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Acute Stress Disorder as a Predictor of Posttraumatic Stress Symptoms

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Abstract

Using the DSM-IV diagnostic criteria for acute stress disorder, the authors examined whether the acute psychological effects of being a bystander to violence involving mass shootings in an office building predicted later posttraumatic stress symptoms. The participants in this study were 36 employees working in an office building where a gunman shot 14 persons (eight fatally). The acute stress symptoms were assessed within 8 days of the event, and posttraumatic stress symptoms of 32 employees were assessed 7 to 10 months later. According to the Stanford Acute Stress Reaction Questionnaire, 12 (33%) of the employees met criteria for the diagnosis of acute stress disorder. Acute stress symptoms were found to be an excellent predictor of the subjects' posttraumatic stress symptoms 7-10 months after the traumatic event. These results suggest not only that being a bystander to violence is highly stressful in the short run, but that acute stress reactions to such an event further predict later posttraumatic stress symptoms.
Am J Psychiatry 155:5, May 1998CLASSEN, KOOPMAN, HALES, ET AL.ACUTE STRESS DISORDER
Acute Stress Disorder
as a Predictor of Posttraumatic Stress Symptoms
Catherine Classen, Ph.D., Cheryl Koopman, Ph.D.,
Robert Hales, M.D., and David Spiegel, M.D.
Objective: Using the DSM-IV diagnostic criteria for acute stress disorder, the authors ex-
amined whether the acute psychological effects of being a bystander to violence involving mass
shootings in an office building predicted later posttraumatic stress symptoms.
Method: The
participants in this study were 36 employees working in an office building where a gunman
shot 14 persons (eight fatally). The acute stress symptoms were assessed within 8 days of the
event, and posttraumatic stress symptoms of 32 employees were assessed 7 to 10 months later.
Results: According to the Stanford Acute Stress Reaction Questionnaire, 12 (33%) of the
employees met criteria for the diagnosis of acute stress disorder. Acute stress symptoms were
found to be an excellent predictor of the subjects’ posttraumatic stress symptoms 7–10 months
after the traumatic event.
Conclusions: These results suggest not only that being a bystander
to violence is highly stressful in the short run, but that acute stress reactions to such an event
further predict later posttraumatic stress symptoms.
(Am J Psychiatry 1998; 155:620–624)
A
cute stress disorder is a new psychiatric diagnosis
in DSM-IV that includes a set of symptoms experi-
enced by some individuals shortly after a traumatic event.
To be diagnosed as suffering from acute stress disorder
the individual must exhibit at least three dissociative
symptoms along with at least one intrusion, avoidance,
and hyperarousal symptom. In addition, the symptoms
must cause clinically significant difficulties in functioning
and persist 2–28 days. Also, the reaction must not be due
to the ingestion of substances or to a general medical con-
dition or be attributable to a brief psychotic disorder or
a preexisting axis I or axis II disorder.
This diagnosis is based on a large body of research
dating back to Lindemann’s classic paper (1) in which
he described survivors’ immediate reactions to the Co-
conut Grove fire. Since Lindemann’s observations there
have been numerous studies that have reports of disso-
ciative, avoidance, and hyperarousal symptoms shortly
after traumatic experiences (2–10). The specific diag-
nostic criteria for acute stress disorder were based on
empirical evidence from studies that systematically
documented acute stress reactions in response to trau-
matic events (2–4, 7).
The scientific basis for the diagnostic category of acute
stress disorder was also justified by research showing that
dissociative reactions immediately after a traumatic ex-
perience predicted later posttraumatic stress disorder
(PTSD) symptoms (2–4, 7, 11–14). These studies were
conducted before the final definition of acute stress dis-
order and its inclusion in DSM-IV and, therefore, did not
include a systematic assessment of all acute stress disor-
der symptoms and their relationship with later PTSD
symptoms. To our knowledge, no published research has
systematically examined the relationship between acute
stress disorder and PTSD symptoms, despite the assump-
tion stated in DSM-IV that acute stress disorder can lead
to PTSD. Therefore, we conducted a study to examine
the relationship between acute stress disorder symptoms
and PTSD symptoms.
Along with documenting the relationship between
acute stress disorder symptoms and PTSD symptoms,
in the present study we examined this relationship
within the context of two other factors, gender and de-
gree of exposure to the traumatic event. Gender has
been shown to be associated with acute stress reactions
(15) and PTSD symptoms (16–19), with women report-
ing the most symptoms. Degree of exposure to the trau-
matic event has been found to be associated with the
level of symptoms following a traumatic event (7, 8, 14,
19–26), although in one anecdotal study no such rela-
tionship was found (27).
Received March 25, 1996; revisions received Feb. 19 and July 11,
1997; accepted Sept. 18, 1997. From the Department of Psychiatry
and Behavioral Sciences, Stanford University School of Medicine, and
the Department of Psychiatry, University of California, Davis. Ad-
dress reprint requests to Dr. Classen, Department of Psychiatry and
Behavioral Sciences, Stanford University School of Medicine, Stan-
ford, CA 94305-5718; classen@leland.stanford.edu (e-mail).
Supported by grants from the John D. and Catherine T. MacArthur
Foundation and the American Psychiatric Association.
The authors thank Ami Atkinson, John Mori, and the persons who
participated in the study.
620 Am J Psychiatry 155:5, May 1998
The hypotheses in this study were as follows: 1) meet-
ing all of the symptom criteria for acute stress disorder
would predict subsequent PTSD symptoms, 2) women
would be more likely than men to exhibit PTSD symp-
toms, and 3) degree of exposure to the threat would be
positively associated with PTSD symptoms. Along with
gender, other demographic variables (education and
marital status) were included in the analyses in order to
control for their contribution to the development of
PTSD symptoms.
The traumatic incident examined was the shooting of
persons by a gunman in an office building where the
respondents in this study worked. Unfortunately, such
events are not rare. In 1993, a thousand employees in
the United States were murdered at their places of work
(28). Research suggests that persons who are bystand-
ers, such as other employees, are deeply affected by
these events. Several studies have examined stress reac-
tions to being a bystander to shootings (24, 29–31).
These studies indicated that acute stress reactions to
such an event are normal. Nevertheless, some individu-
als may exhibit more extreme reactions to the event,
warranting a diagnosis of acute stress disorder in the
immediate aftermath, and may later experience post-
traumatic stress symptoms.
We conducted a study of employees working in an
office building where a shooting spree occurred during
the workday. We examined their acute stress reactions
in the immediate aftermath of this event. Their post-
traumatic stress symptoms were assessed 7 to 10 months
later.
METHOD
The Traumatic Event
On the afternoon of Thursday, July 1, 1993, 14 persons were shot
on two floors and in the stairwell of a high-rise office building at 101
California Street in San Francisco. Eight persons, including the gun-
man, were shot fatally. Many employees were trapped inside the
building for hours while police officers tried to stop the gunman, and
there were rumors that there were at least two gunmen on the loose.
Within 8 days after the shootings, 36 employees from two firms on
nearby floors of the building attended a crisis intervention session and
completed questionnaires about their acute distress symptoms and
other reactions.
Study Group
After obtaining permission from our institutional human subjects
review committee to perform this study, we were granted permission
from two firms to meet with their employees to offer a crisis interven-
tion session and to seek their participation in this study. Before the
intervention and data collection, the subjects were fully informed re-
garding the crisis intervention and the data collection. They were in-
vited to participate in the intervention session and were told that their
participation in the intervention in no way obligated them to partici-
pate in the study. The intervention took approximately 1 hour and
consisted of inviting the employees to describe the thoughts and feel-
ings they had had both during and after the traumatic event, provid-
ing a brief overview of common reactions to trauma as a way of nor-
malizing their experience, providing suggestions for what they could
do to help themselves integrate the experience and then move on in
their lives, and describing how to determine whether they required
professional help.
After the crisis intervention session, the study was introduced, the
procedure of the study was fully explained, and the employees were
again reminded that they were under no obligation to participate.
Written informed consent was received, and the questionnaires were
distributed; 36 employees completed the questionnaires. All worked
in the office building where the shootings occurred; 26 worked in one
firm and 10 worked in another. All questionnaires were completed
within 8 days after the shootings. A follow-up assessment was mailed
to the participants 7 months later, and follow-up mailings and phone
calls were conducted to encourage willing participants to complete
this follow-up assessment. Of the 36 persons who participated in the
original assessment, 32 (89%) completed the follow-up assessment.
Measures
Demographic characteristics. The respondents provided demo-
graphic information in a self-report questionnaire. The variables as-
sessed were sex, age, marital status, and years of education.
Ratings of the threatening event. An additive exposure scale as-
sessed the degree of contact that the respondents had with the trau-
matic event. The types of exposure included being in the office build-
ing at the time of the shooting and seeing the S.W.A.T. (police
tactical) team. None of the subjects saw the gunman or his victims.
The respondents were asked to indicate whether they had experienced
each of these forms of exposure to the event. Exposure was scored as
0 if the respondent was not in the building at the time, 1 if the respon-
dent was in the building but did not see the S.W.A.T. team, and 2 if
the respondent was in the building and saw the S.W.A.T. team.
The respondents were asked to rate how disturbing their experi-
ence with this event was, on a scale of 0–10, where 0 represented “not
at all disturbing” and 10 indicated “extremely disturbing.”
Stanford Acute Stress Reaction Questionnaire. This self-report
measure asks the respondent to indicate the frequency with which he
or she experiences a variety of symptoms during or after a stressful
event. Versions of this measure have been used in studies that have
assessed acute reactions to an earthquake (2), witnessing an execution
(4), and a firestorm (7). This version of the Stanford Acute Stress
Reaction Questionnaire assessed four types of symptoms matching
the criteria for a diagnosis of acute stress disorder: dissociation (nine
items, e.g., “I experienced myself as though I were a stranger”); hy-
perarousal (five items, e.g., “I felt hypervigilant or on edge”); reex-
periencing the traumatic event (six items, e.g., “I had repeated and
unwanted memories of the shootings”); and avoidance of reminders
of the traumatic event (two items, e.g., “I tried to avoid activities or
situations that reminded me of the shootings”). Internal consistency
for this group of subjects, based on Cronbach’s alpha, was high over-
all (0.93) and also for the particular symptom subscales of the ques-
tionnaire (0.72–0.88).
Impact of Event Scale. The Impact of Event Scale (32) is a self-re-
port measure assessing the degree of subjective distress experienced
after a stressful life event. In this study, the Impact of Event Scale was
used in the 7-month follow-up assessment as an additional measure
of PTSD symptoms. Individuals were asked to rate the frequency with
which they had had intrusive or avoidant experiences in the 7 days
before assessment. Intrusive experiences include unwanted thoughts,
feelings, or images of the trauma (e.g., “Pictures about it popped into
my mind”). Avoidant experiences include having tried to avoid re-
minders of the trauma or to dull emotional reactions to it (e.g., “I
stayed away from reminders of it”). Internal consistency (Cronbach’s
alpha) for this group was high overall (0.91) and for both subscales
(intrusion=0.89, avoidance=0.88).
Davidson Trauma Scale. The Davidson Trauma Scale (33) was
developed to assess each of the symptoms in DSM-IV needed for a
diagnosis of PTSD. This instrument comprises 17 items inquiring
about frequency and severity of PTSD symptoms within the past
week; frequency is assessed on a 0–4-point scale in which 0 repre-
sents “not at all” and 4 indicates “every day,” and severity is as-
sessed on a 0–4-point scale in which 0 represents “not at all dis-
tressing” and 4 means “extremely distressing.” This instrument is
used to assess PTSD symptoms and has been validated with adult
survivors of childhood sexual abuse (33), rape survivors, and Hur-
CLASSEN, KOOPMAN, HALES, ET AL.
Am J Psychiatry 155:5, May 1998 621
ricane Andrew survivors (Davidson, unpublished manuscript). Its
internal consistency is excellent; the Cronbach’s alpha was 0.91 in
a test with rape survivors. Its criterion validity was evidenced in the
studies of both rape and hurricane survivors, in which the survivors
diagnosed as having PTSD (with the Structured Clinical Interview
for DSM-III-R) had significantly higher mean scores than did the
survivors not meeting the diagnostic criteria for PTSD. Also, this
measure’s concurrent validity is supported by strong correlations
with the scores on the Impact of Event Scale of rape survivors and
with the SCL-90 global severity scores, anxiety subscale scores, and
depression subscale scores of hurricane survivors (Davidson, un-
published manuscript). Internal consistency for this study group
was high (Cronbach’s alpha=0.92). To yield a summary score on
this measure, we tallied the number of symptoms experienced at
least once in the past week (at least twice for recurrent symptoms)
that were minimally to extremely distressing.
Data Analysis
Means, standard deviations, and frequencies were computed to
summarize the distribution of values for each variable. To test the
relationships between PTSD symptoms and the independent vari-
ables, we conducted multiple regression analysis to analyze PTSD
symptoms (assessed as number of symptoms reported on the David-
son Trauma Scale and subscale scores on the intrusion and avoidance
subscales of the Impact of Event Scale) by three blocks of independent
variables, entered hierarchically. In the first block we used the step-
wise forward procedure with the variables of sex, age, years of edu-
cation, and marital status to examine for preexisting demographic
differences that could account for the variance in posttraumatic stress
symptoms. In the second block we again used the stepwise forward
procedure and entered the degree of exposure to the threatening
event, and in the third block we entered whether the respondent met
the symptom criteria for an acute stress disorder diagnosis. Using this
analytic strategy, we were able to examine whether any significant
variance in PTSD symptoms was associated with demographic and
exposure variables before we analyzed the variance in PTSD symp-
toms associated with meeting the criteria for acute stress disorder, the
variable of most interest. To analyze the relationships between spe-
cific symptoms of acute stress disorder and PTSD symptoms, we com-
puted Pearson’s product moment correlations between the four types
of acute stress disorder symptoms (dissociation, hyperarousal, intru-
sion, and avoidance) and the three measures of PTSD symptoms.
RESULTS
Univariate Statistics on Independent
and Dependent Variables
Of the 36 employees, 24 (67%) were women. The
employees ranged in age from 22 to 74 years (mean=
33.2, SD=10.4) and ranged in education from high
school diploma to graduate school, with 80% having
completed college (28 of 35). Their marital status dis-
tribution (N=35) was as follows: single, 54% (N=19);
married, 34% (N=12); and divorced, 11% (N=4).
The majority of the respondents (69%, N=25) were
in the building at the time of the shooting and saw the
S.W.A.T. team, 17% of the respondents (N=6) were
trapped in the building but did not see the S.W.A.T.
team, and 14% (N=5) neither were trapped in the
building nor saw the S.W.A.T. team. None of our sub-
jects actually saw the gunman or the victims.
When asked how disturbing the event was, the re-
spondents gave the event a mean rating of 6.9 (SD=2.6).
This is almost 2 points above 5, which is labeled “mod-
erately disturbing.”
Of the 36 subjects, 12 (33%) met the criteria for the
acute stress disorder diagnosis. The respondents expe-
rienced a mean of 2.0 dissociative symptoms (SD=1.5)
out of a possible 5 symptoms, a mean of 1.3 symptoms
of reexperiencing the traumatic event (SD=1.3) out of
5, a mean of 2.7 symptoms of anxiety and hyperarousal
(SD=1.7) out of 5, and a mean of 1.0 of 2 possible symp-
toms of avoiding reminders of the event (SD=0.9).
At the 7–10-month follow-up assessment, 32 of the
36 respondents completed the questionnaires, although
one of these respondents did not complete the Davidson
Trauma Scale. The respondents’ mean frequency of PTSD
symptoms reported on the Davidson Trauma Scale was
2.5 (SD=3.9) out of a possible 4. Also, the respondents’
mean score at follow-up on the Impact of Event Scale
intrusion subscale was 7.9 (SD=7.8); their mean score
on the avoidance subscale was 8.1 (SD=9.3).
Relation of PTSD Symptoms to Acute Stress Disorder,
Trauma Exposure, and Demographic Characteristics
The overall regression models were significant for
predicting overall posttraumatic stress frequency scores
on the Davidson Trauma Scale (F=5.86, df=1, 27, p<
0.05, adjusted R
2
=0.15), frequency of intrusive symp-
toms as indicated by the intrusion subscale of the Im-
pact of Event Scale (F=30.38, df=1, 28, p<0.0001, ad-
justed R
2
=0.50), and frequency of avoidance symptoms
as indicated by the avoidance subscale of the Impact of
Event Scale (F=21.25, df=1, 28, p<0.0001, adjusted
R
2
=0.41). The results supported the hypothesis that
PTSD symptoms were associated with meeting all of the
symptom criteria for acute stress disorder; however,
PTSD symptoms were not significantly related to expo-
sure to the traumatic event, contrary to our hypothesis.
None of the demographic variables was significantly re-
lated to any of the measures of PTSD symptoms,
thereby providing no support for the hypothesis that
women would be more likely to show PTSD symptoms.
Meeting the criteria for the acute stress disorder diag-
nosis was significantly related to the overall posttrau-
matic stress frequency score on the Davidson Trauma
Scale (B=3.39, SE=1.40, t=2.42, df=1, 27, p<0.05), to
frequency of intrusive symptoms as indicated by the in-
trusion subscale of the Impact of Event Scale (B=11.79,
SE=2.13, t=5.51, df=1, 28, p<0.0001), and to frequency
of avoidance symptoms as indicated by the avoidance
subscale of the Impact of Event Scale (B=12.70, SE=
2.76, t=4.61, df=1, 28, p<0.0001).
Relation of Acute Stress Disorder to PTSD Symptoms
Table 1 shows the Pearson’s product moment corre-
lation coefficients for the association between acute
stress disorder symptoms and PTSD symptoms in re-
sponse to the shootings. All but two of the 15 relation-
ships were statistically significant and in the positive
direction. This showed that three of the four symptoms
included in the acute stress disorder diagnosis (dissocia-
tion, reexperiencing, and avoidance) and the overall di-
ACUTE STRESS DISORDER
622 Am J Psychiatry 155:5, May 1998
agnosis were strongly related to the frequency of expe-
riencing posttraumatic stress symptoms. Hyperarousal
was found to be positively correlated with intrusion,
although it was not significantly correlated with overall
PTSD or avoidance.
DISCUSSION
This study provides evidence that acute stress disorder
predicts PTSD. As hypothesized, individuals who met all
of the symptom criteria for acute stress disorder were
more likely to report PTSD symptoms 7 to 10 months
later. However, neither extent of exposure to the trau-
matic event nor gender was found to predict PTSD symp-
toms. An exploratory analysis showed that three of the
four symptoms included in the acute stress disorder diag-
nosis (dissociation, reexperiencing the traumatic event,
and avoidance) and the overall diagnosis of acute stress
disorder were strongly related to the frequency of expe-
riencing PTSD symptoms. Of these acute stress disorder
symptoms, dissociation in response to the trauma was
found to be one of the strongest predictors of PTSD
symptoms 7 to 10 months later. This suggests that disso-
ciation may be a fundamental symptom of acute stress
disorder. Hyperarousal was found to predict intrusion at
follow-up but not avoidance or overall posttraumatic
stress. This suggests that hyperarousal might be less im-
portant as a predictor of PTSD.
There are several limitations to this study. The main
limitation is that the subjects were not formally diag-
nosed by a clinician as having either acute stress disor-
der or PTSD. Instead, the diagnoses were based on pa-
per-and-pencil measures that were designed to assess
some but not all diagnostic criteria. The measures did
not assess whether the symptoms caused clinically sig-
nificant distress or impairment in functioning, which
is necessary for a formal diagnosis of acute stress disor-
der or PTSD. Also, other diagnoses that may have ac-
counted for the acute stress disorder symptoms were
not ruled out.
The study group in this study was small, the subjects
were not randomly selected, and there was no control
group. The subjects were recruited from two nearby
floors and consisted of individuals who had agreed to
participate after having received a crisis intervention ses-
sion. A larger group of subjects randomly selected from
all floors would have been better. It would have given us
greater power to test our hypotheses, ensured varying de-
grees of exposure, and circumvented the problem of hav-
ing subjects who were self-selected on the basis of their
desire for crisis intervention. Having a control group that
experienced the traumatic event and did not receive an
intervention would have enabled us to also examine the
relationship between acute stress disorder and PTSD
symptoms when there is no intervention.
Our clinical impression was that the debriefing was
experienced as beneficial. The participants appeared re-
lieved to be able to share their experiences with others
and to learn that they were not alone in their reactions.
Several commented on the helpfulness of the interven-
tion. Thus, to the extent that the intervention was effec-
tive, the relationship between acute stress disorder and
PTSD symptoms may be underestimated.
In this study we did not find a relationship between
exposure and PTSD symptoms, and this negative find-
ing might be due to the small number of subjects or to
a restricted range of exposure. Additionally, it may be
because our measure of exposure lacked sensitivity. In
addition, the small number of subjects precluded exam-
ining the role of acute stress disorder relative to other
predictors of PTSD, such as stressful life events (11).
Notwithstanding these limitations, the results suggest
that when individuals experience a traumatic event and
suffer from acute stress disorder, they may also be vul-
nerable to developing PTSD and might benefit from im-
mediate treatment (34–36). Given the role of dissocia-
tion in acute reactions to a traumatic event, affected
individuals are likely to distance themselves from the
event through amnesia, depersonalization, derealiza-
tion, or other means, thereby avoiding the “grief work”
necessary to working through the traumatic experience
and putting it into perspective (1, 37, 38). Sufferers of
acute stress disorder are likely to split off the event from
their experience if untreated.
Thus, individuals who have experienced a traumatic
event should be given the opportunity to process it. The
goals should include normalizing the reactions to the
trauma, providing a safe environment that enables the
expression of strong feelings, enhancing understanding,
and making meaning out of the experience (38, 39).
Another implication of this study is that when indi-
viduals are not directly the targets of violence but ex-
perience only the threat of violence, they too are vul-
nerable to developing acute stress disorder and PTSD.
A full one-third of the individuals in this study met the
symptom criteria for acute stress disorder and were
more likely to develop PTSD symptoms. These were
individuals who never actually saw the gunman, al-
though several individuals stated that they saw a mem-
ber of the S.W.A.T. team and momentarily thought it
TABLE 1. Correlations Between Symptoms of Acute Stress Disorder
and Posttraumatic Stress at 7–10-Month Follow-Up in 32 Subjects
Who Witnessed a Mass Shooting
Acute Stress Disorder
Symptom
a
Correlation With Frequency of
Posttraumatic Stress Symptom (r)
Overall
Posttraumatic
Stress
b
Intrusion
c
Avoidance
c
Dissociation 0.47** 0.58*** 0.61***
Hyperarousal 0.20 0.53** 0.32
Reexperiencing 0.45** 0.73*** 0.49**
Avoidance 0.39* 0.52** 0.49**
All acute stress disor-
der symptoms 0.44** 0.73*** 0.67***
a
Assessed with Stanford Acute Stress Reaction Questionnaire.
b
Assessed with Davidson Trauma Scale; N=31.
c
Assessed with Impact of Event Scale.
*p<0.05. **p0.01. ***p0.001.
CLASSEN, KOOPMAN, HALES, ET AL.
Am J Psychiatry 155:5, May 1998 623
was the gunman. Nevertheless, there was only the
threat of violence, and it was sufficient for develop-
ment of symptoms.
The results of this study suggest that individuals who
are exposed to violence may develop acute stress disor-
der as a precursor to PTSD symptoms. Given the in-
creasingly violent nature of our society, this puts sub-
stantial numbers of individuals at risk of developing
psychological problems. Given the predictive value of
acute stress disorder symptoms, they provide an oppor-
tunity for early case identification and intervention to
prevent the development of PTSD.
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... Many studies have shown that high scores on the SASRQ predict later high scores on scales that measure posttraumatic symptomatology (Birmes et al., 2001(Birmes et al., , 2003(Birmes et al., , 2005Bowles et al., 2006;Bui et al., 2010;Classen, Koopman, Hales & Spiegel, 1998;Ginzburg & Ein-Dor, 2011;Grieger et al., 2000;Hall et al., 2006;Holman, Garfin, Lubens & Silver, 2020;Hunt et al., 2008;Kassam-Adams et al., 2009;Koopman et al., 1998;Kutz & Dekel, 2006;Lucas-Thompson & Holman, 2013;McKibben, Bresnick, Wiechman Askay & Fauerbach, 2008;P erez et al., 2014;Schlesinger et al., 2020;Shaw et al., 2009Shaw et al., , 2013. Furthermore, higher SASRQ scores predict later anxiety P erez et al., 2014), depression (Ginzburg, 2006;Hunt et al., 2008;Shaw et al., 2009), fear of terrorism (Holman & Silver 2005;Holman et al., 2020), functional impairment Koopman et al., 1998;Lucas-Thompson & Holman, 2013), cognitive avoidance (P erez et al., 2014), and financial stress (Lucas- Thompson & Holman, 2013). ...
... In line with research showing that earlier traumatic events are risk factors when facing new stressors (Brewin et al., 2000), previous trauma and a history of mental illness related to higher scores on the SASRQ after exposure to a stressful event (Classen et al., 1998;Garfin, Holman & Silver, 2015Geng, Zhou, Liang & Fan, 2018;Gil-Rivas et al., 2004;Ginzburg et al., 2016;Holman et al., 2020;Kassam-Adams et al., 2009;Lucas-Thompson & Holman, 2013;Maldonado et al., 2002;Rodin et al., 2013). With respect to single subscales, Koopman et al. (2001) reported that war veterans were more likely to have highs scores on several of the dissociative symptoms in the SASRQ following later exposure to stressful events. ...
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The fourth edition of the Diagnostic and Statistical Manual introduced the diagnosis of Acute Stress Disorder (ASD) for acute pathological reactions including dissociative ones, following a traumatic event. Various measures of ASD have been developed, with the Stanford Acute Stress Reaction Questionnaire (SASRQ) being one of the most commonly used across the world. This paper systematically covers more than 20 years of research with it and 90 papers in different languages. The main conclusion is that the SASRQ and its translations to other languages have consistently shown convergent, divergent, and predictive validity, besides exhibiting good reliability. We finish the paper by advancing suggestions for future development including the use a new SASRQ version that follows DSM-5 criteria, evaluating whether distinct items or subscales differentially predict different types of acute- and long-term posttraumatic symptomatology, and assessing its clinical usefulness.
... In a study by Charney et al. (1993), it is stated that the effects of reactions that occur during trauma on memory make the systems associated with PTSD sensitized in the future. In another study, it was shown that emotional responses such as anger and embarrassment during trauma and acute stress disorder were effective in later appearance of PTSD symptoms (Andrews et al., 2000;Classen et al., 1998;Harvey and Bryant, 1998;Shalev et al., 1996). In a meta-analysis study by Ozer et al. (2003), it was stated that peritraumatic dissociation could be a major psychological risk factor for PTSD. ...
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Bu çalışmada Peritravmatik Stres Envanterinin (PDI) Türkçeye çevrilerek geçerlik ve güvenirliğinin incelenmesi amaçlanmıştır. Araştırmanın örneklemini 18-65 yaş grubunda yer alan 377 kişi oluşturmaktadır. Ölçeğin Türkçe formunun geçerlilik ve güvenirlik analizleri travmatik olay yaşadığını belirten 224 katılımcı üzerinden, karşılaştırma analizleri ise tüm katılımcılar (377) dahil edilerek yapılmıştır. Katılımcılara, PDI Türkçe versiyonunun yanı sıra Demografik Bilgi Formu ve Olayların Etkisi Ölçeği uygulanmıştır. Yapılan analizler neticesinde ölçeğin tümü için Cronbach Alpha iç tutarlılık katsayısı .88 olarak belirlenirken olumsuz duygular alt boyutu iç tutarlılık katsayısı .84, algılanan yaşam tehdidi ve fiziksel uyarılma alt boyutu iç tutarlılık katsayısı .80 olarak saptanmıştır. Doğrulayıcı faktör analizi sonucunda CMIN/DF=2.54, GFI=.91, CFI=.91, SRMR=.07 ve RMSEA=.08 olarak hesaplanmıştır. Peritravmatik Stres Ölçeği ile Olayların Etkisi Ölçeği arasında orta düzeyde olumlu yönde (r=46, p
... Stress-related disorders were then classified as PTSD (ICD-9: 309B; ICD-10: F43.1), acute stress reaction (ICD-9: 308, 309A; ICD-10: F43.0), and adjustment disorder and other stress reactions (ICD-9: 309X, 309B; ICD-10: F43.2, F43.8, F43.9). Because other stress-related disorders, especially acute stress reaction, might be a precursor of subsequent PTSD, 33 all patients who received a PTSD diagnosis within one year after their first stress-related disorder diagnosis were counted as PTSD patients. ...
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Background Prior research provides suggestive evidence on an association between stress-related disorders and mortality. No previous study has however addressed the role of familial confounding on such association. Methods We conducted a nationwide cohort study of 189,757 individuals with a first-onset stress-related disorder between January 1, 1981 and December 31, 2016 in Sweden (i.e., exposed patients), 1,896,352 matched unexposed individuals, and 207,479 unaffected full siblings of the exposed patients. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of all-cause and cause-specific mortality. Findings During a mean follow-up of 9.42 years, an elevated risk of all-cause mortality was observed during the entire follow-up among patients with stress-related disorders, compared with either unexposed individuals or their unaffected full siblings. Such excess risk was most pronounced within the first year after diagnosis of stress-related disorders (HR, 3.19 [95% CI, 2.87-3.54] in population-based comparison; HR, 3.21 [95% CI, 2.56-4.02] in sibling-based comparison). The excess risk decreased but remained statistically significant thereafter (HR, 1.64 [95% CI, 1.60-1.67] in population-based comparison; HR, 1.61 [95% CI, 1.54-1.68] in sibling-based comparison). An increased risk was observed for almost all cause-specific mortality, with greater risk increase for deaths from unnatural causes, especially suicide, and potentially avoidable causes. Interpretation Stress-related disorders were associated with an increased risk of all-cause mortality and multiple cause-specific mortality, and the risk elevation was independent of familial confounding. The excess mortality attributable to unnatural causes and potentially avoidable causes highlights the importance of clinical surveillance of major health hazards among patients with stress-related disorders. Funding EU Horizon 2020 Research and Innovation Action Grant, 1.3.5 Project for Disciplines of Excellence at West China Hospital of Sichuan University, National Natural Science Foundation of China, Icelandic Research Fund (Grant of Excellence), ERC Consolidator Grant, and Swedish Research Council.
... Примечательно, что не обязательно испытать насилие: даже сама угроза стать жертвой насилия может вызвать симптомы посттравматического стрессового расстройства. 73 Эпидемиология Почти отсутствуют данные об эпидемиологической частотности, поскольку острая реакция на стресс является кратковременной, лица в подобном состоянии редко обращаются за помощью к психиатрам, что даёт основание некоторым учёным утверждать, что острая реакция на стресс проявляется намного чаще. Согласно сведениям Всемирной организации здравоохранения, острая реакция на стресс и её последствия очень зависят от индивидуальных особенностей. ...
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Данная методика (учебник) является одним из результатов проекта «Внедрение инновационных методов психосоциальной и физической реабилитации для уязвимых групп в приграничной зоне» (№ LT-RU-1-024), реализованного Публичным учреждением Санаторно-реабилитационный центр «Пушинас» Министерства внутренних дел Литовской Республики с партнерами Государственным бюджетным учреждением здравоохранения «Детская областная больница Калининградской области» и Центром здравоохранения города Паланги. Цель проекта - улучшить доступность и качество психосоциальной и физической реабилитации для уязвимых групп в приграничной зоне. В течение двух лет партнеры проекта внедрили инновационные технологии психосоциальной и физической реабилитации, закупили современное реабилитационное оборудование и инструменты. Публичное учреждение Санаторно-реабилитационный центр «Пушинас» Министерства внутренних дел Литовской Республики оборудовало 3 прилегающих помещения и центральный вход в санаторий специально для использования людьми с ограниченными возможностями. На протяжении всего проекта заинтересованные лица, составляющие целевую группу, постоянно проходили обучение, обменивались мнением и опытом специалисты партнерских организаций. Этот проект финансируется Европейским Союзом Программа приграничного сотрудничества Литва-Россия 20014-2020 гг. была разработана в рамках Европейского Инструмента Соседства и софинансируется Европейским Союзом и Российской Федерацией. Программа способствует продвижению и расширению сотрудничества в приграничных регионах Литвы и России и вносит непосредственный вклад в достижение общей цели прогресса в области совместного процветания и добрососедства между вовлеченными странами. Данная методика была подготовлена при финансовой поддержке Европейского Союза. Содержание методики является предметом ответственности Публичного учреждения Санаторно-реабилитационный центр «Пушинас» Министерства внутренних дел Литовской Республики и не отражает точку зрения Европейского Союза. Данная методика является собственностью Публичного учреждения Санаторно-реабилитационный центр «Пушинас» Министерства внутренних дел Литовской Республики и Публичного учреждения «Шветимо, свейкатос ир социалиню иновацию центрас» (VšĮ „Švietimo, sveikatos ir socialinių inovacijų centras“). После получения письменного одобрения Публичного учреждения «Шветимо, свейкатос ир социалиню иновацию центрас» и Публичного учреждения «Санаторно-реабилитационный центр «Пушинас» Министерства внутренних дел Литовской Республики» настоящая Методика была дополнена, а также была выпущена версия Учебника для студентов Балтийского федерального университета им. Иммануила Канта.
... On the other hand, acute stress disorder defines the symptoms in which dissociation symptoms can be seen in addition to similar symptoms, starts immediately after the trauma and lasts up to one month. Studies have shown that acute stress disorder is a predictor of post-traumatic stress disorder [14][15][16]. In acute stress disorder or PTSD, the person does not need to be directly exposed to a traumatic event but a traumatic life to witness. ...
Article
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COVID-19 pandemic has resulted in important consequences for healthcare workers, such as long shifts, staying away from family members due to the risk of illness, and working under intense stress. Outbreaks are considered as traumatic factors like other natural disasters and are expected to cause trauma-related disorders. In this study, it was aimed to determine the acute stress levels and stress responses of both the community sample and healthcare workers via using the National Stressful Events Survey Acute Stress Disorder Short Scale (NSESSS). A total of 1027 volunteers, including 387 healthcare workers and 640 non-healthcare workers, participated in the study. The NSESSS levels of non-healthcare workers were significantly higher than healthcare worker, females compared to males, and singles than married ones. As the thought that work justice was provided in healthcare workers increased, NSESSS levels decreased. As the difficulty of finding protective equipment in healthcare workers decreased, NSESSS levels decreased. Nurses' ages, time spent on duty, and NSESSS levels were significantly higher than physicians and other healthcare workers. In the pandemic period, it can be a guide in determining the risk factors and risk groups in terms of acute stress, taking preventive mental health measures, and providing early intervention. [Med-Science 2022; 11(1.000): 7-14]
... Как показали наши исследования и ряд других аналогичных работ, такая динамика состояния происходит в зависимости от тяжести перенесенной ЧМТ. Данные нейровизуализационных исследований и нейропсихологического тестирования подтверждают развитие функциональных дефицитов у больных с ЧМТ [4,14,24,42,43,44]. ...
Article
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Objective. To study the role of traumatic brain injury (TBI) in the development of post-traumatic stress disorder (PTSD) in combat veterans. Materials and methods. A total of 87 combat veterans were studied. The duration of the follow-up period was 15–18 years. Mental disorders were diagnosed in terms of ICD-10 criteria. Diagnoses were used to formulate two groups of patients: those with PTSD (study group) and those with organic brain damage with partial symptoms of PTSD (reference group). Along with psychopathological studies, a set of scales and questionnaires was used, including those adapted for investigating the sequelae of combat trauma. Results and conclusions. Clinical signs in the groups of patients in the posttraumatic period provided evidence of the similarity and uniformity of posttraumatic disorders in both groups. The pathogenetic role of the intensity of TBI then became clearer – depending on severity, this led to formation of organic brain damage or had only a pathoplastic role, producing some of the characteristics of the clinical picture of PTSD. The more severe the trauma, the greater the probability of transformation of PTSD into organic brain damage. It is emphasized that the treatment of poststress disorders is a continuous, long-term, complex, and staged process, which includes medication, psychotherapy, and psychosocial interventions.
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Relevance. Posttraumatic stress disorder (PTSD) occurs in people who have suffered a traumatic event (during war, natural disaster, domestic violence, etc.) sometimes even many years after the injury, causing changes in psychological and behavioral levels. Objective is to consider current data on the prevalence, pathophysiology and therapy of patients with PTSD. Methods. Analysis of data presented by PubMed by keywords "posttraumatic stress", "prevalence", "pathophysiology", "psychotherapy", "psychopharmacology". Results. PTSD is observed in 5-10% of the population, twice as often in women than in men, among children PTSD is found in 10%, in girls 4 times more often than in boys. During the war, PTSD is most often associated with stressful events such as bombing, homelessness, sieges, and combat. The highest prevalence of PTSD was among widows and widowers, divorcees, the unemployed and retirees. Hereditary sources of PTSD risk are shown on the basis of general genomic and epigenomic associations, transcriptomic and neuroimaging studies. Changes in the amygdala, islet, hippocampus, anterior cingulate cortex, and prefrontal cortex demonstrate that emotional dysregulation in PTSD occurs due to complications in the large neural network. Methods of non-pharmacological therapy of PTSD are presented and the effectiveness of drugs of different groups (antidepressants; antipsychotics; drugs that affect sympathetic activity, endocannabinoid system, etc.) is described. Conclusions. Posttraumatic stress disorder is a common disorder that is often undiagnosed, leading to significant psychological and behavioral disorders, increasing the risk of suicide. The review presents modern ideas about its pathophysiology and treatment options.
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In 1978, G. Klerman published an essay in which he named the then-nascent “neo-Kraepelinian” movement and formulated a “credo” of nine propositions expressing the movement's essential claims and aspirations. Klerman's essay appeared on the eve of the triumph of neo-Kraepelinian ideas in the DSM-III. However, this diagnostic system has subsequently come under attack, opening the way for competing proposals for the future of psychiatric nosology. To better understand what is at stake, in this paper I provide a close reading and consideration of Klerman's credo in light of the past forty years of research and reflection. The credo is placed in the context of two equally seminal publications in the same year, one by S. Guze, the leading neo-Kraepelinian theorist, and the other by R. Spitzer and J. Endicott, defining mental disorder. The divergences between Spitzer and standard neo-Kraepelinianism are highlighted and argued to be much more important than is generally realized. The analysis of Klerman's credo is also argued to have implications for how to satisfactorily resolve the current nosological ferment in psychiatry. In addition to issues such as creating descriptive syndromal diagnostic criteria, overthrowing psychoanalytic dominance of psychiatry, and making psychiatry more scientific, neo-Kraepelinians were deeply concerned with the conceptual issue of the nature of mental disorder and the defense of psychiatry's medical legitimacy in response to antipsychiatric criticisms. These issues cannot be ignored, and I argue that proposals currently on offer to replace the neo-Kraepelinian system, especially popular proposals to replace it with dimensional measures, fail to adequately address them.
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The clinical construct of “anxiety neurosis” was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.
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We integrated existing cognitive processing models of posttrauma reactions into a longitudinal model. Data were obtained after a multiple shooting in a city office block. The subject group comprised 158 office workers who were in the building at the time of the shootings. The methodology of this research was a repeated measures survey, with data collection at 4, 8, and 14 months posttrauma. Measures included the Impact of Events Scale (IES) and the Symptom Checklist-90-Revised. A path analysis was performed with the IES as an indication of cognitive processing. Intrusion and avoidance were shown to mediate between exposure to trauma and symptom development. Intrusion was also found to be negatively related to subsequent symptom levels. The findings provide provisional support for a cognitive processing model.