Emergency department predictors of posttraumatic stress reduction for trauma-exposed individuals with and without an early intervention

Abstract

Objective: Recent data have supported the use of an early exposure intervention to promote a reduction in acute stress and posttraumatic stress disorder (PTSD) symptoms after trauma exposure. The present study explored a comprehensive predictive model that included history of trauma exposure, dissociation at the time of the trauma and early intervention, and physiological responses (cortisol and heart rate) to determine which variables were most indicative of reduced PTSD symptoms for an early intervention or treatment as usual.

Method: Participants (n = 137) were randomly assigned to the early intervention condition (n = 68) or assessment-only condition (n = 69) while receiving care at the emergency department of a Level 1 trauma center. Follow-up assessments occurred at 4 and 12 weeks posttrauma.

Results: Findings suggested that dissociation at the time of the 1st treatment session was associated with reduced response to the early intervention. No other predictors were associated with treatment response. For treatment as usual, cortisol levels at the time of acute care and dissociation at the time of the traumatic event were positively associated with PTSD symptoms.

Conclusions: Dissociation at the time at which treatment starts may indicate poorer response to early intervention for PTSD. Similarly, dissociation at the time of the event was positively related to PTSD symptoms in those who received treatment as usual.

Trial registration: ClinicalTrials.gov NCT00895518.

Figure 1

Receiver operating characteristic (ROC) curves for intervention and assessment (treatment as usual) conditions using the respective dissociation variables as predictors of posttraumatic stress disorder diagnostic status at Week 12. The ROC curve for the intervention condition used postevent dissociation. The ROC curve for the assessment condition used peritraumatic dissociation.