A longitudinal evaluation of active outreach after an aeroplane crash: screening for post-traumatic stress disorder and depression and assessment of self-reported treatment needs

Figures & data

Figure 1. Response and non-response at T1 (2 months after the crash), T2 (9 months after the crash) and T3 (44 months after the crash).

Table 1. Demographics, treatment needs and symptoms of post-traumatic stress disorder (PTSD) and depression in the base population and studied samples.

		Adult survivors	T1: 2 months	T2: 9 months	T3: 44 months	T3: MINI
Total n		121	76	77	55	38
Age	n	118	73	74	55	38
	Mean (SD)	40.15 (13.20)	40.03 (14.05)	41.68 (13.97)	44.27 (13.13)	42.95 (12.60)
Gender	Men	84 (69.4%)	49 (64.5%)	49 (63.6%)	35 (63.6%)	24 (63.2%)
	Women	36 (29.8%)	27 (35.5%)	28 (36.4%)	20 (36.4%)	14 (36.8%)
Nationality	Dutch	60 (49.6%)	44 (57.9%)	45 (58.4%)	32 (58.2%)	23 (60.5%)
	Turkish	46 (38.0%)	25 (32.9%)	26 (33.8%)	17 (30.9%)	10 (26.3%)
	Iranian	4 (3.3%)	3 (3.9%)	3 (3.9%)	3 (5.5%)	3 (7.9%)
	Other^a	11 (9.1%)	4 (5.3%)	3 (3.9%)	3 (5.5%)	2 (5.3%)
Treatment needs	n		74	76	54	38
	Unmet needs		25 (32.9%)	15 (19.5%)	6 (10.9%)	6 (15.8%)
	Met needs (treatment)		28 (36.8%)	42 (54.5%)	34 (61.8%)	23 (60.5%)
	No need		21 (27.6%)	19 (24.9%)	14 (25.9%)	9 (23.7%)
TSQ score	n		70	75	52	37
	Mean (SD)		5.23 (3.46)	4.79 (3.47)	4.27 (3.31)	3.49 (2.91)
PHQ-2 score	n		73	76	53	37
	Mean (SD)		1.95 (1.93)	1.84 (1.93)	1.51 (1.41)	1.38 (1.36)

Variables may have different sample sizes and percentages do not always add up to 100% owing to missing values. ^a Other countries were: USA, UK, Bulgaria, Germany, Italy, Sudan, Syria and Taiwan.

MINI, Mini International Neuropsychiatric Interview; TSQ, Trauma Screening Questionnaire; PHQ-2, Patient Health Questionnaire-2.

Table 2. Demographics of non-responders.

		T1: 2 months	T2: 9 months	T3: 44 months	T3: MINI
Total n		45	44	66	17
Age	n	45	44	63	17
	Mean (SD)	38.76 (12.02)	37.59 (11.51)	42.03 (13.30)	47.24 (14.17)
Gender	Men	35 (77.8%)	35 (79.5%)	49 (74.2%)	11 (64.7%)
	Women	9 (20.0%)	8 (18.2%)	16 (24.2%)	6 (35.3%)
Nationality	Dutch	16 (35.6%)	15 (34.1%)	28 (42.4%)	9 (52.9%)
	Turkish	21 (46.7%)	20 (45.5%)	29 (43.9%)	7 (36.8%)
	Iranian	1 (2.2%)	1 (2.3%)	1 (1.5%)	0
	Other^a	7 (15.6%)	8 (18.2%)	8 (12.2%)	1 (5.8%)

Variables may have different sample sizes and percentages do not always add up to 100% owing to missing values. ^a Other countries were: USA, UK, Bulgaria, Germany, Italy, Sudan, Syria and Taiwan.

MINI, Mini International Neuropsychiatric Interview.

Table 3. Treatment needs at T1 related to post-traumatic stress disorder (PTSD) trajectories.

		Explanation trajectories	Treatment needs at T1, n (%)			Mean TSQ
Trajectory	n (%)	T1–T2–T3	Met needs	No need	Unmet needs	T1	T2	T3
Resilient	38 (42.7)	0–0–0^a	11 (39.3)	14 (66.7)	5 (20.0)	2.54	1.89	2.06
Chronic	30 (33.7)	1–1–1	10 (35.7)	3 (14.3)	12 (48.0)	8.37	8.27	8.28
Recovery	9 (10.4)	1–0–0/1–1–0	5 (17.9)	0 (0.0)	2 (8.0)	7.46	4.00	3.57
Delayed onset	9 (10.4)	0–1–0/0–1–1^b	2 (7.1)	3 (14.3)	4 (16.0)	3.78	7.27	4.96
Relapse	3 (3.4)	1–0–1	0 (0.0)	1 (4.7)	2 (8.0)	9.00	3.67	7.45

^a 0 indicates not at risk for PTSD and 1 indicates at risk for PTSD, measured with the TSQ; a score of 6 or higher implies being at risk for PTSD. ^b 0–0–1 did not exist in this sample.

TSQ, Trauma Screening Questionnaire.

Table 4. Risk groups for post-traumatic stress disorder (PTSD) and depression measured with the Trauma Screening Questionnaire (TSQ) and Patient Health Questionnaire-2 (PHQ-2).

		T1: 2 months	T2: 9 months	T3: 44 months
TSQ^a	n	28	33	37
	Risk	8	9	7
	No risk	20	24	30
PHQ-2^b	n	30	33	38
	Risk	6	7	8
	No risk	24	26	30

^aAt risk was defined as a score of 6 or higher. ^b At risk was defined as a score of 3 or higher.

Table 5. Diagnostic performance of the Trauma Screening Questionnaire (TSQ) and Patient Health Questionnaire-2 (PHQ-2) in predicting post-traumatic stress disorder (PTSD) and major depressive disorder (MDD).

Screener	Time-point	Sensitivity	Specificity	PPV	NPV	AUC (95% CI)	n
TSQ^a	1	.75	.79	.38	.95	.78 (.59–.98)	28
	2	1.00	.86	.56	1.00	.96 (.90–1.00)	33
	3	.80	.90	.57	.97	.93 (.83–1.00)	37
PHQ-2^b	1	.60	.88	.50	.92	.72 (.45–.96)	30
	2	.89	.67	.92	1.00	.96 (.89–1.00)	33
	3	.38	.90	.50	.84	.87 (.74–.96)	38

^aA cut-off of 6 or higher was taken to indicate risk for PTSD. ^b A cut-off of 3 or higher was taken to indicate risk for depression.

PPV, positive predictive value; NPV, negative predictive value; AUC, area under the curve.

Figure 2. Flow diagram of the course of unmet treatment needs, no need for treatment and met needs (treatment group) between time-points 1 and 2 and between time-points 2 and 3.

Diagnostic performance of the Trauma Screening Questionnaire (TSQ) and Patient Health Questionnaire-2 (PHQ-2) in predicting any anxiety-, mood- or trauma-related disorder.

Screener	Time-point	Sensitivity	Specificity	Positive predictive power	Negative predictive power	n
TSQ^a	1	.50	.86	.78	.63	28
	2	.53	.94	.90	.67	34
	3	.40	1.00	1.00	.60	38
PHQ-2^b	1	.27	.87	.67	.54	30
	2	.44	1.00	1.00	.65	33
	3	.30	.89	.75	.53	38

^aA cut-off of 6 or higher was taken to indicate risk for PTSD. ^b A cut-off of 3 or higher was taken to indicate risk for depression.