Peritraumatic Distress Inventory Research Articles

The Peritraumatic Distress Inventory: Factor structure and predictive validity in traumatically injured patients admitted through a Level I trauma center

Peritraumatic distress is defined as the emotional and physiological distress experienced during and/or immediately after a traumatic event and is associated with the development and severity of posttraumatic stress disorder (PTSD) and related psychological difficulties. The Peritraumatic Distress Inventory (PDI) is a widely-used self-report measure for which psychometric evaluation has been limited. This study sought to assess the factor structure and predictive validity of the PDI with a clinical sample of 600 traumatically injured patients admitted to a Level I trauma center, 271 of whom completed a phone-based PTSD screening ∼30-days post-injury. The results confirmed previously proposed one- and two-factor solutions for the PDI. PDI scores predicted PTSD severity and positive PTSD screens (i.e., clinically elevated vs. non-elevated). Data suggested an optimal cutoff score of 23 (sensitivity = 71%; specificity = 73%) for predicting clinically elevated PTSD 30-days post-injury. This study provides further evidence supporting the PDI as a valid and reliable measure of peritraumatic distress and a useful clinical tool with significant prognostic value.

Prediction of Posttraumatic Stress Disorder From Peritraumatic Dissociation and Distress Among Men and Women Victims of Violent Crimes

ABSTRACTThis prospective study evaluated the main and interactive effects of peritraumatic reactions with gender on posttraumatic stress disorder (PTSD) onset, independently of known risk factors. Further, 111 adult victims of violent crime completed the Structured Clinical Interview, the Modified PTSD Symptom Scale, the Peritraumatic Dissociative Experience Questionnaire, and the Peritraumatic Distress Inventory. Hierarchical regressions and chi-square tests were conducted for continuous and categorical measures of PTSD. Extremely elevated scores of peritraumatic dissociation (PD) and peritraumatic distress (PDI) were obtained for both sexes. Greater PDI and PD were related to more PTSD symptoms. No significant interaction effects with gender emerged. These results remained when acute stress disorder was controlled for. Analyses on categorical data produced similar results. Victims of violent crimes recall severe peritraumatic reactions. The more severe these are, the more likely they are to develop significant PTSD symptomatology in the months that follow.

Prevalence and determinants of post-traumatic stress disorder, anxiety and depression symptoms in street children survivors of the 2010 earthquake in Haiti, four years after

Working with street children and adolescents who lived through the 2010 earthquake in Port-au-Prince, this paper aims to assess the prevalence of symptoms of PTSD, anxiety and depression in relation to peritraumatic distress, and age, and to explore other risk factors and socio-demographic characteristics, four years after the events. Between March and June 2014, with a sample of 128 children and adolescents (120 boys and 8 girls) aged between 7 and 18, of an average age of 13.88 (SD=2.15), all living on the streets of Port-au-Prince, we used the following scales: the Trauma Exposure (TE), the Life Events Subscale of the CAPS; the Peritraumatic Distress Inventory (PDI); the Children's Revised Impact of Event Scale (CRIES-13) and the Children Depression Inventory (CDI); (BAI). Our study reveals a high prevalence of PTSD, depression and anxiety among street children. It also demonstrates that this prevalence is lower than that of several other groups of children who were also victims of the 2010 earthquake in Port-au-Prince. Children living in the streets for economic reasons presented a lower prevalence of symptoms of PTSD, anxiety and depression than those who were on the streets as a result of psychological or physical abuse within their own families, in adoptive families or in children's homes. This study demonstrates the importance of care provision for these children in terms of helping them develop coping and resilience strategies. It also stresses the importance of providing them with nonviolent living environments and opportunities to facilitate their return to normality.

Gender Differences in the Prediction of Acute Stress Disorder From Peritraumatic Dissociation and Distress Among Victims of Violent Crimes.

Peritraumatic dissociation and distress are strong predictors of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) development. However, there is limited data concerning gender differences in these relations, particularly among victims of violent crimes (VVC). The objective of this study is to examine whether peritraumatic dissociation and distress predict the number of ASD symptoms differently for men and women VVC. In all, 162 adults (97 women, M age = 39.6 years), 63% of whom experienced physical assaults, completed the Acute Stress Disorder Interview, the Peritraumatic Dissociative Experience Questionnaire, and the Peritraumatic Distress Inventory. Analyses included t tests and multiple hierarchical regressions models controlling for known PTSD risk factors. The regression model showed dissociation and distress to be significant predictors of ASD for both men and women (β = .349 and β =.312 respectively; all p < .001). A significant three-way interaction was also observed between peritraumatic distress (PDI), past potentially traumatic experiences, and gender. In simple slopes analyses, the combination of high levels of PDI and of a high number of past potentially traumatic events were associated with greater risk of ASD in men only (b = 3.78, p < .001). However, women experienced greater PDI, t(157) = 5.844, p = .005, than men, and elevated distress was associated with more ASD symptoms independently of past traumatic events. Gender differences were revealed as a function of past potentially traumatic experiences. There is a cumulative impact of past potential traumas and current distress that predicts ASD in men, while in women, it contributes to ASD via increased distress.

Resilience, post‐traumatic growth, and work engagement among health care professionals after the Great East Japan Earthquake: A 4‐year prospective follow‐up study

Although attention has been paid to post-traumatic stress disorder (PTSD) among health care professionals after disasters, the impact of traumatic events on their work has not been elucidated. The aim of this study was to examine whether disaster-related distress, resilience, and post-traumatic growth (PTG) affect work engagement among health care professionals who had been deployed to the areas affected by the Great East Japan Earthquake that occurred on March 11, 2011. We recruited disaster medical assistance team members who were engaged in rescue activities after the earthquake. The short version of the Resilience Scale (RS-14) and Peritraumatic Distress Inventory (PDI) were administered one month after the earthquake, and the short form of Posttraumatic Growth Inventory (SF-PTGI) and Utrecht Work Engagement Scale (UWES) were administered four years after the earthquake. Work engagement is composed of vigor, dedication, and absorption. Regression analyses were used to examine the relationship of UWES with RS-14, PDI, and SF-PTGI. We obtained baseline data of 254 participants in April 2011, and 191 (75.2%) completed the follow-up assessment between December 2014 and March 2015. The results showed that RS-14 predicted vigor, dedication, and absorption; in addition, SF-PTGI was positively related with these three parameters (p<0.01 for all). Resilience at baseline and PTG after rescue activities may increase work engagement among health care professionals after disasters. These findings could be useful for establishing a support system after rescue activities during a large-scale disaster and for managing work-related stress among health care professionals.

Post-Traumatic Stress Symptoms and Burnout Among Medical Rescue Workers 4 Years After the Great East Japan Earthquake: A Longitudinal Study.

This study aimed to evaluate factors associated with post-traumatic stress disorder (PTSD) symptoms and burnout 4 years after the Great East Japan Earthquake among medical rescue workers in Disaster Medical Assistance Teams (DMATs). We examined participants' background characteristics, prior health condition, rescue work experiences, and the Peritraumatic Distress Inventory (PDI) score at 1 month after the earthquake. Current psychological condition was assessed by the Impact of Event Scale-Revised and Maslach Burnout Inventory administered 4 years after the earthquake. By applying univariate and multivariate linear regression analyses, we assessed the relative value of the PDI and other baseline variables for PTSD symptoms and burnout at 4 years after the earthquake. We obtained baseline data from 254 participants during April 2 to 22, 2011. Of the 254 participants, 188 (74.0%) completed the follow-up assessment. PDI score 1 month after the earthquake was associated with symptoms of PTSD (β=0.35, P<.01) and burnout (β=0.21, P<.01). Stress before deployment was a related factor for burnout 4 years after the earthquake in these medical rescue workers (β=2.61, P<.04). It seems important for DMAT headquarters to establish a routine system for assessing the PDI of medical rescue workers after deployment and screen those workers who have high stress prior to deployment (Disaster Med Public Health Preparedness. 2016;10:848-853).

War Exposure, Peritraumatic Distress, Traumatic Grief and PTSD among Democratic Republic of Congo (DRC) Refugees living in Rwanda: Kigeme and Gihembe Camps

War Exposure, Peritraumatic Distress, Traumatic Grief and PTSD among Democratic Republic of Congo (DRC) Refugees living in Rwanda: Kigeme and Gihembe Camps Among Democratic Republic of Congo refugees living in Rwanda, at Gihembe and Kigeme refugee camps, the relationships between War exposure and Psychological disorders, and mediation role of Peritraumatic Distress between Traumatic Exposure and PTSD were studied. A sample consisting of One hundred thirty (130) DRC refugees, 74 males and 56 females aged between 15 and 65 years old participated in this retrospective study. Trauma exposure was assessed by Comprehensive Traumatic Inventory (CTI; α:0.97), Peritraumatic distress by Peritraumatic Distress Inventory (PDI; α:0.92), current PTSD symptoms were assessed using PTSD Checklist (PCL; α:0.89), depressive symptoms by Beck Depression Inventory (BDI; α:0.90), Traumatic Grief symptoms were assessed using Inventory of Traumatic Grief (ITG; α:0.87) and general psychiatric symptoms were measured by SCL-90 (α:0.95). A multiple regression analysis was conducted to examine the contribution of these variables. War exposure correlated with PTSD symptoms, Peritraumatic distress, and general psychiatric symptoms (GPS). Peritraumatic distress symptoms among DRC refugees were influenced by witnessing abuse, injury (β=0.24; p=0.03) and displacement (β=0.22; p=0.02).The study shows that Depression among these refugees was associated with betrayal (β=0.29; p=0.02) and displacement situations (β=0.26; p=0.008). The Baron and Kenny procedure (1986) (including three separate regressions), along with the Sobel test, was used to test mediation effect. Peritraumatic distress mediates the relationship between Traumatic exposure and PTSD (the Sobel test statistic of 3.4; p˂0.000). War exposure is a complex situation, where PTSD results from trauma exposure and psychological distress.

Religious Beliefs, PTSD, Depression and Resilience in Survivors of the 2010 Haiti Earthquake

BackgroundThis study examines relationships between religious beliefs regarding the origin of the 2010 earthquake in Haiti and posttraumatic symptomatology as well as depressive symptoms and resilience among its survivors. MethodWe used convenient sampling to recruit participants (n=167). They completed six scales, which had been translated into Haitian Creole, including measures such as the Earthquake Experiences Exposure (EEE), the Peritraumatic Distress Inventory (PDI), the Peritraumatic Dissociative Experience Questionnaire (PDEQ), the PTSD Checklist (PTSD-CL), the Beck Depression Inventory (BDI) and the Connor–Davidson Resilience Scale (CD- RISC) ResultsAmong our participants, 51% were male, (mean age=30.5, SD=11.03), 92% (n=155) were believers in some sort of supernatural force and 65% (n=108) endorsed the earthquake as a natural phenomenon. There was significant difference in average scores at peritraumatic distress, PTSD symptoms and Resilience measures between those perceiving a divine origin and/or a punishment through the event and those who did not. Peritraumatic responses were best predictors for PTSD (β=.366, p<.001) and Depression symptoms (β=.384, p<.001). Voodoo adherents appeared to be vulnerable to depression, but reported superior resilience factors

Incidence and Predictors of Acute Psychological Distress and Dissociation After Motor Vehicle Collision: A Cross-Sectional Study

Objective: We examined the incidence and predictors of peritraumatic distress and dissociation after one of the most common forms of civilian trauma exposure: motor vehicle collision (MVC). Method: In this study, patients presenting to the emergency department after MVCs who were without serious injury and discharged to home after evaluation (n = 935) completed an emergency department interview evaluating sociodemographic, collision-related, and psychological characteristics. Results: The incidence and predictors of distress (Peritraumatic Distress Inventory score ≥23) and dissociation (Michigan Critical Events Perception Scale score >3) were assessed. Distress was present in 355 of 935 patients (38%), and dissociation was present in 260 of 942 patients (28%). These outcomes showed only moderate correlation (r = .45) and had both shared and distinct predictors. Female gender, anxiety symptoms prior to the MVC, and vehicle damage severity predicted both distress and dissociation. Higher socioeconomic status (higher education, higher income, full-time employment) had a protective effect against distress but not dissociative symptoms. Better physical health and worse overall mental health were associated with increased risk of dissociation but not distress. Distress but not dissociation was associated with lower patient confidence in recovery and a longer expected duration of recovery. Conclusion: There are unique predictors of peritraumatic distress and dissociation. Further work is needed to better understand the neurobiology of peritraumatic distress and dissociation and the influence of these peritraumatic outcomes on persistent psychological sequelae.

Long-term outcomes among child and adolescent survivors of the 2010 Haitian earthquake.

We examined the prevalence and predictive factors of PTSD and depression in relation with peritraumatic distress, trauma exposure, and sociodemographic characteristics among children and adolescent who survived the 2010 Haiti's earthquake. We analyzed data collected between June and July 2012 from a sample of 872 participants aged 7 to 17 in 12 schools, door-to-door canvassing and two centers for street children at Port-au-Prince. Participants completed the Impact of Event Scale Revised (IES-R), Peritraumatic Distress Inventory, Child Depression Inventory 2 (CDI), and sociodemographic and traumatic exposure questionnaires. Of 872 participants, respectively 322 (36.93%); and 403 (46.21%) reported a clinically significant symptoms of PTSD and depression, which were significantly higher among girls. The best predictive variables are peritraumatic distress for PTSD (β=0.53,P<.0001) a traumatic exposure for depression (β=0.23,P<.0001). The comorbidity between PTSD and depression symptoms is 22.25%. This first study in children on the prevalence of PTSD and depression resulting from the 2010 Haiti earthquake demonstrates a need for improvement in treatment aimed at reducing PTSD and depression. Such treatment should be geared primarily toward girls, adolescents between the ages of 14 and 17 and those children and adolescents who have lost a family member in the earthquake.

(239) Stress-related psychological symptoms contribute to neck pain persistence after motor vehicle collision: path analysis results from a prospective longitudinal study

Peritraumatic distress symptoms and subsequent posttraumatic stress disorder (PTSD) symptoms after motor vehicle collision (MVC) have been proposed to promote the development of MVC-related neck pain (MRNP) via a number of mechanisms. We used a path analysis model to evaluate longitudinal associations between peritraumatic distress symptom clusters (life threat, helplessness/anger, loss of control, and guilt/shame, assessed in the emergency department (ED) using the Peritraumatic Distress Inventory), PTSD symptom clusters (avoidance, intrusion/re-experiencing, and hyperarousal, assessed 6 weeks, 6 months, and one year after MVC using the Impact of Events Scale-Revised (IES-R)), and MRNP severity (assessed via 0-10 NRS at each timepoint). Of note, patients reporting neck pain at any timepoint were asked whether their pain was MVC-related; only MRNP was included in analyses. Analyses were performed in Mplus using data from a prospective cohort study of European Americans (n = 948) who presented to the ED within 24 hours of MVC and were discharged to home. ED evaluation was performed via in-person interview and follow-up interviews were performed via telephone interview or internet-based questionnaire. Confirmatory factor analyses of distress and IES-R subscales indicated acceptable fits to the data (RMSEA/CFI of 0.084/0.933 and 0.051/0.958 respectively). Overall fit of the longitudinal model of relationships between distress and PTSD subscales and MRNP was excellent (RMSEA = 0.049 [90% CI 0.036 to 0.052] in trimmed model). Peritraumatic helplessness/anger in the ED predicted 6 week MRNP severity (β = .148, p < 0.0001). Six week and six month PTSD hyperarousal symptoms, but not avoidance or intrusion symptoms, partially mediated the relationship between MRNP at six weeks and six months and between MRNP at six months and one year, respectively. These results support the hypothesis that stress-related psychological symptoms contribute to/mark vulnerability to persistent MRNP after MVC. Supported by NIAMS R01AR056328. Peritraumatic distress symptoms and subsequent posttraumatic stress disorder (PTSD) symptoms after motor vehicle collision (MVC) have been proposed to promote the development of MVC-related neck pain (MRNP) via a number of mechanisms. We used a path analysis model to evaluate longitudinal associations between peritraumatic distress symptom clusters (life threat, helplessness/anger, loss of control, and guilt/shame, assessed in the emergency department (ED) using the Peritraumatic Distress Inventory), PTSD symptom clusters (avoidance, intrusion/re-experiencing, and hyperarousal, assessed 6 weeks, 6 months, and one year after MVC using the Impact of Events Scale-Revised (IES-R)), and MRNP severity (assessed via 0-10 NRS at each timepoint). Of note, patients reporting neck pain at any timepoint were asked whether their pain was MVC-related; only MRNP was included in analyses. Analyses were performed in Mplus using data from a prospective cohort study of European Americans (n = 948) who presented to the ED within 24 hours of MVC and were discharged to home. ED evaluation was performed via in-person interview and follow-up interviews were performed via telephone interview or internet-based questionnaire. Confirmatory factor analyses of distress and IES-R subscales indicated acceptable fits to the data (RMSEA/CFI of 0.084/0.933 and 0.051/0.958 respectively). Overall fit of the longitudinal model of relationships between distress and PTSD subscales and MRNP was excellent (RMSEA = 0.049 [90% CI 0.036 to 0.052] in trimmed model). Peritraumatic helplessness/anger in the ED predicted 6 week MRNP severity (β = .148, p < 0.0001). Six week and six month PTSD hyperarousal symptoms, but not avoidance or intrusion symptoms, partially mediated the relationship between MRNP at six weeks and six months and between MRNP at six months and one year, respectively. These results support the hypothesis that stress-related psychological symptoms contribute to/mark vulnerability to persistent MRNP after MVC. Supported by NIAMS R01AR056328.

Symptoms of Posttraumatic Stress Disorder and Social Support Among Children and Adolescents After the 2010 Haitian Earthquake

This study explored the prevalence of posttraumatic stress disorder (PTSD) symptoms related to social support received by the children and adolescents who survived the earthquake on January 12, 2010, in Haiti. A strategy of stratified sampling was used, and 540 children and teenagers were questioned. Questionnaires based on the PTSD Checklist, the Impact of Event Scale-Revised, and the Peritraumatic Distress Inventory, among others, were used and bivariate statistical analyses were carried out. The results showed high rates of complete and partial PTSD symptoms, with higher rates among females, and indicated the need for reinforcing social support as a resilience factor for youth.

Assessment of prevalence and determinants of posttraumatic stress disorder and depression symptoms in adults survivors of earthquake in Haiti after 30 months

BackgroundOn January 12, 2010, a powerful 7.0 magnitude earthquake struck the Republic of Haiti and destroyed Port-au-Prince, the capital and others cities across the country. While some studies have examined the long-term traumatic effects of the seismic event on children and adolescents victims, so far no study has examined the consequences on adults generally. As such, this study aims to investigate the traumatic consequences of the earthquake among adults related to degree of exposure, peritraumatic distress, depressive symptoms and sociodemographic factors two and a half years after. In addition, predictive factors of PTSD and depressive symptoms were also identified. MethodsFrom June to July 2012, a total of 1355 adults (660 women) was assessed by means the traumatic exposure questionnaire, the Life Events Checklist subscale, the Peritraumatic Distress Inventory (PDI), the Impact of Event Scale – Revised (IES-R) and the Beck Depression Inventory (BDI), in addition to social demographic characteristics. ResultsThe prevalence rates of PTSD and depressive symptoms were 36.75% (498 cases) and 25.98% (352 cases) respectively. The risk factors for PTSD and depressive symptoms were young and old age, female gender, unemployed status and low level of education. The bests predictives variables were peritraumatic distress for PTSD (β=.57, p<.0001) and for depressive symptoms (β=.21, p<.0001). The commorbidity between PTSD and depression was 13.36%. ConclusionsThis study found that psychological symptoms are frequent event 30 months after the earthquake. The different mental health care providers, the public health ministry, NGOs working on the ground in Haiti should design programmes in order to aid the psychological wellbeing of the population focussing on youth, older and retired adults, females, people with low levels of education and those who do not work.

Associations between Disaster Exposures, Peritraumatic Distress, and Posttraumatic Stress Responses in Fukushima Nuclear Plant Workers following the 2011 Nuclear Accident: The Fukushima NEWS Project Study

BackgroundThe 2011 Fukushima Daiichi Nuclear Power Plant accident was the worst nuclear disaster since Chernobyl. The nearby Daini plant also experienced substantial damage but remained intact. Workers for the both plants experienced multiple stressors as disaster victims and workers, as well as the criticism from the public due to their company's post-disaster management. Little is known about the psychological pathway mechanism from nuclear disaster exposures, distress during and immediately after the event (peritraumatic distress; PD), to posttraumatic stress responses (PTSR).MethodsA self-report questionnaire was administered to 1,411 plant employees (Daiichi, n = 831; Daini, n = 580) 2–3 months post-disaster (total response rate: 80.2%). The socio-demographic characteristics and disaster-related experiences were assessed as independent variables. PD and PTSR were measured by the Japanese versions of Peritraumatic Distress Inventory and the Impact of Event Scale-Revised, respectively. The analysis was conducted separately for the two groups. Bivariate regression analyses were performed to assess the relationships between independent variables, PD, and PTSR. Significant variables were subsequently entered in the multiple regression analyses to explore the pathway mechanism for development of PTSR.ResultsFor both groups, PTSR highly associated with PD (Daiichi: adjusted β, 0.66; p<0.001; vs. Daini: adjusted β, 0.67; p<0.001). PTSR also associated with discrimination/slurs experience (Daiichi: 0.11; p<0.001; vs. Daini, 0.09; p = 0.005) and presence of preexisting illness(es) (Daiichi: 0.07; p = 0.005; vs. Daini: 0.15; p<.0001). Other disaster-related variables were likely to be associated with PD than PTSR.ConclusionAmong the Fukushima nuclear plant workers, disaster exposures associated with PD. PTSR was highly affected by PD along with discrimination/slurs experience.

Frequency and predictors of post-traumatic stress disorder after stroke: A pilot study

ObjectiveFew data exist about post-stroke symptoms of post-traumatic stress disorder (sPTSD) and none on DSM-IV formally diagnosed PTSD (fdPTSD). We investigated the frequency and predictors of sPTSD and fdPTSD 1–6months after a nondisabling ischemic stroke (IS) or transient ischemic attack (TIA). MethodsConsecutive patients were assessed for sPTSD (Impact of Events Scale-Revised, IES-R, significant if >30) and fdPTSD (PTSD-Interview). We recorded sociodemographic factors, stroke features (including severity of the initial deficit, persistent disability, localization), associated mood changes, peritraumatic reactions during the stroke (Peritraumatic Distress Inventory (PDI) for fear and distress, Peritraumatic Dissociative Experience Questionnaire for cognitive appraisal), and psychiatric history. Patients with sPTSD and fdPTSD were compared to patients with IES-R<30. ResultsAmong the 40 patients (65% male, mean age 52years) studied post-IS (n=30; mean initial NIHSS 4) or TIA, 25% had sPTSD, including 10% with fdPTSD. sPTSD was more frequent in women (p=0.02), patients with intense peritraumatic reactions especially on PDI (p=0.001) or identified prior depression and anxiety (p=0.007). No other demographic factors or stroke characteristics were associated with sPTSD. Forty percent of sPTSD patients were depressed versus none of the controls (p<0.002). All fdPTSD patients had ≥3 prior psychiatric co-morbidities. ConclusionsAfter nondisabling IS or TIA, sPTSD is frequent, with fdPTSD for 10%. Patients with intense peritraumatic reactions, women, and those with prior psychiatric morbidity, require particular attention to detect sPTSD.

Prediction of Trauma-Related Disorders

In the month following a motor vehicle accident, the rate of posttraumatic stress disorder (PTSD) and other trauma-related disorders (ie, mood, other anxiety disorders, and substance use disorders) may reach 30%.1 From a clinical perspective, there is an unmet need to develop screening tools that can help identify individuals at risk of developing such disorders. The Peritraumatic Distress Inventory (PDI) is a 13-item self-report measure—validated in several languages—that has been shown in several studies to predict the development of posttraumatic stress symptoms or disorder.2–4 In a prospective study of 79 motor vehicle accident victims, Nishi et al5 proposed an optimum cutoff point of 23 for the PDI to predict acute PTSD 1 month after the accident. However, to this day, the measure has not been used to predict the full spectrum of trauma-related disorders. The aim of this study was to fill that gap. Method. The study, approved by an independent ethics committee, included 211 subjects consecutively hospitalized in a Trauma Center following a motor vehicle accident from January 2003 to July 2006. The PDI was administered within 5 days of admission after written informed consent was obtained. Six weeks after the accident, the patients underwent a semistructured PTSD diagnostic interview6 as well as the Mood, Anxiety, and Substance Use Disorders sections of a structured psychiatric interview7 by trained psychiatrists. Partial PTSD as described by Blanchard et al8 was also screened for. Subjects with a history of posttraumatic amnesia were excluded. Nineteen subjects were lost at the 6-week follow-up and therefore dropped from the analyses. Results. The final cohort consisted of 192 subjects, 137 adult men and 55 women. The mean age of subjects was 35.14 years (SD = 15.39). Injury severity was classified as mild (10%), moderate (49%), or severe (41%). In the final cohort, 154 subjects fulfilled DSM-IV-TR criteria A1 and A2 for trauma exposure. The mean PDI total score was 15.68 (SD = 8.71). At the follow-up, 66 patients fulfilled criteria for partial (n = 31) or full (n = 35) PTSD, 19 for major depressive disorder, 10 for at least 1 anxiety disorder, and 3 for a psychoactive substance disorder. No association was found between injury severity and PTSD (χ2 = 0.96, df = 1, NS). The PDI score was, however, significantly associated with an increased risk of acute PTSD (χ2 = 5.15, df = 1, P = .02). According to the occurrence of traumatic events, receiver operating characteristic curve analysis showed an area under the curve (AUC) of 0.7 (Figure 1). The optimum predictive cutoff point of the PDI was a score of 14 (sensitivity 68%, specificity 61%). On the one hand, 90% of the victims with a PDI score > 28 developed PTSD or partial PTSD at follow-up. On the other hand, 90% of those with a score < 7 did not develop PTSD. In order to detect PTSD or partial PTSD 6 weeks later, we propose a cutoff score of 14 (PTSD: sensitivity 84% and specificity 47%, AUC 0.6; partial PTSD: sensitivity 73% and specificity 60%, AUC 0.7). Figure 1 Receiver Operating Characteristic (ROC) Curve for Occurrence of PTSD and PDI Scorea The PDI could be a useful tool for screening individuals at risk of developing trauma-related disorders. We recommend that trauma survivors with a PDI score 28 would need immediate care and follow-up. Finally, for those with a score of 7 through 28, we propose a checkup after a few weeks.

Peritraumatic distress: Its relationship to posttraumatic stress and complicated grief symptoms in sudden death survivors

Although sudden death has been linked to posttraumatic stress disorder (PTSD), its role in complicated grief (CG) and sudden death survivors is unknown. This questionnaire study investigated the role of peritraumatic distress in PTSD and CG symptoms in adults (n = 125) an average of 28.37 months (SD = 3.12) after a loved one's sudden death. The Peritraumatic Distress Inventory, Impact of Event Scale-Revised, and Inventory of Complicated Grief were administered to assess symptoms of peritraumatic distress, PTSD, and CG, respectively. Peritraumatic distress was the strongest correlate of both PTSD (β = .42, p < .001) and CG (β = .39, p < .001) symptoms, in a model containing current distress (Hopkins Symptom Checklist-21). Peritraumatic distress may be a key mechanism in the development of both PTSD and CG, therefore suddenly bereaved individuals reporting higher peritraumatic distress may be at risk of both adverse trauma and grief reactions.

Peritraumatic Distress, Watching Television, and Posttraumatic Stress Symptoms among Rescue Workers after the Great East Japan Earthquake

BackgroundThe Great East Japan Earthquake of March 11, 2001 left around 20,000 dead or missing. Previous studies showed that rescue workers, as well as survivors, of disasters are at high risk for posttraumatic stress disorder (PTSD). This study examined the predictive usefulness of the Peritraumatic Distress Inventory (PDI) among rescue workers of Disaster Medical Assistance Teams (DMATs) deployed during the acute disaster phase of the Great East Japan Earthquake.Methodology/Principal FindingsIn this prospective observational study, the DMAT members recruited were assessed 1 month after the earthquake on the PDI and 4 months after the earthquake on the Impact of Event Scale-Revised to determine PTSD symptoms. The predictive value of the PDI at initial assessment for PTSD symptoms at the follow-up assessment was examined by univariate and multiple linear regression analysis. Of the 254 rescue workers who participated in the initial assessment, 173 completed the follow-up assessment. Univariate regression analysis revealed that PDI total score and most individual item scores predicted PTSD symptoms. In particular, high predictive values were seen for peritraumatic emotional distress such as losing control of emotions and being ashamed of emotional reactions. In multiple linear regression analysis, PDI total score was an independent predictor for PTSD symptoms after adjusting for covariates. As for covariates specifically, watching earthquake television news reports for more than 4 hours per day predicted PTSD symptoms.Conclusions/SignificanceThe PDI predicted PTSD symptoms in rescue workers after the Great East Japan Earthquake. Peritraumatic emotional distress appears to be an important factor to screen for individuals at risk for developing PTSD among medical rescue workers. In addition, watching television for extended period of time might require attention at a time of crisis.

Concern over radiation exposure and psychological distress among rescue workers following the Great East Japan Earthquake Concern over radiation exposure and distress

BackgroundOn March 11, 2011, the Great East Japan Earthquake and tsunami that followed caused severe damage along Japans northeastern coastline and to the Fukushima Daiichi nuclear power plant. To date, there are few reports specifically examining psychological distress in rescue workers in Japan. Moreover, it is unclear to what extent concern over radiation exposure has caused psychological distress to such workers deployed in the disaster area.MethodsOne month after the disaster, 424 of 1816 (24%) disaster medical assistance team workers deployed to the disaster area were assessed. Concern over radiation exposure was evaluated by a single self-reported question. General psychological distress was assessed with the Kessler 6 scale (K6), depressive symptoms with the Center for Epidemiologic Studies Depression Scale (CES-D), fear and sense of helplessness with the Peritraumatic Distress Inventory (PDI), and posttraumatic stress symptoms with the Impact of Event Scale-Revised (IES-R).ResultsRadiation exposure was a concern for 39 (9.2%) respondents. Concern over radiation exposure was significantly associated with higher scores on the K6, CES-D, PDI, and IES-R. After controlling for age, occupation, disaster operation experience, duration of time spent watching earthquake news, and past history of psychiatric illness, these associations remained significant in men, but did not remain significant in women for the CES-D and PDI scores.ConclusionThe findings suggest that concern over radiation exposure was strongly associated with psychological distress. Reliable, accurate information on radiation exposure might reduce deployment-related distress in disaster rescue workers.

Peritraumatic Distress and the Course of Posttraumatic Stress Disorder Symptoms: A Meta-Analysis

To examine how peritraumatic distress modulates the severity of posttraumatic stress disorder (PTSD) according to the timing of the PTSD symptom assessments. A systematic literature review of English- and French-language studies having administered the Peritraumatic Distress Inventory (PDI) was conducted. Meta-analyses were performed on correlations relating PDI and PTSD symptom scores obtained from the sampled studies. The meta-analyses, which included calculations of regression slopes, took into consideration the time at which PTSD symptoms were assessed following the traumatic event and the timing of the PDI assessment. The literature review yielded a total of 22 studies. The meta-analysis performed over all studies resulted in a pooled correlation coefficient of 0.55 between the PDI and PTSD symptom scores. Meta-regression analyses conducted over all data revealed no apparent decrease in the correlations according to the timing of the PTSD symptom assessments. However, there were numerical or statistically significant declines in regression slopes when the meta-regressions were separately conducted on studies having administered the PDI either within, or following, a 1-month period after a traumatic event. While PDI or PTSD symptom score correlations remain generally significant, they tend to decline as time elapses between the traumatic event and the PTSD assessment. This suggests there may be factors other than peritraumatic distress that increasingly account for the long-term trajectory PTSD symptoms.