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Gepubliceerd in: Journal of Abnormal Child Psychology 1/2017

22-04-2016

Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents

Auteurs: Carla Kmett Danielson, Joseph R. Cohen, Zachary W. Adams, Eric A. Youngstrom, Kathryn Soltis, Ananda B. Amstadter, Kenneth J. Ruggiero

Gepubliceerd in: Research on Child and Adolescent Psychopathology | Uitgave 1/2017

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Abstract

The present study aimed to utilize a Receiver Operating Characteristic (ROC) approach in order to improve clinical decision-making for adolescents at risk for the development of psychopathology in the aftermath of a natural disaster. Specifically we assessed theoretically-driven individual, interpersonal, and event-related vulnerability factors to determine which indices were most accurate in forecasting PTSD. Furthermore, we aimed to translate these etiological findings by identifying clinical cut-off recommendations for relevant vulnerability factors. Our study consisted of structured phone-based clinical interviews with 2000 adolescent-parent dyads living within a 5-mile radius of tornados that devastated Joplin, MO, and northern Alabama in Spring 2011. Demographics, tornado incident characteristics, prior trauma, mental health, and family support and conflict were assessed. A subset of youth completed two behavioral assessment tasks online to assess distress tolerance and risk-taking behavior. ROC analyses indicated four variables that significantly improved PTSD diagnostic efficiency: Lifetime depression (AUC = .90), trauma history (AUC = .76), social support (AUC = .70), and family conflict (AUC = .72). Youth were 2–3 times more likely to have PTSD if they had elevated scores on any of these variables. Of note, event-related characteristics (e.g., property damage) were not related to PTSD diagnostic status. The present study adds to the literature by making specific recommendations for empirically-based, efficient disaster-related PTSD assessment for adolescents following a natural disaster. Implications for practice and future trauma-related developmental psychopathology research are discussed.
Voetnoten
1
Only 2.1 % of all adolescents contacted were ruled out due to Internet access, suggesting that our inclusion criteria did not have an adverse impact on the generalizability of our results.
 
2
In addition to the methods outlined by Strauss and colleagues regarding tertiles, Kraemer’s (1992a) method to optimize thresholds was also examined. Results using Kraemer’s approach were remarkably similar to the cutpoint in the high categories (low for social support) using the initial method. The one exception was depressive symptoms, wherein a cutpoint of greater than 3, opposed to 2, symptoms resulted in the highest kappa (0.70).
 
3
It should be noted that this new probability is not a true assessment of the interaction between social support and conflict. Instead, Fig. 2 provides a quick heuristic for interested clinicians to calculate an estimated range of the additive consequences of having a significant interaction between two vulnerabilities.
 
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Metagegevens
Titel
Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents
Auteurs
Carla Kmett Danielson
Joseph R. Cohen
Zachary W. Adams
Eric A. Youngstrom
Kathryn Soltis
Ananda B. Amstadter
Kenneth J. Ruggiero
Publicatiedatum
22-04-2016
Uitgeverij
Springer US
Gepubliceerd in
Research on Child and Adolescent Psychopathology / Uitgave 1/2017
Print ISSN: 2730-7166
Elektronisch ISSN: 2730-7174
DOI
https://doi.org/10.1007/s10802-016-0159-3

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