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Peritraumatic distress predicts posttraumatic stress symptoms in older people

In a recent publication of the International Journal of Geriatric Psychiatry, Chung et al. (2009) found that 35% of older people were suffering from posttraumatic stress disorder (PTSD) after a fall. However, they found no predictive factors for the development of PTSD. We would like to report the preliminary results of a study carried out with the main objective of assessing the predictive power of peritraumatic reactions in older adults. Peritraumatic distress, a measure of the intensity of DSM-IV PTSD criteria A2, indexes ‘fear, helplessness, and horror’ as well as other reactions experienced during or immediately after trauma exposure while peritraumatic dissociation refers to alterations in the experience of time, place, and persons. Older adults were enrolled in the study from the emergency department (ED) of Toulouse and Bordeaux University Hospitals. The study was approved by the institutional ethical committee of the Toulouse University Hospital. Eligible adults (age >65 years, French speaking) were admitted to the ED after either a road traffic accident or a violent assault. Exclusion criteria comprised mental retardation, prior psychiatric disorder, Mini Mental State Examination score <28, or a life-threatening condition. During the recruitment period, 34 participants were enrolled in the study and were assessed within 1 week of ED admission. Twenty-five of these subjects (73.5%) completed a second assessment 1 month after admission. Peritraumatic reactions were assessed at baseline and PTSD symptoms at 1 month. The Peritraumatic Distress Inventory (PDI) was used to assess distress at the time of the traumatic event. The PDI is composed of 13 selfreport items scored on a 5-point scale, with higher total scores indicating increased distress (range: 0–52) (Brunet et al., 2001). Peritraumatic dissociation was assessed using the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). The PDEQ is a 10-item self-report questionnaire, with each item scored on a 5point scale and higher total scores indicating increased dissociation (range: 10–50) (Birmes et al., 2005). The primary outcome measure was PTSD symptoms measured using the Clinician-Administered PTSD Scale (CAPS). The CAPS provides a total symptom severity score (range: 0–136) with higher scores indicating an increased level of PTSD symptoms (Blake et al., 1995). Clinical and sociodemographic data were collected from medical charts and are reported in Table 1. Five (20%) participants met the criteria for PTSD at 1 month. Pearson’s correlation analyses revealed that 1-month CAPS score was not significantly correlated with gender or age. It was, however, significantly associated with baseline PDI score (r1⁄4 0.60, p< 0.01) and PDEQ score (r1⁄4 0.41, p< 0.05). Multiple regression analysis was then performed to assess the ability of peritraumatic variables (PDI and PDEQ) to predict 1-month PTSD symptoms. Due to the small sample size, all other independent variables were excluded from the analysis. The model identified PDI score as the only significant peritraumatic predictor of 1-month PTSD symptoms (b1⁄4 0.78, p< 0.01) and predicted 32.2% of the total variance. Our results do not replicate those of Chung et al. (2009) concerning the association between PTSD symptoms and gender or age. This discrepancy might be explained by the small sample size. Nevertheless, the main original finding from this study is that peritraumatic distress is a significant predictor of acute PTSD symptoms 1 month after trauma in older adults. Similar to results in younger adults, increased distress at the time of a trauma predicts increased levels of PTSD symptoms in elderly subjects. Previous research has highlighted the association between peritraumatic dissociation and the development of PTSD symptoms in adults (Lensvelt-Mulders et al., 2008). Our study confirms these results but suggests that peritraumatic distress might be a better predictor than dissociation in older adults. There are several limitations to our study. The small sample size and low number of PTSD cases limited the analysis to symptoms only. Furthermore, assessing PTSD symptoms 1month posttraumamight be too early and the impact of peritraumatic distress and dissociation on long-term symptoms remains to be explored.