The development of a clinically useful tool for predicting the development of psychological disorder following injury

• Published in: British journal of clinical psychology Vol. 48; no. 1; pp. 31 - 45
• Main Authors: Mason, S., Farrow, T. F. D., Fawbert, D., Smith, R., Bath, P. A., Hunter, M., Woodruff, P. W., Turpin, G.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-03-2009; British Psychological Society
• Subjects: Accidents; Adult; Adult and adolescent clinical studies; Anxiety; Anxiety Disorders - diagnosis; Anxiety Disorders - epidemiology; Anxiety Disorders - psychology; Anxiety disorders. Neuroses; Anxiety-Depression; Biological and medical sciences; Clinical psychology; Cohort Studies; Comorbidity; Depression; Depressive Disorder - diagnosis; Depressive Disorder - epidemiology; Depressive Disorder - psychology; Epilepsy, Post-Traumatic - diagnosis; Epilepsy, Post-Traumatic - epidemiology; Epilepsy, Post-Traumatic - psychology; Female; Humans; Injuries; Male; Medical sciences; Mental Disorders - diagnosis; Mental health; Mood disorders; Odds Ratio; Personality disorders; Post-traumatic stress disorder; Posttraumatic stress disorder; Predictive Value of Tests; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Qualitative analysis; ROC Curve; Sensitivity; Sensitivity and Specificity; Severity of Illness Index; Surveys and Questionnaires; Symptoms; United Kingdom - epidemiology; Wounds and Injuries - epidemiology; Wounds and Injuries - psychology; Mood disorder; Human; Theoretical model; Follow up study; Anxiety disorder; Depression; Early; Posttraumatic stress disorder; Physical injury; Lesion; Psychopathology; Predictive factor
• ISSN: 0144-6657; 2044-8260
• DOI: 10.1348/014466508X344799

Objectives
To identify factors significantly associated with post‐traumatic stress disorder (PTSD), anxiety, and depression at 3 months post‐injury; to develop a generic model to predict the occurrence of PTSD, anxiety, and depression at 3 months post‐injury; and to validate this model in a test data set of patients.
Design
Prospective cohort study.
Methods
Participants were 823 patients attending an emergency department (ED) following accidental injury. Baseline questionnaires were completed, with 1 and 3 months postal follow‐ups. Predictor variables demonstrating significant associations with two of the three outcome measures (3‐month HAD anxiety and depression scores and PTSD symptoms) were included in multivariate regression models for each outcome. Non‐significant predictor variables were removed until all remaining independent variables made the most significant contribution to each of the three models. Models were validated using a test dataset.
Results
Previous history of mental health problems, neuroticism score and having PTSD symptoms at 1 month predicted adverse outcomes at 3 months. When used on the test datasets, the areas under the receiver operating curve (ROC) curve for the models predicting outcomes at 3 months were: PTSD=0.91 (sensitivity=88.5%); anxiety=0.87 (sensitivity=93.7%); and depression=0.87 (sensitivity=96.7%).
Conclusions
The final model performed moderately well across the three outcomes and may be useful clinically as a generic rule‐out tool to identify those who will not require follow up, watchful waiting or intervention.