the researchers found that PTSD prevalence after follow-up was on average 11.8 percent in those exposed to a traumatic event — 9.2 percent in men and 16.4 percent in women. They also found that the results in women with less than a secondary education and prior exposure to interpersonal trauma, such as child abuse or sexual assault, indicated a much higher risk of chronic PTSD. Other previously known risk factors such as age, marital status and type of trauma did not increase individuals’ the risk of developing PTSD.

Chronic PTSD is difficult to treat. Knowing soon after trauma exposure how likely a survivor will develop it may help those at significant risk. The findings, recently reported in the journal World Psychiatry, could assist health professionals identify and intercede more quickly with interventions for PTSD — such as cognitive behavioral therapy — that have been shown to be effective in treating the disorder, especially in the emergency room setting — where most victims of trauma are often first seen.

The published study includes an online tool allowing a clinician an immediate access to the risk estimate model.

“We are moving from the near impossible task of trying to predict who will develop PTSD to more accurately identifying a risk score for each individual who was exposed to a traumatic event,” says Arieh Y. Shalev, MD, the Barbara Wilson Professor of Psychiatry at NYU School of Medicine and lead author of the report. “Knowing that a person has an increased risk for PTSD will help mitigate it more rapidly, and with fewer residual consequences.”

Shalev adds: “Early symptoms, previously known to globally predict the risk of PTSD among trauma survivors (e.g., 11% in road traffic accidents or 38% following terror in our previous work) were unable to tell us who, within a group, was at particularly high risk. We now can precisely predict each individual’s risk, thus moving PTSD evaluation to a more personalized and individualized risk estimate.”

For example, Shalev points out, the new analysis model can help determine that a specific patient will likely (e.g., > 40%; 50%) remain with chronic PTSD unless treated, whereas another from the same study group may only have 2% risk. “It is a more immediate call for action that the previous group estimates could not provide,” he says.


A Comparable Tool to Those Used in Heart Disease and Cancer Diagnosis

Shalev and his colleagues, who are members of the International Consortium to Predict PTSD, analyzed medical records of nearly 2,500 patients in 10 longitudinal studies of civilian trauma survivors treated in emergency departments in the United States, Australia, Japan, the Netherlands, Switzerland and Israel. They were able to assign odds of likelihood of developing PTSD based on initial CAPS scores. The international source of their sample, and the relatively small differences between sources of data, increased the researchers’ confidence that the model can be generalized for a world-wide use.

The researchers add that the new PTSD evaluation model joins a large family of online tools used in other clinical areas, such as heart disease and cancer, to assign a likelihood of developing a disease or a recurrence based on current information (e.g., cholesterol, weight and smoking history in heart attacks). NeuroscienceNews.com image is in the public domain.

The researchers add that the new PTSD evaluation model joins a large family of online tools used in other clinical areas, such as heart disease and cancer, to assign a likelihood of developing a disease or a recurrence based on current information (e.g., cholesterol, weight and smoking history in heart attacks). In the case of PTSD, patients with higher initial CAPS scores could require earlier intervention, while lower scores might justify a “watchful waiting” approach with additional follow-up assessments.

In the United States, 70 percent of adults have experienced some type of trauma, and over 10 percent will go on to develop PTSD.

“Early symptom severity has shown to be a major predictor of PTSD risk, so enhanced evaluation provides a valid warning and a call for action,” Shalev says. “We hope that that quantifying individuals’ PTSD risk will be a first step toward systematic prevention of the disorder.”

About this neuroscience research article

Along with Shalev, authors from NYU School of Medicine were Eugene M. Laska, PhD, Willem F. van der Mei, MPH, and Wei Qi, MD, of the Department of Psychiatry. Other study authors were Martin Gevonden, PhD, at Vrije Universiteit Amsterdam; Andrew Ratanatharathorn, PhD, at Columbia University Medical Center; Sarah Lowe, PhD, at Montclair State University; Betty S. Lai, PhD, at Boston College; Richard A. Bryant, PhD, at University of New South Wales; Douglas Delahanty, PhD, at Kent State University; Yutaka J. Matsuoka, MD, PhD, at National Cancer Center Japan; Miranda Olff, PhD, at University of Amsterdamand Arq Psychotrauma Expert Group, The Netherlands; Ulrich Schnyder, MD, University of Zurich; Soraya Seedat, PhD, Stellenbosch University; Terri A. deRoon-Cassini, PhD, Medical College of Wisconsin; Ronald C. Kessler, PhD,Harvard Medical School; and Karestan C. Koenen, PhD, at Harvard T.H. Chan School of Public Health.

Funding: The research was funded by National Institutes of Health.

Source: Matt Prior – NYU Langone
Publisher: Organized by NeuroscienceNews.com.
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Open access research for “Estimating the risk of PTSD in recent trauma survivors: results of the International Consortium to Predict PTSD (ICPP)” by Arieh Y. Shalev, Martin Gevonden, Andrew Ratanatharathorn, Eugene Laska, Willem F. van der Mei, Wei Qi, Sarah Lowe, Betty S. Lai, Richard A. Bryant, Douglas Delahanty, Yutaka J. Matsuoka, Miranda Olf, Ulrich Schnyder, Soraya Seedat, Terri A. deRoon‐Cassini, Ronald C. Kessler, Karestan C. Koenen, and the International Consortium to Predict PTSD in World Psychiatry. Published January 2 2019.
doi:10.1002/wps.20608

Cite This NeuroscienceNews.com Article
NYU Langone “New Analytic Model to Better Identify Those at Risk of PTSD.” NeuroscienceNews. NeuroscienceNews, 11 January 2019.
<http://neurosciencenews.com/ptsd-model-10511/>.
NYU Langone(2019, January 11). New Analytic Model to Better Identify Those at Risk of PTSD. NeuroscienceNews. Retrieved January 11, 2019 from http://neurosciencenews.com/ptsd-model-10511/
NYU Langone “New Analytic Model to Better Identify Those at Risk of PTSD.” http://neurosciencenews.com/ptsd-model-10511/ (accessed January 11, 2019).

Abstract

Estimating the risk of PTSD in recent trauma survivors: results of the International Consortium to Predict PTSD (ICPP)

A timely determination of the risk of post‐traumatic stress disorder (PTSD) is a prerequisite for efficient service delivery and prevention. We provide a risk estimate tool allowing a calculation of individuals’ PTSD likelihood from early predictors. Members of the International Consortium to Predict PTSD (ICPP) shared individual participants’ item‐level data from ten longitudinal studies of civilian trauma survivors admitted to acute care centers in six countries. Eligible participants (N=2,473) completed an initial clinical assessment within 60 days of trauma exposure, and at least one follow‐up assessment 4‐15 months later. The Clinician‐Administered PTSD Scale for DSM‐IV (CAPS) evaluated PTSD symptom severity and diagnostic status at each assessment. Participants’ education, prior lifetime trauma exposure, marital status and socio‐economic status were assessed and harmonized across studies. The study’s main outcome was the likelihood of a follow‐up PTSD given early predictors. The prevalence of follow‐up PTSD was 11.8% (9.2% for male participants and 16.4% for females). A logistic model using early PTSD symptom severity (initial CAPS total score) as a predictor produced remarkably accurate estimates of follow‐up PTSD (predicted vs. raw probabilities: r=0.976). Adding respondents’ female gender, lower education, and exposure to prior interpersonal trauma to the model yielded higher PTSD likelihood estimates, with similar model accuracy (predicted vs. raw probabilities: r=0.941). The current model could be adjusted for other traumatic circumstances and accommodate risk factors not captured by the ICPP (e.g., biological, social). In line with their use in general medicine, risk estimate models can inform clinical choices in psychiatry. It is hoped that quantifying individuals’ PTSD risk will be a first step towards systematic prevention of the disorder.

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