Hanspeter Moergeli

German version of Clinician-Administered PTSD Scale

This study assessed the reliability of a German translation of the Clinician-Administered PTSD Scale (CAPS) by using data from 45 survivors of accidents who were hospitalized at the department of traumatology of a university hospital. Assessments were carried out 5 days (Time 1) and 6 months (Time 2) after the accident. Internal consistency proved to be comparable to that of the original English version: Cronbachs alpha was .88 at T1 and .92 at T2 for the CAPS total score. The CAPS correlated significantly with the validated German version of the Impact of Event Scale (IES) (T1: r = .56, T2: r = .78). The data suggest that the German version of the CAPS is a reliable instrument for the assessment of posttraumatic stress disorder symptomatology in accident victims. Further studies are necessary to validate further the questionnaire.

Does acute stress disorder predict post-traumatic stress disorder in traffic accident victims? Analysis of a self-report inventory

The objective of this study was to account for acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) morbidity in a self-report survey of traffic accident victims and to evaluate the relationship between ASD and PTSD in this sample, and furthermore, to find both a model of independent variables accounting for variance in ASD and PTSD symptom level. Ninety patients, treated at an emergency ward after traffic accidents, participated in this longitudinal self-report survey. ASD was assessed using the Acute Stress Disorder Scale (ASDS) and PTSD was assessed at 6-8 months follow-up using the Posttraumatic Diagnostic Scale (PDS). Twenty-five patients (28%) met the cutoff scores for ASDS. Fifteen patients (17%) fulfilled criteria for PTSD according to the PDS. ASD was only able to predict 50% of patients who later developed high levels of PTSD symptomatology. A model of three variables explained 35% of the variance in ASD symptom level. Two variables explained 40% of the variance in PTSD symptom level. In both regression models, dissatisfaction with social support was associated with a higher symptom level. The results from this study reflect already voiced problems with the ASD diagnosis. The lack of precision in predicting who will develop PTSD is pronounced in this study. The acute traumatic symptom level explains a large part of the variance in PTSD symptom level. However, other variables also seem to play an important role.Research evidence indicates that approximately 10 h a week is a sufficient intensity for short-term day treatment programmes for patients with personality disorders. In this article, we discuss which therapeutic components should be included in such a programme. Relevant research and clinical literature are reviewed. The fit between the therapeutic components and the programme as a whole is discussed according to: 1) scientific evidence of the effectiveness of the therapeutic components, 2) a sound theoretical rationale, 3) evidence of user satisfaction among patients, 4) clinical experiences of staff, 5) comprehensiveness and consistency, and 6) available therapeutic skills and resources. We advocate an 11-h treatment programme comprising small group psychotherapy, art group therapy, large group psychotherapy, cognitive group therapy, problem-solving group therapy and optional adjuncts (cognitive behavioural group therapy) for patients with additional anxiety and eating disorders.

Development of chronic pain following severe accidental injury. Results of a 3-year follow-up study.

OBJECTIVE Motor vehicle accidents (MVA) and work-related injuries are two of the more common causes of chronic pain. Nevertheless, there is little evidence on predicting factors regarding the development of chronic pain following physical injury. METHODS The present study investigated temporal associations between accident-related factors, psychological factors [symptoms of posttraumatic stress disorder (PTSD), anxiety, depression, coping], and the development of chronic pain in a sample of individuals who had sustained severe accidental injuries (N=90). Assessments were performed within 1 month of the accident, and at 6, 12, and 36 months post trauma. RESULTS A total of 40 individuals (44%) reported accident-related pain 3 years after the accident. Individuals with chronic pain showed significantly more symptoms of PTSD, depression, and anxiety, more disability, and more days off work. Analysis of temporal associations between psychological variables and the development of chronic pain indicated that the separation of the pain from the nonpain group mostly occurred between 6 (T2) and 12 months (T3). Differences were much less pronounced at T1. CONCLUSION The prevalence of chronic pain in severely injured patients 3 years after the accident is considerably high. The development of chronic pain is more related to psychological factors, particularly PTSD symptoms, in the aftermath of the accident, as compared to sociodemographic and accident-related variables at the time of the accident. These findings may be helpful to elucidate the problems in predicting chronic pain conditions in injured subjects and to recognize the onset of a chronic pain condition more reliably.

Mutual influence of posttraumatic stress disorder symptoms and chronic pain among injured accident survivors: A longitudinal study

The relationship between acute stress disorder (ASD), posttraumatic stress disorder symptoms (PTSD), and chronic pain was investigated in a longitudinal study of injured accident victims (N = 323, 64.7% men). Assessments took place 5 days (T1), 6 (T2) months, and 12 (T3) months postaccident. Relations between pain and posttraumatic stress symptoms were tested by structural equation modeling. Subjects diagnosed with full or subsyndromal PTSD at T2 and at T3 (14 and 19%) reported significantly higher pain intensity. Cross-lagged panel analysis yielded a mutual maintenance of pain intensity and ASD or PTSD symptoms across T2. Across the second half year, PTSD symptoms impacted significantly on pain but not vice versa. Clinicians need to pay careful attention to PTSD symptoms in accident survivors suffering from chronic pain.

Quality of life and dyadic adjustment in oral cancer patients and their female partners

The diagnosis of cancer affects not only the lives of patients, but also the lives of their family members. The purpose of this study was to examine the impact of oral cancer on quality of life (QoL), psychological distress and marital satisfaction in a sample of patients and their wives. Thirty-one men treated for oral cancer (mean time since diagnosis 3.7 years) and their female partners (n = 31) were assessed by questionnaires with regard to QoL (WHOQOL-BREF), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), quality of relationship (Dyadic Adjustment Scale, DAS) and physical complaints (EORTC QOL-H&N35). Quality of life was remarkably high in patients and their partners. In patients, lower QoL was associated with more physical complaints and higher levels of psychological distress (HADS), whereas in wives, QoL was found to be related to marital quality (DAS) and levels of distress. In couples with highly discrepant ratings of marital satisfaction, wives reported more psychological distress. The findings indicate that overall QoL is considerably high in patients treated for oral cancer and their partners living in stable relationships. Quality of life correlates stronger with the quality of relationship in spouses than in patients. Generally, marital satisfaction appears to be an important moderating factor regarding QoL and psychological distress.

Disclosure and Social Acknowledgement as Predictors of Recovery from Posttraumatic Stress: A Longitudinal Study in Crime Victims

Objective: To address posttraumatic stress disorder (PTSD) predictors with research focused on the coping styles of traumatized individuals. Method: A total of 86 crime victims (mean age 46.1, standard deviation 17.6) were assessed at 5 and 11 months post-crime. Disclosure of trauma, social acknowledgement, dysfunctional posttraumatic cognitions, and PTSD symptom severity were assessed by self-reports. Results: Dysfunctional posttraumatic cognitions, disclosure attitudes, and social disapproval correlated positively with PTSD severity. Hierarchical regression analyses revealed the particular value of disclosure attitudes and perceived social disapproval in predicting PTSD symptom severity at 11 months post-crime. Conclusions: In addition to known predictors of PTSD, disclosure attitudes and social acknowledgement should also be considered. Future research should focus on broader concepts such as the victims perception of, and interaction with, their social environment, and on the objective factors of social interaction, in addition to intrapersonal processes of posttraumatic recovery.

Post-traumatic stress disorder in serious accidental injury: 3-year follow-up study

BACKGROUND Long-term data on post-traumatic stress disorder (PTSD) following accidents are scarce. AIMS To assess and predict PTSD in people 3 years after severe accidental injury. METHOD Severely injured patients were recruited consecutively from the intensive care unit (n=121) and assessed within 1 month of the trauma. Follow-up interviews were conducted 6 months, 12 months and 36 months later; 90 patients participated in all four interviews. Symptoms were assessed using the Clinician-Administered PTSD Scale. RESULTS Post-traumatic stress disorder was diagnosed in 6% of patients 2 weeks after the accident, in 2% after 1 year and in 4% after 3 years. Robust predictors of later PTSD symptom level were intrusive symptoms shortly after the accident and biographical risk factors. There were individual changes over time between the categories PTSD, sub-threshold PTSD and no PTSD. Whereas PTSD symptom severity was low or decreased for most of the patients, some of them showed an increase or a delayed onset. Patients with persisting PTSD symptoms at 6 months and patients with delayed onset of symptoms are at risk of long-term PTSD. CONCLUSIONS The prevalence of PTSD was low over the whole period of 3 years.

Patient Satisfaction With Outpatient Psychiatric Treatment: The Role of Diagnosis, Pharmacotherapy, and Perceived Therapeutic Change

Objective: To investigate the influence of diagnosis, type of treatment, and perceived therapeutic change on patient satisfaction following psychiatric treatment for nonpsychotic, nonsubstance-related disorders. Method: We mailed questionnaires, including Larsens Client Satisfaction Questionnaire and Grawes Bern Inventory of Treatment Goals, to outpatients who had undergone 8 or more therapy sessions 1 year following treatment. Results: Patients with somatoform, eating, and personality disorders were less satisfied than patients with affective, anxiety, and adjustment disorders. Symptom reduction and changes in the interpersonal domain were important outcomes associated with patient satisfaction. Although pharmacotherapy itself was not related to patient satisfaction, patients who perceived improvements in pharmacotherapy as one of the most important treatment outcomes were less satisfied than others. Preliminary evidence shows that coping with specific problems and symptoms is associated with satisfaction among male patients, whereas changes in the interpersonal domain seem to produce satisfaction among female patients. Conclusion: Patient-reported change and diagnostic category appear to play a relevant role in generating patient satisfaction. Further research is needed to clarify the interactions between sex, perceived outcome, and satisfaction.

Coping with Serious Accidental Injury: A One-Year Follow-Up Study

Background: The aim of this study was to analyze changes of coping strategies in severely injured accident victims over time and to compare patients with high and low posttraumatic stress disorder (PTSD) symptom levels with regard to their coping patterns and accident-related cognitions. Methods: 106 consecutive patients with severe accidental injuries admitted to a trauma surgery intensive care unit (ICU) were assessed within 1 month after the trauma and 6 and 12 months later. Assessments included a clinical interview, the Freiburg Questionnaire of Coping with Illness, the patients’ accident-related cognitions, the Clinician-Administered PTSD Scale, the 90-item revised Symptom Checklist (SCL-90-R), and the Sense of Coherence Questionnaire (SOC). Patients who met the criteria for either full or subsyndromal PTSD at least once over the observation period (36 subjects; 34.0%) were assigned to a highly symptomatic group (HSG), the remainder (70 subjects; 66.0%) to a less symptomatic group. Results: Overall, active problem-focused coping was predominant immediately after the accident and declined over time, with a stronger decrease in the HSG. Patients in the HSG scored higher on the SCL Global Severity Index and lower on the SOC. The patients’ subjective appraisal of accident severity was higher in the HSG, whereas there was no group difference with regard to accident-related variables such as type of accident, injury severity and mild to moderate traumatic brain injury. Conclusions: Active problem-focused coping, although utilized most frequently and often regarded as protective, might be an inadequate strategy in face of acute stress following a severe accident. Clinicians should not expect their patients to cope very actively in the acute ICU phase. In the subsequent rehabilitation, active coping seems to be more adaptive.

Posttraumatic Stress Disorder following Accidental Injury: Rule or Exception in Switzerland?

Background: There is still marked variability in the findings concerning psychiatric disorders associated with traumatic injury. The aim of this study was to determine the incidence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following accidental injuries, and to predict the PTSD symptom level at 6 months, taking into particular consideration the role of pre-existing psychiatric morbidity and insufficient command of the local language. Method: A total of 255 accident survivors who were hospitalized for at least 2 consecutive nights at a Swiss university hospital for treatment of recently acquired physical injuries were interviewed within 2 weeks of the trauma and 6 months after the accident. Patients who did not have a good command of German but were fluent in Italian, Spanish, Portuguese, Serbo-Croatian or Albanian were assessed using interpreters. The main outcome measure was the Clinician-Administered PTSD Scale. Results: Ten patients (3.9%) were diagnosed as having ASD. At 6 months, 8 patients (3.1%) had PTSD. A regression model using 12 potential predictor variables explained 40% of the variance of PTSD symptoms; mild traumatic brain injury (p < 0.001), pain (p < 0.05), ASD symptom level (p < 0.001) and emotional coping (p = 0.001) predicted higher PTSD symptom levels, while high Sense of Coherence (p < 0.05) and perceived responsibility for the accident (p < 0.01) were associated with lower PTSD symptom levels at follow-up. Conclusions: ASD and PTSD seem to occur less frequently following accidental injuries than previously reported in the literature. Pre-existing psychiatric morbidity and lack of proficiency in the locally spoken language do not appear to play an important role in the development of PTSD.