Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents.
Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents.
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DOI：
10.1007/s10802-016-0159-3
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发表时间：
2017-01
影响因子：
3.6
通讯作者：
Ruggiero, Kenneth J.
中科院分区：
文献类型：
--
作者：
Danielson, Carla Kmett;Cohen, Joseph R.;Adams, Zachary W.;Youngstrom, Eric A.;Soltis, Kathryn;Amstadter, Ananda B.;Ruggiero, Kenneth J.
本研究旨在利用受试者操作特征(ROC)方法来改善自然灾害后易患精神病的青少年的临床决策。具体地说，我们评估了理论驱动的个人、人际关系和事件相关的易感性因素，以确定哪些指数在预测创伤后应激障碍方面最准确。此外，我们的目标是通过确定相关易感因素的临床截止建议来翻译这些病因学发现。我们的研究包括对生活在2011年春季摧毁密苏里州乔普林和阿拉巴马州北部的龙卷风半径5英里范围内的2000名青少年-父母二人组的结构化电话临床采访。评估了人口统计学、龙卷风事件特征、既往创伤、心理健康以及家庭支持和冲突。一组年轻人在网上完成了两项行为评估任务，以评估承受痛苦和冒险行为。ROC分析表明，四个变量显著提高了创伤后应激障碍的诊断效率：终生抑郁(AUC=0.90)、创伤史(AUC=0.76)、社会支持(AUC=0.70)和家庭冲突(AUC=0.72)。如果年轻人在这些变量中的任何一个上得分较高，他们患创伤后应激障碍的可能性是后者的2-3倍。值得注意的是，与事件相关的特征(例如，财产损坏)与创伤后应激障碍的诊断状态无关。本研究通过为自然灾害后的青少年提供基于经验的、有效的与灾害相关的创伤后应激障碍评估的具体建议来补充文献。对实践和未来与创伤相关的发展精神病理学研究的意义进行了讨论。
The present study aimed to utilize a Receiver Operating Characteristic (ROC) approach in order to improve clinical decision-making for adolescents at risk for the development of psychopathology in the aftermath of a natural disaster. Specifically we assessed theoretically-driven individual, interpersonal, and event-related vulnerability factors to determine which indices were most accurate in forecasting PTSD. Furthermore, we aimed to translate these etiological findings by identifying clinical cut-off recommendations for relevant vulnerability factors. Our study consisted of structured phone-based clinical interviews with 2,000 adolescent-parent dyads living within a 5-mile radius of tornados that devastated Joplin, MO, and northern Alabama in Spring 2011. Demographics, tornado incident characteristics, prior trauma, mental health, and family support and conflict were assessed. A subset of youth completed two behavioral assessment tasks online to assess distress tolerance and risk taking behavior. ROC analyses indicated four variables that significantly improved PTSD diagnostic efficiency: Lifetime depression (AUC=.90), trauma history (AUC=.76), social support (AUC=.70), and family conflict (AUC=.72). Youth were 2–3 times more likely to have PTSD if they had elevated scores on any of these variables. Of note, event-related characteristics (e.g., property damage) were not related to PTSD diagnostic status. The present study adds to the literature by making specific recommendations for empirically-based, efficient disaster-related PTSD assessment for adolescents following a natural disaster. Implications for practice and future trauma-related developmental psychopathology research are discussed.
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