L’intensité de la détresse péritraumatique prédit la survenue des symptômes post-traumatiques parmi des victimes d’agressions [Peritraumatic distress intensity predicts the occurrence of posttraumatic symptoms among assault victims]

L. Jehel; S. Paterniti; A. Brunet; P. Louville; J.-D. Guelfi

doi:10.1016/S0013-7006(06)76272-8

La détresse émotionnelle péritraumatique est une dimension récente dont nous avons cherché à vérifier à quel point elle pouvait prédire l’évolution des symptômes post-traumatiques. Les victimes ont été recrutées consécutivement dans 5 centres de consultations spécialisées en région parisienne auprès de victimes d’agressions individuelles et de hold-up. Parmi les 100 sujets inclus initialement, 63 ont été suivis par deux évaluations à 6 mois d’intervalle, la première par un clinicien avec une hétéro-évaluation associée à des questionnaires et la deuxième uniquement par des questionnaires: le Peritraumatic Distress Inventory (PDI) pour la mesure de la détresse émotionnelle péritraumatique ; le Peritraumatic Dissociative Experience Questionnaire a été utilisé pour mesurer l’intensité de la dissociation ; l’Impact of Event Scale- Revised (IES-R) pour mesurer l’intensité des symptômes de l’état de stress post-traumatique (ESPT) ; le Mini International Neuropsychiatric Interview (MINI) pour le diagnostic de dépression et d’état de stress post-traumatique (ESPT) posé par un évaluateur. Les scores de dissociation péritraumatique évalués à la première étape étaient corrélés aux scores d’IES-R initiaux et à 6 mois avec respectivement des coefficients de corrélation de 0,50 et 0,63 entre les scores de PDEQ et PDI initial et le score d’IES-R à 6 mois. Alors que les analyses statistiques descriptives indiquent des «tendances» de lien, c’est par une régression linéaire multiple hiérarchique en tenant compte du type d’événement qu’il apparaît que le score de détresse péritraumatique améliore la variance de 14 % pour prédire le score d’IES-R à 6 mois comparé à la prédiction du score d’IES-R initial. Cette étude est la première qui montre sur une enquête prospective la puissance du score de détresse émotionnelle péritraumatique pour prédire l’évolution d’un trouble post-traumatique. Nos résultats confirment que le type de traumatisme prédit fortement le pronostic à 6 mois dans cette population. Among the peritraumatic reactions after a traumatic event, one best identifies dissociation as a predictor of serious post-traumatic problems. The dimension of emotional distress is recent in the literature and we have attempted to identify how it may contribute to the prediction of the evolution of post-traumatic symptoms. Methods: 1. Population. Victims of individual aggression and those of a hold-up were recruited consecutively in the Paris area from five consulting centers. Individuals who had lost consciousness, had psychotic or dementia problems, or had a serious somatic pathology were excluded. Overall, we included 101 individuals with a traumatic experience (DSM IV criteria) that took place in the past 12 months. Two evaluations with a six-month interval were made. The first involved a face-to-face consultation with a clinician and the second required the individuals to complete self-reports. 2. Instruments. The Peritraumatic Distress Inventory (PDI) was administered to measure peritraumatic emotional distress, in the first phase. The Peritraumatic Dissociative Experience Questionnaire (PDEQ) was used to measure the intensity of the trauma and the dissociation, in this first phase. The Impact of Event Scale Revised (IES-R) was administered to assess the severity of the PTSD symptoms, in the first phase and at six months. The Mini International Neuropsychiatry Interview (MINI) was used in diagnosing depression and PTSD. Results: Among the 63 subjects who were followed-up after the initial meeting and completed the second half of the study, 29 were victims of physical assault, 20 of a hold-up, 7 of a robbery, and 5 were confronted with another menacing situation ; thus 40 were victims of aggression. According to the first consultation, 46 individuals presented symptoms of PTSD and 22 presented an episode of major depression. Between those who were followed-up for the whole study and those who dropped out after the initial consultation there were no significant differences with regards to gender, type of aggression, initial PDI scores (t = 0.38, df = 96, p = .7), PDEQ scores (t = 0.7, df = 96, p = 0.94), or IES-R scores (t = 0.23, df = 97, p = 0.082). Individuals who were victims of physical or sexual assault showed higher scores on the IES-R than individuals who claimed no such assault. The scores for peritraumatic dissociation were correlated with the initial IES-R scores with a correlation coefficient of 0.50. The scores from the PDEQ and the initial PDI were correlated with the IES-R scores at six months with a coefficient of 0.63. Using a multi-hierarchical linear regression controlling for type of experience, it appeared that the score of peritraumatic distress improved the variance by 14 % in predicting the IES-R score at six months, compared to the prediction of the score of the initial IES-R. Discussion: This is the first study using a prospective inquiry to demonstrate the power of the peritraumatic emotional distress score. Our results suggest that the type of trauma is a strong predictor of prognosis at six months. Despite our small sample size, the absence of significant differences between the drop-out group and our subjects reduces the probability of a bias in our selection criteria to explain our results. This study points to the fact that the measurement of peritraumatic emotional distress (PDI) is a good predictor of PTSD symptoms six months down the road. This study underlines the importance of an initial psychotraumatic consultation to identify the type of trauma and to measure the intensity of the peritraumatic symptoms in order to predict the severity of the evolution.

L’intensité de la détresse péritraumatique prédit la survenue des symptômes post-traumatiques parmi des victimes d’agressions [Peritraumatic distress intensity predicts the occurrence of posttraumatic symptoms among assault victims]

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