ABSTRACT
BACKGROUND: This study sets out to identify risk factors for post-traumatic stress disorder (PTSD) after a road traffic accident with a view to improving prevention. METHODS: The study used a prospective cohort of road traffic accident casualties. All subjects over 15 years of age were recruited in the course of an interview conducted while they were receiving care in a hospital of the Rhône area administrative département. Six months after their accident, they answered a self-administered postal questionnaire that included the Post-traumatic Check-List Scale (PCLS) in order to evaluate PTSD. Multivariate logistic regression analysis was conducted to compare those subjects with a PCLS score of 44 or over with those with a lower score, in order to identify factors that might be associated with PTSD. RESULTS: 592 subjects (out of 1168) returned the 6-month questionnaire and 541 completed the PCLS test. One hundred subjects had a PCLS score ≥ 44, suggesting PTSD, and 441 subjects did not. The factors associated with PTSD were initial injury severity, post-traumatic amnesia, the feeling of not being responsible for their accident and persistent pain 6 months after it. A lower odds-ratio was associated with users of two-wheel than four-wheel motor vehicles (OR=0.4; 0.2-0.9). CONCLUSION: Besides predictive factors for PTSD (injury severity, post-traumatic amnesia and the feeling of not being responsible for their accident), our study suggested a reduced risk of PTSD among two-wheel motor vehicle users.
Subject(s)
Accidents, Traffic/psychology , Stress Disorders, Post-Traumatic/psychology , Adolescent , Adult , Aged , Bicycling/injuries , Bicycling/psychology , Checklist , Chronic Disease , Cohort Studies , Cross-Sectional Studies , Female , Follow-Up Studies , France , Humans , Life Change Events , Male , Middle Aged , Motorcycles , Multivariate Analysis , Pain/psychology , Patient Admission , Psychometrics , Reproducibility of Results , Risk Factors , Socioeconomic Factors , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/epidemiology , Stress Disorders, Post-Traumatic/prevention & control , Surveys and Questionnaires , Walking/injuries , Walking/psychology , Young AdultABSTRACT
BACKGROUND: To date, there have been no studies comparing cognitive therapy (CT) with Rogerian supportive therapy (RST) in borderline personality disorder. METHOD: Sixty-five DSM-IV borderline personality disorder outpatients were recruited at 2 centres: Lyon and Marseille. Thirty-three patients were randomly allocated to CT and 32 to RST. The therapists were the same in both groups. Both treatments shared the same duration (1 year) and amount of therapy. Assessment by independent evaluators utilised the Clinical Global Impression (CGI) Scale, the Hamilton Depression Scale, Beck Depression Inventory, Beck Anxiety Inventory, Hopelessness Scale, Young Schema Questionnaire II, Eysenck Impulsivity Venturesomeness Empathy (IVE) Inventory, a self-harming behaviours checklist and scales measuring quality of life and the therapeutic relationship. The response criterion was a score of 3 or less on the CGI, associated with a Hopelessness Scale score of <8. RESULTS: No patient committed suicide during the trial. Fifty-one patients were evaluated at week 24, 38 at week 52 and 21 at week 104. Cognitive therapy retained the patients in therapy for a longer time. The response criterion found no significant between-group differences at any measurement point in the completers. However, at week 24, CT was better than RST on the Hopelessness Scale, IVE scale and regarding the therapeutic relationship. At week 104, the CGI improvement (patient and evaluator) was significantly better in CT than in RST. High baseline depression and impulsivity predicted dropouts. CONCLUSIONS: CT retained the patients in therapy longer, showed earlier positive effects on hopelessness and impulsivity, and demonstrated better long-term outcomes on global measures of improvement.
Subject(s)
Borderline Personality Disorder/therapy , Cognitive Behavioral Therapy/methods , Person-Centered Psychotherapy/methods , Adult , Borderline Personality Disorder/complications , Borderline Personality Disorder/diagnosis , Female , Follow-Up Studies , Humans , Impulsive Behavior/complications , Impulsive Behavior/psychology , Impulsive Behavior/therapy , Male , Pilot Projects , Psychiatric Status Rating Scales/statistics & numerical data , Quality of Life/psychology , Treatment Outcome , Suicide PreventionABSTRACT
BACKGROUND: To date, there have been no studies comparing cognitive behavior therapy (CBT) with Rogerian therapy in post-traumatic stress disorder. METHOD: Sixty outpatients with DSM-IV chronic post-traumatic stress disorder were randomized into two groups for 16 weekly individual sessions of CBT or Rogerian supportive therapy (ST) at two centers. No medication was prescribed. Measures included the Post-Traumatic Stress Disorder Checklist Scale (PCLS), the Hamilton Anxiety Scale, Beck Depression Inventory, and Quality of Life. The general criterion of improvement (GCI) was a score of less than 44 on the PCLS. RESULTS: Forty-two patients were evaluated at post-test, 38 at week 52 and 25 at week 104. At post-test, the rate of patients leaving the trial due to worsening or lack of effectiveness was significantly higher in the ST group (p = 0.004). At this point, no between-group difference was found on the GCI and any of the rating scales. Intent-to-treat analysis found no difference for the GCI, but patients in the CBT group showed greater improvement on the PCLS and Hamilton Anxiety Scale. Naturalistic follow-up showed sustained improvement without between-group differences at weeks 52 and 104. CONCLUSIONS: CBT retained significantly more patients in treatment than ST, but its effects were equivalent to those of ST in the completers. CBT was better in the dimensional intent-to-treat analysis at post-test.
Subject(s)
Antidepressive Agents/therapeutic use , Benzodiazepines/therapeutic use , Cognitive Behavioral Therapy/methods , Stress Disorders, Post-Traumatic/therapy , Adolescent , Adult , Aged , Chronic Disease , Combined Modality Therapy , Diagnostic and Statistical Manual of Mental Disorders , Drug Therapy/statistics & numerical data , Female , Follow-Up Studies , Humans , Male , Middle Aged , Quality of Life/psychology , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/drug therapy , Surveys and QuestionnairesABSTRACT
BACKGROUND: The Posttraumatic Stress Disorder Checklist Scale (PCLS) is a short self-report inventory for assessing the 3 main syndromes of Posttraumatic Stress Disorder (PTSD). The aim of this study was the validation of the French version of the PCLS in PTSD subjects and nonclinical subjects. METHODS: One-hundred and thirteen outpatients suffering from PTSD according to DSM-IV were administered the PCLS. The patients' scores on the PCLS were then compared to those of 31 nonclinical control subjects. Thirty-five of the patients were administered the PCLS twice over an interval of 1-2 weeks and also completed questionnaires measuring depression, phobia and anxiety. RESULTS: The patients' total score and subscores on the PCLS were found to be significantly higher than those of control subjects. The cutoff score of 44 on the French version PCLS distinguishes well between the PTSD group and control group with a high diagnostic efficacy (0.94). Factor analysis revealed 3 main factors corresponding to the reexperiencing, numbing and hyperarousal syndromes. The PCLS showed satisfactory test-retest reliability and internal consistency. CONCLUSIONS: The PCLS is therefore a valid and effective measurement of PTSD. It may be a useful tool for screening and assessing PTSD in psychiatric as well as in primary-care settings.
