Acute stress disorder following an industrial accident

Abstract

Acute stress disorder (ASD) was introduced as a new diagnostic category in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV; American Psychiatric Association, 1994). Despite some controversy regarding the symptom criteria of ASD, little empirical data have yet been published on this new category. The current research was designed to investigate the prevalence, course, and phenomenology of this disorder following an industrial accident. Acute stress reactions were investigated in 47 males following an explosion in an oil refinery. Assessments were conducted by experienced clinicians at two points in time (2 weeks and 3 months posttrauma). Measures included a standardised structured interview (Sl-PTSD) and three self-report scales assessing traumatic stress (IES), anxiety (BAI), and depression (BDI). Six per cent of the sample met criteria for ASD at 2 weeks posttrauma. This lower-than-expected prevalence appeared to be a function of low levels of avoidance behaviour. Those people present at the time of the explosion scored higher than those who were not present on clinician-rated measures of symptom severity, but not on self-report measures. A significant reduction in symptoms occurred between 2 weeks and 3 months posttrauma, and no subjects went on to develop PTSD. While the current study largely supports the diagnostic criteria for ASD, considerable research remains to be done on this new category of traumatic stress reaction. In particular, the impact of early interventions in ameliorating the symptoms of acute stress disorder and preventing the progression to PTSD should be the focus of future research.