Clinical Decision-Making Following Disasters: Efficient Identification of PTSD Risk in Adolescents.
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.
National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA. danielso@musc.edu.
Carla Kmett
CK
Danielson
Department of Psychology, University of Illinois-Urbana-Champaign, Champaign, IL, USA.
Joseph R
JR
Cohen
National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President Street, Charleston, SC, 29425, USA.
Zachary W
ZW
Adams
Department of Psychology, University of North Carolina, Chapel Hill, NC, USA.
Eric A
EA
Youngstrom
Department of Psychology, University of Memphis, Memphis, TN, USA.
Kathryn
K
Soltis
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA.
Ananda B
AB
Amstadter
Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC, USA.|Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
Kenneth J
KJ
Ruggiero
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D000407:Alabama; D002648:Child; D000066491:Clinical Decision-Making / Q000379:methods*; D004190:Disasters; D005260:Female; D006801:Humans; D008297:Male; D008923:Missouri; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis*; D055869:Tornadoes
Adolescents; Evidence-based assessment; PTSD risk assessment; Stress disorders; Traumatic stress