Advertisement

The Posttaumatic Adjustment Scale (PAS) is an effective measure in predicting psychological distress in patients following major trauma

Published:November 09, 2022DOI:https://doi.org/10.1016/j.injury.2022.11.019

      Highlights

      • The Posttraumatic Adjustment Scale (PAS) is effective in predicting later psychological distress in patients who have experienced major trauma.
      • A PAS-P of more than 10 predicted the development of PTSD symptoms or moderate global psychological distress with 72% sensitivity and 71% specificity.
      • The PAS-P was more sensitive in identifying patients who went on to develop psychological symptoms according to IES-R and CORE-10 scores, than clinician referral (71% versus 52%).

      Abstract

      Aims

      To determine whether a psychological screening tool - the Posttraumatic Adjustment Scale (PAS), predicts later psychological distress for admissions to a Major Trauma Centre (MTC) and to identify whether there was an unmet need in relation to the psychological support offered.

      Methods

      Patient demographics and details of their injuries were retrieved from the Trauma Audit & Research Network (TARN) database. All patients admitted to Leeds General Infirmary MTC were approached for inclusion in the study over a three-month period. The PAS was administered to all participants at baseline. Following discharge, patients were sent two validated psychological measures via post, the Impact of Events Scale – Revised (IES-R) and the Clinical Outcomes in Routine Evaluation System (CORE-10). Relationships between continuous variables were examined using a Spearman's rank test (SR). The diagnostic accuracy of the different psychological screening systems was examined and compared using Receiver Operator Characteristic (ROC) analysis.

      Results

      Eighty-two patients completed the PAS, 26 of whom had been referred to clinical psychology and 56 who were not. Fifty-seven of these patients (70%) returned follow-up IES-R and CORE-10 data, 20 who had been referred to psychology and 37 who had not. The PAS-P score recorded shortly after admission correlated strongly with the CORE-10 (SR rs 0.54, p<0.0001) and IES-R (SR rs 0.63, p<0.0001) scores recorded at early follow up. A PAS-P of more than 10 predicted the development of PTSD symptoms (IES-R 33 or more) or moderate global psychological distress (CORE-10 15 or more) with 72% sensitivity and 71% specificity. To identify patients who went on to develop psychological symptoms according to either measure (IES-R 33 or more or CORE-10 15 or more), the PAS-P was more sensitive than clinician referral (71% vs 52%, p<0.05) with similar specificity (72% vs 75%, p=0.78).

      Conclusions

      In an unselected group of trauma inpatients treated in a MTC, the PAS is an effective means of identifying those who are likely to go on to suffer PTSD symptoms or psychological distress. It may useful to use the PAS as a measure to formalise psychology referrals.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Moran CG
        • Lecky F
        • Bouamra O
        • Lawrence T
        • Edwards A
        • Woodford M
        • et al.
        Changing the System - Major Trauma Patients and Their Outcomes in the NHS (England) 2008–17.
        EClinicalMedicine. 2018; : 2-3
      1. NHS England. NHS standard contract for major trauma service (all ages). 2013.

        • Haagsma JA
        • Ringburg AN
        • van Lieshout EMM
        • van Beeck EF
        • Patka P
        • Schipper IB
        • et al.
        Prevalence rate, predictors and long-term course of probable posttraumatic stress disorder after major trauma: A prospective cohort study.
        BMC Psychiatry. 2012; 12
        • Spreadborough S
        • Radford K
        • das Nair R
        • Brooks A
        • Duffy M.
        A study of outcomes of patients treated at a UK major trauma centre for moderate or severe injuries one to three years after injury.
        Clin Rehabil. 2018; 32
        • Sullivan DR
        • Marx B
        • Chen MS
        • Depue BE
        • Hayes SM
        • Hayes JP.
        Behavioral and neural correlates of memory suppression in PTSD.
        J Psychiatr Res. 2019; 112
        • Su X
        • Xia C
        • Wang W
        • Sun H
        • Tan Q
        • Zhang S
        • et al.
        Abnormal metabolite concentrations and amygdala volume in patients with recent-onset posttraumatic stress disorder.
        J Affect Disord. 2018; : 241
        • Tousignant B
        • Jackson PL
        • Massicotte E
        • Beauchamp MH
        • Achim AM
        • Vera-Estay E
        • et al.
        Impact of traumatic brain injury on social cognition in adolescents and contribution of other higher order cognitive functions.
        Neuropsychol Rehabil. 2018; 28
      2. Post-traumatic stress disorder NICE guideline. NICE 2018. https://www.nice.org.uk/guidance/ng116/resources/posttraumatic-stress-disorder-pdf-66141601777861 (accessed March 3, 2022).

      3. Overview - Post-traumatic stress disorder - NHS. Natl Heal Serv 2018. https://www.nhs.uk/mental-health/conditions/post-traumatic-stress-disorder-ptsd/overview/(accessed March 3, 2022).

        • Visser E
        • Gosens T
        • Den Oudsten BL
        • De Vries J
        The course, prediction, and treatment of acute and posttraumatic stress in trauma patients: A systematic review.
        J Trauma Acute Care Surg. 2017; 82
        • Report NCAG
        Regional Networks for Major Trauma.
        NHS Clinical Advisory Groups Report, 2010: 1-137
        • Utzon-Frank N
        • Breinegaard N
        • Bertelsen M
        • Borritz M
        • Eller NH
        • Nordentoft M
        • et al.
        Occurrence of delayed-onset post-traumatic stress disorder: A systematic review and meta-analysis of prospective studies.
        Scand J Work Environ Heal. 2014; 40
        • Kastello JC.
        Predictors of postraumatic stress disorder and depression among low-income women exposed to perinatal intimate partner violence.
        George Mason University, 2015 ([dissertation])
        • Shih R
        • Schell T.
        Prevalence of PTSD and Major Depression Following Trauma-Center Hospitalization.
        J Trauma. 2010; : 69
        • Mason S
        • Turpin G
        • Woods D
        • Wardrope J
        • Rowlands A.
        Risk factors for psychological distress following injury.
        Br J Clin Psychol. 2006; : 45
        • Boscarino JA
        • Kirchner HL
        • Hoffman SN
        • Sartorius J
        • Adams RE
        • Figley CR.
        A brief screening tool for assessing psychological trauma in clinical practice: Development and validation of the New York PTSD Risk Score.
        Gen Hosp Psychiatry. 2011; : 33
        • Johnson L
        • Lodge C
        • Vollans S
        • Harwood PJ.
        Predictors of psychological distress following major trauma.
        Injury. 2019; 50: 1577-1583
        • O'Donnell ML
        • Creamer MC
        • Parslow R
        • Elliott P
        • Holmes ACN
        • Ellen S
        • et al.
        A Predictive Screening Index for Posttraumatic Stress Disorder and Depression Following Traumatic Injury.
        J Consult Clin Psychol. 2008; : 76
        • Creamer M
        • Bell R
        • Failla S.
        Psychometric properties of the Impact of Event Scale - Revised.
        Behav Res Ther. 2003; 41
        • Barkham M
        • Bewick B
        • Mullin T
        • Gilbody S
        • Connell J
        • Cahill J
        • et al.
        The CORE-10: A short measure of psychological distress for routine use in the psychological therapies.
        Couns Psychother Res. 2013; 13
        • Bellew M
        • Brown A
        • Miller C
        • Wainwright N
        • Aaron D.
        Major Trauma Clinical psychology Service for Adults and Children.
        Leeds Teach Hosp NHS Trust. 2013; (accessed March 3, 2022)
        • Powers MB
        • Warren AM
        • Rosenfield D
        • Roden-Foreman K
        • Bennett M
        • Reynolds MC
        • et al.
        Predictors of PTSD symptoms in adults admitted to a Level I trauma center: A prospective analysis.
        J Anxiety Disord. 2014; 28