Abstract
Background: Motor Vehicle Collision qualifies as an extreme traumatic stress that can result in post traumatic stress disorder. Costs for treatment of anxiety disorders are currently estimated at $42 Billion United States Dollars annually.
Objective
To investigate the efficiency of distress thermometer in early detection of anxiety disorder in victims of Motor Vehicle Collision. Compare proficiency of Distress thermometer to a more extensive and time consuming diagnostic evaluation, preformed by specialist.
Method
The quantitative research design will be used for this study. The study will consist two parts, the first being a short set of questionnaires. Secondly, to those victims whose cut off scores will be 4 or greater, telephone interview with psychologist will be performed, where longer version of screening for Post Traumatic Stress Disorder will be initiated. After which results will compared and results and conclusion to be determined
Statement of the problem
Motor vehicle accidents (MVAs) are among the leading global causes of morbidity and mortality across the globe. In the United States, more than 3.5 million people become victims of MVAs annually (Butler, Moffic and Turkal, 1999). MVAs are a major source of concern because they also cause a variety of mild and severe psychological problems (Blaszczynski et al.1998; Hepp et al2008.). One such problem is Post Traumatic Stress Disorder (PTSD). MVAs have been leading among the causes of PTSD (cited in Khouzam and Donnelly 2001). Given the high prevalence of MVA-related PSTD, it is imperative to diagnose PSTD in primary care settings where victims receive medical attention (Beck, Coffey and Palyo 2004). However, early intervention necessitates a fast, simple, cost effective and reliable diagnostic instrument (Wittchen et al., 2002).
Conceptual framework
In order to accelerate improvement, the model is understood to be a very vital tool. For instance, the Post Traumatic Stress Disorder outcome has been improved using this model. The stress levels of MVC victims can be identified and monitored at an early stage so as to minimize the incidence of PTSD. This model has four components: 1) planning, 2) doing, 3) studying, and 4) acting. Incorporation of a stress thermometer in stress and for data collection is laid down which will assist the definition of the project, assessment of the current situation and analysis of how MVC victims respond to stress.
Secondly, the doing component is comprised of three tasks: 1) carrying out the plan, 2) documenting observations, and 3) recording the relevant data. Stress tracking charts will be employed. The resultant increased self awareness in MVC victims may lead to decreased incidences of PTSD (Shawn et al., p.84) necessary for reliable data recording.
Thirdly, data analysis will be compared with those of previous studies so as to refute or verify the hypothesis.
Fourth, the acting component looks at the changes that need to be made and determines whether or not to proceed to the next cycle which involves planning a continuous improvement approach after the hypothesis of this study has been accepted. Necessary changes will be determined that were proposed and set the way forward in the improvement approach.
Comparison is easily made between the current study and the expectations that are predicted as the hypothesis/objectives of the project. Finally, the model helps to set a continuous path for the cycle of improvement (SA Health Manager Wiki, 2007).
Literature Review
Predictors of PTSD
There are several PTSD predictors of post motor vehicle collision that have been identified. Beck and Shepherd (2003) carried out a study to examine the symptoms of PTSD and emotional distress among victims of motor vehicle accidents. The 85 patients used were classified as dysfunctional, interpersonally distressed, and adaptive coppers. The adaptive copers portrayed less symptoms of PTSD, anxiety or depression compared to the other two groups. Patients who had dysfunctional and interpersonally distressed coping characteristics had a higher chance of developing post trauma difficulties.
Frommberger et al. (1998) examined how PTSD can be predicted using immediate reactions following a motor vehicle accident. The researchers found that out of the 179 patients who developed PTSD, they had more serious injuries, anxiety and depression.
Other predictors of PTSD include peri-traumatic dissociation and acute stress disorder (ASD). Bryant and Harvey (2003) determined gender differences in the relationship among PTSD, ASD and peri-traumatic dissociation. The 171 patients were examined for ASD 1 month following the accident and for PTSD 6 months after the incident. In all the cases, the conditions were more pronounced in females than in males.
Other studies that have focused on predictors of PTSD include: McDermott and Cvitanovich (2000) on the prevalence of psychopathology among road accident patients, the 1999 study by Harvey and Braynt on the predictors of acute stress disorder among MVA victims and the Ehlers et al. (1998) study on predictors of PTSD.
Assessment of PTSD
The assessment of PTSD is crucial in determining patients who are at high risk of developing the condition so as to manage the condition earlier. PTSD can be assessed in different ways. The researchers used a sample of 74 MVA survivors who were admitted in an emergency department (citations). They found that victims who had elevated HR had less likelihood of meeting the criteria for PTSD 13 months after the accident and had less symptoms of PTSD. However, vital data such as elevated HR and blood pressure can still be used to assess for PTSD.
Besides vital data, PTSD can also be assessed using physiological responsiveness. Veazey et al. (2004) examined differences in physiological responsiveness between MVA victims who had developed PTSD and those who had not. The researchers concluded that physiological responsiveness to situations that are reminiscent of the traumatic event is a useful tool for assessing patients who are at high risk of developing PTSD.
In their study, Meiser-Stedman et al. (2008) sought to determine whether cognitive processes can be used to predict PTSD in a sample of 59 child and adolescent victims of MVAs. It was discovered that PTSD was indeed associated with maladaptive appraisals and other cognitive processes.
Factors Associated with PTSD
PTSD is associated with several. Victims with PTSD portray greater incidence of depression and anxiety problems in comparison to non-PTSD victims (Kupchik et al., 2007; Mayou et al., 2001). Patients with PTSD exhibit alexithymia, an adaptive way of dealing with stress (Alvarez and Shipko 1991). Unlike other studies which viewed gender as a risk factor for PTSD (Ursano et al.1999). According to Jeavons (2007), gender has no association with PTSD. Other studies assert that PTSD is not associated with past traumatic experiences (Koren, Amon and Klein1999) or premorbid psychiatric conditions (Ursano et al.1999).
These studies contradict other studies which found that PTSD is significantly associated with past history of psychiatric morbidity (Kuch, Cox and Evans 1996; Irish et al.2008), anxiety disorders, psychiatric treatment and past experience of motor vehicle accidents (Koren et al.1999; Harvey and Bryant 1999). Some scholars such as Jeavons (2000) argue that it is individuals’ unique experience with the event and coping mechanism rather than features of the event that influence their subsequent reaction to a traumatic incident..higher IES scores among the PTSD group than the non-PTSD group will be illustrated in the study by Kupchik et al. (2007).
Anxiety Screening and Diagnosis: The Distress Thermometer
PTSD is a psychological disorder which is linked to other psychological problems. The Distress Thermometer (DT) was developed to recognize distress among cancer patients (Ransom, Jacobsen and Booth-Jones 2006). It “addresses the need for a quick, easily understood measure of distress in medical populations” (National Comprehensive Cancer Network, 344-374 & Roth et al., 1904-1908). It can also be used to measure distress among MVA victims and thus help to diagnose PTSD since it is more effective (Jacobsen et al. 2005; Roth et al.1998; Trask et al 2002; Akizuki et al.2003; Hoffman et al.2004
Method
As noted by Wohlfarth and colleagues (Wohlfarth, Brink, Winkel & Kmitten, et al., 2003, p. 101–109), a two-step approach to identify PTSD has been recommended. Firstly, individuals are administered self-report measures relevant for a particular disorder (Mayou, Ehlers & Bryant, 2002, p. 665-675). Hence, clinicians can efficiently allocate clinical services where most needed. In the case of MVC survivors, the use of easy to administer self-report screening tools may help to identify individuals in both psychological and medical settings with serious psychological trauma after (Coffey, et al., 2006, p. 1).