Can structured interviews for posttraumatic stress disorder assist clinical decision-making after motor vehicle accidents? An exploratory analysis.

Motor vehicle accidents (MVAs) represent one of the most common causes of posttraumatic stress disorder (PTSD) worldwide. Predicting those MVA survivors who are likely to experience PTSD in the longer-term has attracted substantial research attention, but most investigators have concluded that early traumatic stress symptoms have only moderate predictive power. The present study focuses on a decision-tree approach that might be useful to clinicians attempting to identify subgroups of MVA survivors with graduated degrees of risk. Eighty-three consecutive MVA admissions (response rate, 65%) were assessed by structured clinical interview within 2 weeks of the accident and at 18 months follow-up. Meeting full criteria for PTSD (other than the time criterion) at baseline achieved a positive predictive power of 0.92 in identifying those who had PTSD over the following 18 months. For the remainder, the PTSD "arousal" domain achieved a positive predictive power of 0.81 for predicting those with either subthreshold PTSD or full PTSD over the 18-month follow-up period. The implications for further research into a stepped approach to intervention and monitoring are discussed.