Predictors of acute stress disorder severity

Background: The DSM-IV diagnosis of acute stress disorder (ASD) describes a posttraumatic reaction that occurs two to twenty-eight days following a trauma and involves symptoms of intrusion, avoidance, hyper-arousal and dissociation. A better understanding of ASD and its pathogenesis could lead to improved post-trauma health care interventions. The aim of this study was to determine prospectively whether a combination of clinical, cognitive and demographic variables were predictive of ASD severity in an acutely traumatized sample. Methods: We assessed demographic (e.g. age, gender, education), clinical (e.g. sleep quality, trait anxiety, previous psychiatric diagnoses), and cognitive (e.g. negative cognitions following trauma) variables in a sample of 125 adult motor vehicle accident survivors (age: 32.26±9.99; gender: 56.6% male) approximately 10 days after the accident. Univariate analyes and stepwise linear regression were performed to identify variables predictive of ASD severity. Results: Although a number of factors were individually associated with ASD severity, in a regression model only 3 factors, trait anxiety, suicide risk and post-traumatic cognitions, emerged as predictive of the severity of the disorder. Limitations: The cross-sectional nature of the study and use of self-report measures are important to bear in mind. Conclusions: Higher levels of trait anxiety, risk for suicide and negative appraisals of the traumatic event were predictive of ASD severity. As these factors may help to identify those who may be at risk of more severe responses after a traumatic event, and who may benefit from secondary prevention strategies, they should be assessed for in acute trauma survivors.