Estimating the risk of PTSD in recent trauma survivors: results of the International Consortium to Predict PTSD (ICPP)

Arieh Y Shalev; Martin Gevonden; Andrew Ratanatharathorn; Eugene Laska; Willem F van der Mei; Wei Qi; Sarah Lowe; Betty S Lai; Richard A Bryant; Douglas Delahanty; Yutaka J Matsuoka; Miranda Olff; Ulrich Schnyder; Soraya Seedat; Terri A deRoon-Cassini; Ronald C Kessler; Karestan C Koenen; International Consortium to Predict PTSD

doi:10.1002/wps.20608

Estimating the risk of PTSD in recent trauma survivors: results of the International Consortium to Predict PTSD (ICPP)

World Psychiatry. 2019 Feb;18(1):77-87. doi: 10.1002/wps.20608.

Authors

Arieh Y Shalev¹, Martin Gevonden², Andrew Ratanatharathorn³, Eugene Laska¹, Willem F van der Mei¹, Wei Qi¹, Sarah Lowe⁴, Betty S Lai⁵, Richard A Bryant⁶, Douglas Delahanty⁷, Yutaka J Matsuoka⁸, Miranda Olff⁹, Ulrich Schnyder¹⁰, Soraya Seedat¹¹, Terri A deRoon-Cassini¹², Ronald C Kessler¹³, Karestan C Koenen¹⁴; International Consortium to Predict PTSD

Collaborators

International Consortium to Predict PTSD:
Yael Errera-Ankri, Anna C Barbano, Sarah Freedman, Jessie Frijling, Carel Goslings, Jan Luitse, Alexander McFarlane, Derrick Silove, Hanspeter Moergeli, Joanne Mouthaan, Daisuke Nishi, Meaghan O'Donnell, Marit Sijbrandij, Sharain Suliman, Mirjam van Zuiden

Affiliations

¹ Department of Psychiatry, New York University School of Medicine, New York, NY, USA.
² Department of Biological Psychology, Vrije Universiteit, Amsterdam, The Netherlands.
³ Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
⁴ Department of Psychology, Montclair State University, Montclair, NJ, USA.
⁵ Department of Counseling, Developmental and Educational Psychology, Lynch School of Education, Boston College, Chestnut Hill, MA, USA.
⁶ School of Psychology, University of New South Wales, Sydney, NSW, Australia.
⁷ Department of Psychological Sciences, Kent State University, Kent, OH, USA.
⁸ Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan.
⁹ Department of Psychiatry, University of Amsterdam, Amsterdam, The Netherlands, and Arq Psychotrauma Expert Group, Diemen, The Netherlands.
¹⁰ University of Zurich, Zurich, Switzerland.
¹¹ Department of Psychiatry, Stellenbosch University, Parow, Cape Town, South Africa.
¹² Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
¹³ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
¹⁴ Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Abstract

A timely determination of the risk of post-traumatic stress disorder (PTSD) is a prerequisite for efficient service delivery and prevention. We provide a risk estimate tool allowing a calculation of individuals' PTSD likelihood from early predictors. Members of the International Consortium to Predict PTSD (ICPP) shared individual participants' item-level data from ten longitudinal studies of civilian trauma survivors admitted to acute care centers in six countries. Eligible participants (N=2,473) completed an initial clinical assessment within 60 days of trauma exposure, and at least one follow-up assessment 4-15 months later. The Clinician-Administered PTSD Scale for DSM-IV (CAPS) evaluated PTSD symptom severity and diagnostic status at each assessment. Participants' education, prior lifetime trauma exposure, marital status and socio-economic status were assessed and harmonized across studies. The study's main outcome was the likelihood of a follow-up PTSD given early predictors. The prevalence of follow-up PTSD was 11.8% (9.2% for male participants and 16.4% for females). A logistic model using early PTSD symptom severity (initial CAPS total score) as a predictor produced remarkably accurate estimates of follow-up PTSD (predicted vs. raw probabilities: r=0.976). Adding respondents' female gender, lower education, and exposure to prior interpersonal trauma to the model yielded higher PTSD likelihood estimates, with similar model accuracy (predicted vs. raw probabilities: r=0.941). The current model could be adjusted for other traumatic circumstances and accommodate risk factors not captured by the ICPP (e.g., biological, social). In line with their use in general medicine, risk estimate models can inform clinical choices in psychiatry. It is hoped that quantifying individuals' PTSD risk will be a first step towards systematic prevention of the disorder.

Keywords: Post-traumatic stress disorder; clinician-administered PTSD scale for DSM-IV (CAPS); exposure to prior interpersonal trauma; female gender; lower education; prediction; prevention; risk assessment tool; trauma survivors.

Abstract

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