The development of a clinically useful tool for predicting the development of psychological disorder following injury

Br J Clin Psychol. 2009 Mar;48(Pt 1):31-45. doi: 10.1348/014466508X344799. Epub 2008 Sep 16.


Objectives: To identify factors significantly associated with post-traumatic stress disorder (PTSD), anxiety, and depression at 3 months post-injury; to develop a generic model to predict the occurrence of PTSD, anxiety, and depression at 3 months post-injury; and to validate this model in a test data set of patients.

Design: Prospective cohort study.

Methods: Participants were 823 patients attending an emergency department (ED) following accidental injury. Baseline questionnaires were completed, with 1 and 3 months postal follow-ups. Predictor variables demonstrating significant associations with two of the three outcome measures (3-month HAD anxiety and depression scores and PTSD symptoms) were included in multivariate regression models for each outcome. Non-significant predictor variables were removed until all remaining independent variables made the most significant contribution to each of the three models. Models were validated using a test dataset.

Results: Previous history of mental health problems, neuroticism score and having PTSD symptoms at 1 month predicted adverse outcomes at 3 months. When used on the test datasets, the areas under the receiver operating curve (ROC) curve for the models predicting outcomes at 3 months were: PTSD=0.91 (sensitivity=88.5%); anxiety=0.87 (sensitivity=93.7%); and depression=0.87 (sensitivity=96.7%).

Conclusions: The final model performed moderately well across the three outcomes and may be useful clinically as a generic rule-out tool to identify those who will not require follow up, watchful waiting or intervention.

Publication types

  • Validation Study

MeSH terms

  • Adult
  • Anxiety Disorders / diagnosis
  • Anxiety Disorders / epidemiology*
  • Anxiety Disorders / psychology
  • Cohort Studies
  • Comorbidity
  • Depressive Disorder / diagnosis
  • Depressive Disorder / epidemiology*
  • Depressive Disorder / psychology
  • Epilepsy, Post-Traumatic / diagnosis
  • Epilepsy, Post-Traumatic / epidemiology*
  • Epilepsy, Post-Traumatic / psychology
  • Female
  • Humans
  • Male
  • Mental Disorders / diagnosis*
  • Odds Ratio
  • Predictive Value of Tests
  • Prospective Studies
  • ROC Curve
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Surveys and Questionnaires*
  • United Kingdom / epidemiology
  • Wounds and Injuries / epidemiology*
  • Wounds and Injuries / psychology