Acute Stress Disorder as a Predictor of Posttraumatic Stress Disorder: A Systematic Review

Objective: The utility of the acute stress disorder diagnosis to describe acute stress reactions and predict subsequent posttraumatic stress disorder (PTSD) was evaluated.

Data Sources: A systematic search was conducted in the PsycINFO, MEDLINE, and PubMed databases for English-language articles published between 1994 and 2009 using keywords that combined acute stress disorder and posttraumatic stress disorder.

Study Selection: Studies were selected that assessed for acute stress disorder within 1 month of trauma exposure and assessed at a later time for PTSD, using established measures of acute stress disorder and PTSD.

Data Extraction: For each study, capacity of the acute stress disorder diagnosis to predict PTSD was calculated in terms of sensitivity, specificity, and positive and negative predictive power. For studies that reported subsyndromal acute stress disorder, the same analyses were calculated for cases that initially satisfied subsyndromal acute stress disorder criteria.

Data Synthesis: Twenty-two studies were identified as suitable for analysis (19 with adults and 3 with children). Diagnosis of acute stress disorder resulted in half the rate of distressed people in the acute phase being identified relative to including cases with subsyndromal acute stress disorder. In terms of prediction, the acute stress disorder diagnosis had reasonable positive predictive power (proportion of people with acute stress disorder who later developed PTSD). In contrast, the sensitivity (proportion of people who developed PTSD who initially met criteria for acute stress disorder) was poor.

Conclusions: The acute stress disorder diagnosis does not adequately identify the majority of people who will eventually develop PTSD. There is a need to formally describe acute stress reactions, but this goal may be achieved more usefully by describing the broad range of initial reactions rather than by attempting to predict subsequent PTSD.

J Clin Psychiatry

Submitted: January 26, 2009; accepted September 2, 2009.

Online ahead of print: December 14, 2010 (doi:10.4088/JCP.09r05072blu).

Corresponding author: Richard A. Bryant, PhD, School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia (r.bryant@unsw.edu.au).