Appropriateness of DSM-III-R criteria for posttraumatic stress disorder

Psychiatric morbidity following a natural disaster: an Australian bushfire

This study investigated the prevalence of mental health problems after a major bushfire in Australia and examined the validity of the General Health Questionnaire (GHQ) (Goldberg 1978) against the Anxiety, Affective and Post-Traumatic Stress Disorder modules of the Diagnostic Interview Schedule (DIS; Robins et al. 1981). Study 1 was carried out 12 months after the Ash Wednesday bushfires and sought to include all the victims of the fires. Study 2 was conducted 20 months after the fires and included a sample of victims who had experienced major losses in the fires. Twelve months after the fires, 42% (n = 1,526) of the victims were defined as a potential psychiatric case using the GHQ. This rate indicated a significantly greater level of morbidity than found in communities that have not experienced a natural disaster. Twenty months after the fires, 23% (n = 43) were defined as "cases". The 28-item GHQ was found to be a valid instrument for defining the presence of psychiatric disorder in a disaster-effected community. The findings demonstrated that lasting psychiatric morbidity is associated with natural disasters.

Psychological factors affecting health after toxicological disasters

Exposure to toxic substances in the environment is an ever more common event, that may cause physical as well as psychological harm. When an entire community is exposed, the term 'toxicological disaster' is used. The mere threat of such an event may be a source of stress, associated with changes in mental health, physical health, and changes in health-related behaviors. A review is presented of the literature about the effects of the stressful experience of toxicological disasters on health and health-related behaviors. Three questions are examined: (a) do toxicological disasters represent a specific type of stressor, different from other stressors?; (b) which stress-mediated health effects have been observed in the aftermath of toxicological disasters? and (c) is there evidence for a higher vulnerability in certain identifiable risk groups? On the basis of the available literature, it is concluded that toxicological disasters may have profound effects on subjective health, especially on symptom reporting, and on a number of psychophysiological parameters. Evidence for a substantial impact of disaster-related stress on either physical or psychiatric morbidity remains inconclusive. In this respect toxicological disasters do not appear to differ from other stressors. There is some evidence that toxicological disasters may have a more pronounced effect on health-related behaviors, especially on reproductive behavior (number of births and abortions). Women, and especially those who have young children to care for, appear to be more at risk for the observed health effects. The evidence for a higher vulnerability in other risk groups (e.g., former psychiatric patients remains inconclusive.

The clinical boundaries of posttraumatic stress disorder

Three sets of clinical boundaries exist for posttraumatic stress disorder (PTSD), as for all concepts of psychiatric disorder. The first involves the border with normal psychology in general, and with the normal psychology of stress response in particular. This boundary can be surveyed from a number of vantage points and the maps which result will not necessarily correspond. The second boundary issue involves internal boundaries between psychiatric disorders, specifically between PTSD and other concepts of disorder. The high level of comorbidity documented in PTSD has ensured that this aspect of boundary setting is particularly contentious. The third set of boundaries is concerned with subtyping within the global construct of PTSD. The validity and extent of subtyping would be based on the degree to which phenomenological differences exist in relation to PTSD syndromes occurring in the wake of certain types of traumatic events. Such clinical subtyping might however need to be buttressed by external validity indicators such as differential treatment responses or outcome. A final boundary issue of major significance to therapists involves the need to place oneself unambiguously on the side of the trauma survivor in the struggle to resolve the traumatic experiences. The pivotal position of PTSD in the psychopathological arena is discussed.

Posttraumatic stress disorder in adolescents after Hurricane Andrew

OBJECTIVE

To examine rates and correlates of posttraumatic stress disorder (PTSD) in adolescents after Hurricane Andrew.

METHOD

A random-digit dialing sample of 158 Hispanic, 116 black, and 104 white adolescent-parent pairs were surveyed in high- and low-impact areas within Dade County, Florida, 6 months after Hurricane Andrew. Subjects completed a structured telephone interview focused on within-disaster experiences and emotional reaction, disaster-related losses, lifetime exposure to violent or traumatic events, recent stressful experiences, and psychiatric symptomatology.

RESULTS

Approximately 3% of males (95% confidence interval 0.4 to 5.3) and 9% of females (95% confidence interval 4.6 to 13.7) met the criteria for PTSD. Rates were highest among blacks (8.3%, 95% confidence interval 2.3 to 14.2) and Hispanics (6.1%, 95% confidence interval 2.2 to 9.9) and increased with age (odds ratio of 1.34, 95% confidence interval 1.04 to 1.72) and the number of undesirable events reported (odds ratio of 1.38, 95% confidence interval 1.21 to 1.57).

CONCLUSIONS

While only a relatively small percentage of adolescents reported symptoms consistent with a diagnosis of PTSD, most reported some posttraumatic symptoms. Postdisaster planning should recognize that common stressful events occurring after disasters may be more strongly associated with PTSD than magnitude of contact with the actual disaster.

Life after trauma: personality and daily life experiences of traumatized people

In this study, we explored differences in personality and daily life experiences of traumatized (n = 26) versus nontraumatized (n = 30) college students. Study participants completed a variety of personality measures as well as a 28-day experience sampling study assessing daily activities, emotions, and physical health. Although not differing on general demographics, traumatized individuals reported more trait anxiety and lower self-esteem than nontraumatized individuals. They scored higher on Neuroticism, were more introverted, and were less emotionally stable than nontraumatized participants. Traumatized individuals also reported more cognitive disturbances, emotional blunting, and interpersonal withdrawal. They did not report being more depressed, but did endorse cognitive styles associated with heightened risk for depression. Earlier age of trauma was associated with more pathological outcomes: lower self-esteem and psychological well-being, more anxiety, more pessimism, and emotional constriction of positive mood. We compare this symptom profile to that of posttraumatic stress disorder.

A trial of eye movement desensitization compared to image habituation training and applied muscle relaxation in post-traumatic stress disorder

Thirty-six patients with PTSD were randomly allocated to individual treatment with imaginal exposure (image habituation training -- IHT), or applied muscle relaxation (AMR) or eye movement desensitization (EMD). Assessment by a blind independent rater and self-report instruments applied pre and posttreatment and at 3-month follow-up indicated that all groups improved significantly compared with a waiting list and that treatment benefits were maintained at follow-up. Despite a failure to demonstrate differences among groups, there was some suggestion that immediately after treatment EMD was superior for intrusive memories.

Social facts and the sociological imagination: the contributions of sociology to psychiatric epidemiology

This paper provides a conceptual framework for understanding the relationship of psychiatry, epidemiology, and sociology. After a section on definitions, seven empirical contributions by sociologists to the field of psychiatric epidemiology are briefly presented to illustrate the notion of the social fact (contributions by Durkheim, Dunham, Hollingshead, Srole and Langner, Kerckhoff and Back, Dohrenwend, and Brown). Four broad sociological theories are reviewed, as illustrations of the sociological imagination (stratification theory, the idea of Verstehen, symbolic interactionism, and the sociology of knowledge). It is concluded that two major contributions of sociology to psychiatric epidemiology are the concepts and data related to the social fact, and the possibilities offered by the sociological imagination.

Undiagnosed post-traumatic stress disorder following motor vehicle accidents

OBJECTIVES

To determine the pattern of emergence of post-traumatic stress disorder (PTSD) among motor vehicle accident victims and to examine the influence of PTSD on subsequent levels of disability.

DESIGN

A longitudinal study of motor vehicle accident victims one month and 18 months after the accident.

SUBJECTS

Twenty-four motor vehicle accident victims admitted by the trauma team at the Royal Adelaide Hospital. A 52% response rate was achieved.

MAIN OUTCOME MEASURES

Post-traumatic stress disorder as diagnosed by the Diagnostic Interview Schedule and disability as measured with the Sickness Impact Profile.

RESULTS

Eighteen months after their accidents, six of the 24 subjects had clinically significant PTSD and one was considered borderline. None had been previously diagnosed or treated. The group with PTSD had higher scores on all measures of psychological distress one month after the accident and were more likely to use immature psychological defences. There was no association between physical outcome (measured with the modified Glasgow Outcome Scale) at six months and subsequent diagnosis of PTSD. However, the group with PTSD had higher levels of disability on assessment with the Sickness Impact Profile, particularly in the domain of social functioning. The results suggest PTSD was associated with work-related dysfunction equal to that associated with severe physical handicap.

CONCLUSION

The data from this pilot study suggest that PTSD after motor vehicle accidents is an important cause of disability, which may also become the focus for damages in litigation. Thus, there is a need for further investigation of the early patterns of distress and to design preventive programs for victims of road accidents.