Post-Traumatic Stress Disorder – Protective and Risk Factors: A Study of 18 Survivors of a Plane Crash

After attending this presentation, attendees will have a betterunderstanding of how an individual’s characteristics may constitutevulnerability or protective factors related to the development ofpsychopathological symptoms of Post-Traumatic StressDisorder (PTSD).This presentation will impact the forensic science community byadding data regarding PTSD risk factors.Objective: Many retrospective studies on the risk factors fordeveloping post-traumatic stress disorder have been published in theliterature, however their results are equivocal. The mechanism by whichonly some subjects who are exposed to an intense traumatic eventdevelop PTSD is still not completely clear (Shear, 2002). The studypresented here proposes to identify predictive risk factors related todeveloping PTSD through data gathered from the survivors of an airdisaster in which 16 people died and 23 were wounded.Method: The investigations were conducted six months followingthe traumatic event by a team that consisted of four psychiatristsspecialized in clinical and forensic psychiatry, two forensicpsychologists, and two medical legal doctors.In order to increase diagnostic accuracy and to avert any attempts atfeigning harm (Hall, 2007), two expert psychiatrists, randomly chosenfrom among the four examiners, jointly conducted psychiatricobservations of each of the survivors using the Clinician-AdministeredPTSD Scale-Diagnostic Version (CAPS-DX) to diagnose post-traumaticstress disorder. Each examiner calculated individual scores and theaverage weighted scores of each of them were used in the final legalmedical diagnoses. Other diagnostic instruments used include the ZungSelf-Rated Anxiety Scale (SAS); Zung Self-Rating Depression Scale(SDS); and the Profile of Mood States (POMS) by McNair, Lorr, andDroppleman.1 With the goal of obtaining an evaluation of personalitystructure, the Rorschach projective test, using the Exner scoring system,was used. The subjects also underwent careful anamnestic and clinicalexaminations to ascertain any prior personal or family psychiatrichistories, as well as to evaluate personality structure and cognitivecapacity. Particular attention was paid to the behavior of each subject inthe periods preceding and following the crash. The investigatorscompared personal declarations given during interviews with those ofthe other survivors, and recorded emotional/affective reactions. Thesubjects’ physical injuries were also evaluated by medical legal doctorsusing the Patient Health Questionnaire 15-Item Somatic SymptomSeverity Scale (PHQ-15) (Kroenke, 2002). This 15-item selfadministereddiagnostic instrument was used to measure the severity ofproblems that arose from the injuries. It consists of seven questionsrelated to regional pain, and eight questions related to general physicaldiscomfort. For each symptom, the subjects’ responses were recorded asfollows: 0 (“not bothered at all”); 1 (“bothered a little”); or, 2 (“bothereda lot”).Results: Six-months following the traumatic event, only four of thesurvivors (22.2%) showed no psychopathological symptomatology.Fourteen survivors (77.8%) exhibited emotional/affective symptomsrelated to the event. Seven (38.9% of the entire sample) presented withall of the symptoms of PTSD; two had co-morbid depressive disorder;and seven presented with subsyndromal psychopathological symptomsfor PTSD, which mostly involved increased arousal (i.e.,hypervigilance, exaggerated startle reaction, and difficulty sleeping).In addition to the severity of the traumatic event itself, other riskfactors identified that correlated to the development of PTSD were theloss of a relative, the manifestation of depressive symptoms, and theseverity of physical injuries sustained. Conversely, low levels of hostilityand high levels of self-efficacy represented protective factors againstdeveloping PTSD.Conclusions: The results demonstrate tha[...]