1
|
Schultebraucks K, Stevens JS, Michopoulos V, Maples-Keller J, Lyu J, Smith RN, Rothbaum BO, Ressler KJ, Galatzer-Levy IR, Powers A. Development and validation of a brief screener for posttraumatic stress disorder risk in emergency medical settings. Gen Hosp Psychiatry 2023; 81:46-50. [PMID: 36764261 PMCID: PMC10866012 DOI: 10.1016/j.genhosppsych.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Predicting risk of posttraumatic stress disorder (PTSD) in the acute care setting is challenging given the pace and acute care demands in the emergency department (ED) and the infeasibility of using time-consuming assessments. Currently, no accurate brief screening for long-term PTSD risk is routinely used in the ED. One instrument widely used in the ED is the 27-item Immediate Stress Reaction Checklist (ISRC). The aim of this study was to develop a short screener using a machine learning approach and to investigate whether accurate PTSD prediction in the ED can be achieved with substantially fewer items than the IRSC. METHOD This prospective longitudinal cohort study examined the development and validation of a brief screening instrument in two independent samples, a model development sample (N = 253) and an external validation sample (N = 93). We used a feature selection algorithm to identify a minimal subset of features of the ISRC and tested this subset in a predictive model to investigate if we can accurately predict long-term PTSD outcomes. RESULTS We were able to identify a reduced subset of 5 highly predictive features of the ISRC in the model development sample (AUC = 0.80), and we were able to validate those findings in the external validation sample (AUC = 0.84) to discriminate non-remitting vs. resilient trajectories. CONCLUSION This study developed and validated a brief 5-item screener in the ED setting, which may help to improve the diagnostic process of PTSD in the acute care setting and help ED clinicians plan follow-up care when patients are still in contact with the healthcare system. This could reduce the burden on patients and decrease the risk of chronic PTSD.
Collapse
Affiliation(s)
- K Schultebraucks
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA; Department of Population Health, NYU Grossman School of Medicine, New York, USA.
| | - J S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA; Center for Visual and Neurocognitive Rehabilitation, Atlanta Veterans' Affairs Health Care System, Atlanta, GA, USA
| | - V Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - J Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - J Lyu
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - R N Smith
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Behavioral, Social and Health Education Sciences, Emory University School of Public Health, Atlanta, GA, USA
| | - B O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - K J Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; McLean Hospital, Belmont, MA, USA
| | - I R Galatzer-Levy
- Department of Psychiatry, NYU Grossman School of Medicine, New York, USA
| | - A Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
2
|
Kaczmarczyk M, Spitzer C, Wingenfeld K, Wiedemann K, Kühl L, Schultebraucks K, Otte C. No association between major depression with and without childhood adversity and the stress hormone copeptin. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0039-3403002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - C Spitzer
- Charité Universitätsmedizin, Berlin, Germany
| | | | - K Wiedemann
- Charité Universitätsmedizin, Berlin, Germany
| | - L Kühl
- Charité Universitätsmedizin, Berlin, Germany
| | | | - C Otte
- Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
3
|
Kaczmarczyk M, Otte C, Wiedemann K, Kuehl LK, Schultebraucks K, Spitzer C, Wingenfeld K. Major depression and atrial natriuretic peptide: The role of adverse childhood experiences. Psychoneuroendocrinology 2019; 101:7-11. [PMID: 30391559 DOI: 10.1016/j.psyneuen.2018.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 01/04/2023]
Abstract
Atrial natriuretic peptide (ANP) exerts anxiolytic effects in animals and humans. Patients with anxiety, trauma-associated and depressive disorders exhibit lower ANP plasma levels compared to healthy individuals. However, the role of ANP in patients with major depressive disorder (MDD) with and without concomitant adverse childhood experiences (ACE) and in healthy individuals with and without ACE is not clear. We recruited a total of 93 women: 23 women with MDD and ACE, 24 women with MDD without ACE, 22 women with ACE but no current or lifetime MDD, and 24 healthy women without ACE. ANP plasma levels were measured with a radioimmunoassay. The four groups did not differ in demographic and clinical variables. We found a positive correlation between age and plasma levels of ANP (r = .39; p < .001). After controlling for age, there was no significant main effect of MDD or ACE on ANP plasma levels, but a significant interaction between MDD and ACE such that ACE was associated with reduced basal ANP levels in the absence of MDD. We assume that low plasma ANP might be a consequence of ACE in the absence of current psychopathology. Therefore, future studies are needed to replicate our findings and to characterize the influencing factors of ACE on ANP more comprehensively, for example by including a comprehensive trauma and comorbidity anamnesis as well as cardiovascular state and risk factors.
Collapse
Affiliation(s)
- M Kaczmarczyk
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - C Otte
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - K Wiedemann
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
| | - L K Kuehl
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany
| | - K Schultebraucks
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany; Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - C Spitzer
- Asklepios Fachklinikum Tiefenbrunn, Rosdorf, Germany
| | - K Wingenfeld
- Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany.
| |
Collapse
|
4
|
Schultebraucks K, Wingenfeld K, Quinkler M, Otte C. Cognitive function in patients with primary adrenal insufficiency (Addison's disease). Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|