Acute Stress Disorder and Post Traumatic Syndrome

A study is being conducted at IDRAAC that looks specifically at ASD predicting full threshold PTSD and subthreshold PTSD. It is important to note that people with subthreshold PTSD have symptoms that fail to satisfy all of the PTSD diagnostic criteria. However, these symptoms are frequent and clinically significant.¹

Aim of the study: The goal of the study is to identify both full and subthreshold PTSD by looking at the severity of ASD and not just ASD diagnosis. It also looks at how important the time at which ASD was measured (wave 1 or wave 2) is.

Hypothesis: To find out if ASD data from waves 1 and 2 could be used as a diagnostic tool to predict PTSD or its subsyndromal forms (post Beirut Port Blast).

Methods:

Study design: Prospective cohort study is being carried out over several months, in the wake of the August 4, 2020, Beirut port explosion.

Settings: The Saint George Hospital University Medical Center (SGHUMC) in Beirut serves as the main center for recruiting participants for this study.

Characteristics of study participants: All SGHUMC employees over the age of 18 (including clinical and non-clinical staff) are eligible to participate.

Start date of data collection: 1-2 weeks post blast (Wave 1).

Follow up dates: 3-4 weeks post blast (Wave 2), six months after the blast (Wave 3).

Data collection: In the first wave, data is gathered in-person. However, online surveys are used to gather data in waves 2 and 3.

Follow up methods: In order to improve the follow-up, participants are prompted by SMS and emails with a link / QR code to repeat the survey after each wave.

Incentives: Participants have a chance to win a $200 gift card in a random drawing. They get a free lunch ticket to use in the hospital cafeteria, as well as free consultations with a psychologist or psychiatrist at SGHUMC for themselves or their family members.

Variables and measurements:

The survey inquiries about the sociodemographic characteristics of the participants (age, gender, education level), work environment (profession, department), and the explosion (location of the individual during the explosion, damage to one’s place, questions such as being injured, seeing dead bodies, mutilations, death of loved ones). For mental health problems, the Acute Stress Disorder Scale (ASDS) is used to measure ASD, the Patient Health Questionnaire (PHQ-9) is used to measure depression, and the General Anxiety Disorder (GAD-7) is used to measure anxiety.

The survey, in wave 3 of data collection, includes questions on adverse childhood events (physical/sexual abuse, neglect) as well as the PTSD checklist for DSM-5 (PCL-5) used for assessing full threshold and subthreshold PTSD.

Statistical analysis:

Data is analyzed using StataMP version 13. Frequencies and mean ± SD are used to report categorical and continuous variables respectively.

Results:

The overall number of participants at each wave, as well as the number of participants who are followed up from wave 1 and/or 2 to wave 3, is determined.
The characteristics of study’s participants are summarized using descriptive statistics (age, gender, profession, types of childhood adversities).
Additionally, variables related to the outcomes (ASD total score, frequency of ASD in waves 1 and 2, and prevalence of both full and subthreshold PTSD in wave 3) are presented.

Main results: To evaluate the sensitivity, specificity, PPV, and NPV of ASD diagnosis/severity in predicting both full and subthreshold PTSD.

Funding:

The study is self-funded and supported by anonymous donors.

1. McLaughlin KA, Koenen KC, Friedman MJ, Ruscio AM, Karam EG, Shahly V, et al. Subthreshold posttraumatic stress disorder in the world health organization world mental health surveys. Biol Psychiatry. 2015 Feb 15;77(4):375–84.