Pas Score

Journal of Consulting and Clinical Psychology
2008, Vol. 76, No. 6, 923–932

Copyright 2008 by the American Psychological Association
0022-006X/08/$12.00 DOI: 10.1037/a0012918

A Predictive Screening Index for Posttraumatic Stress Disorder and
Depression Following Traumatic Injury
Meaghan L. O’Donnell

Mark C. Creamer and Ruth Parslow

Australian Centre for Posttraumatic MentalHealth; University of
Melbourne, Parkville; and National Trauma Research Institute

Australian Centre for Posttraumatic Mental Health and
University of Melbourne, Parkville

Peter Elliott

Alexander C. N. Holmes

Australian Centre for Posttraumatic Mental Health and Heart
Research Centre

University of Melbourne, Parkville, and Royal
Melbourne Hospital

Steven Ellen

Rodney JudsonAlfred Psychiatric Research Centre and The Alfred Hospital

Royal Melbourne Hospital

Alexander C. McFarlane

Derrick Silove and Richard A. Bryant

The Centre of Military and Veterans’ Health

University of New South Wales

Posttraumatic stress disorder (PTSD) and major depressive episode (MDE) are frequent and disabling
consequences of surviving severe injury. The majority of thosewho develop these problems are not
identified or treated. The aim of this study was to develop and validate a screening instrument that
identifies, during hospitalization, adults at high risk for developing PTSD and/or MDE. Hospitalized
injury patients (n 527) completed a pool of questions that represented 13 constructs of vulnerability.
They were followed up at 12 months and assessed for PTSDand MDE. The resulting database was split
into 2 subsamples. A principal-axis factor analysis and then a confirmatory factor analysis were
conducted on the 1st subsample, resulting in a 5-factor solution. Two questions were selected from each
factor, resulting in a 10-item scale. The final model was cross-validated with the 2nd subsample.
Receiver-operating characteristic curves were thencreated. The resulting Posttraumatic Adjustment Scale
had a sensitivity of .82 and a specificity of .84 when predicting PTSD and a sensitivity of .72 and a
specificity of .75 in predicting posttraumatic MDE. This 10-item screening index represents a clinically
useful instrument to identify trauma survivors at risk for the later development of PTSD and/or MDE.
Keywords: predictive screen,posttraumatic stress disorder, depression, injury

In 2005, over 2 million people in the United States were hospitalized following nonfatal injuries (National Center for Injury
Prevention and Control, 2006). Within the 12 months following
their injury, 10%–30% of these injury survivors would have de-

veloped posttraumatic stress disorder (PTSD; O’Donnell,
Creamer, Pattison, & Atkin, 2004; Zatzick,Jurkovich, Gentilello,
Wisner, & Rivara, 2002) and 10%–15% would have developed
major depressive episode (MDE; O’Donnell, Creamer, Pattison, &

Meaghan L. O’Donnell, Australian Centre for Posttraumatic Mental Health,
Heidelberg West, Victoria, Australia; Department of Psychiatry, University of
Melbourne, Parkville, Victoria, Australia; and National Trauma Research
Institute, Prahran,Victoria, Australia; Mark C. Creamer and Ruth Parslow,
Australian Centre for Posttraumatic Mental Health and Department of Psychiatry, University of Melbourne; Peter Elliott, Australian Centre for Posttraumatic Mental Health and Heart Research Centre, Melbourne, Victoria, Australia; Alexander C. N. Holmes, Department of Psychiatry, University of
Melbourne, and Royal Melbourne Hospital, Parkville,Victoria, Australia;
Steven Ellen, Alfred Psychiatric Research Centre and The Alfred Hospital,
Prahran, Victoria, Australia; Rodney Judson, Royal Melbourne Hospital; Alexander C. McFarlane, The Centre of Military and Veterans’ Health, Adelaide,
South Australia, Australia; Derrick Silove, Psychiatry Research and Teaching
Unit, School of Psychiatry, University of New South Wales, Sydney, Australia;...