A Risk Assessment Tool to Predict Sustained PTSD Symptoms Among Women Reporting Abuse

Derivation and validation of risk prediction for posttraumatic stress symptoms following trauma exposure

BACKGROUND

Posttraumatic stress symptoms (PTSS) are common following traumatic stress exposure (TSE). Identification of individuals with PTSS risk in the early aftermath of TSE is important to enable targeted administration of preventive interventions. In this study, we used baseline survey data from two prospective cohort studies to identify the most influential predictors of substantial PTSS.

METHODS

Self-identifying black and white American women and men (n = 1546) presenting to one of 16 emergency departments (EDs) within 24 h of motor vehicle collision (MVC) TSE were enrolled. Individuals with substantial PTSS (⩾33, Impact of Events Scale - Revised) 6 months after MVC were identified via follow-up questionnaire. Sociodemographic, pain, general health, event, and psychological/cognitive characteristics were collected in the ED and used in prediction modeling. Ensemble learning methods and Monte Carlo cross-validation were used for feature selection and to determine prediction accuracy. External validation was performed on a hold-out sample (30% of total sample).

RESULTS

Twenty-five percent (n = 394) of individuals reported PTSS 6 months following MVC. Regularized linear regression was the top performing learning method. The top 30 factors together showed good reliability in predicting PTSS in the external sample (Area under the curve = 0.79 ± 0.002). Top predictors included acute pain severity, recovery expectations, socioeconomic status, self-reported race, and psychological symptoms.

CONCLUSIONS

These analyses add to a growing literature indicating that influential predictors of PTSS can be identified and risk for future PTSS estimated from characteristics easily available/assessable at the time of ED presentation following TSE.

Literature review and methodological considerations for understanding circulating risk biomarkers following trauma exposure

Exposure to traumatic events is common. While many individuals recover following trauma exposure, a substantial subset develop adverse posttraumatic neuropsychiatric sequelae (APNS) such as posttraumatic stress, major depression, and regional or widespread chronic musculoskeletal pain. APNS cause substantial burden to the individual and to society, causing functional impairment and physical disability, risk for suicide, lost workdays, and increased health care costs. Contemporary treatment is limited by an inability to identify individuals at high risk of APNS in the immediate aftermath of trauma, and an inability to identify optimal treatments for individual patients. Our purpose is to provide a comprehensive review describing candidate blood-based biomarkers that may help to identify those at high risk of APNS and/or guide individual intervention decision-making. Such blood-based biomarkers include circulating biological factors such as hormones, proteins, immune molecules, neuropeptides, neurotransmitters, mRNA, and noncoding RNA expression signatures, while we do not review genetic and epigenetic biomarkers due to other recent reviews of this topic. The current state of the literature on circulating risk biomarkers of APNS is summarized, and key considerations and challenges for their discovery and translation are discussed. We also describe the AURORA study, a specific example of current scientific efforts to identify such circulating risk biomarkers and the largest study to date focused on identifying risk and prognostic factors in the aftermath of trauma exposure.

Factors associated with common mental health problems of humanitarian workers in South Sudan

BACKGROUND

The latest data on major attacks against civilian aid operations have identified South Sudan as the most dangerous country for aid workers globally. Exposure to other traumatic events and chronic stress is also common in this population. No research exists on the mental health of humanitarian workers in South Sudan.

OBJECTIVES

This study examined symptom burden and predictors of posttraumatic stress disorder (PTSD), depression, anxiety, hazardous alcohol consumption, and burnout among humanitarian workers in South Sudan.

METHOD

We conducted a cross-sectional online survey with humanitarian workers (national and international staff, consultants, United Nations volunteers). We applied validated measures useful for this setting. We applied Least Absolute Shrinkage and Selection Operator (LASSO) regression to fit models with high prediction accuracy for each outcome and used ordinary least squares (OLS) regression to obtain final coefficients and perform inference.

RESULTS

A total of 277 humanitarian workers employed by 45 organizations completed the survey (a response rate in the order of 10%). We estimated prevalence of PTSD (24%), depression (39%), anxiety disorder (38%), hazardous alcohol consumption in men (35%) and women (36%), and the burnout components emotional exhaustion (24%) and depersonalization (19%). Chronic stress exposure was positively associated with PTSD (p < .001), depression (p < .001), anxiety (p < .001), emotional exhaustion (p < .01), and depersonalization (p < .001). We found no significant association between emotion focused and problem focused coping and mental health outcomes. Associations between dysfunctional coping and depression (p < .001) and anxiety (p < .01) were positive. Higher levels of spirituality were associated with lower risk of hazardous alcohol consumption (p < .001). Contrary to expectations, working directly with humanitarian aid beneficiaries was significantly associated with lower risk for emotional exhaustion (p < .01).

CONCLUSION

Our results suggest that humanitarian workers in South Sudan experience substantial levels of mental ill-health. This study points to the need for staff support strategies that effectively mitigate humanitarian workers' chronic stress exposure. The dynamics between coping and mental health among humanitarian workers require further study.