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A Multisite Study of the Capacity of Acute Stress Disorder Diagnosis to Predict Posttraumatic Stress Disorder

Richard A. Bryant, Ph.D.; Mark Creamer, Ph.D.; Meaghan L. O'Donnell, Ph.D.; Derrick Silove, M.D.; and Alexander C. McFarlane, M.D.

Objective: Previous studies investigating the relationship between acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) have reported mixed findings and have been flawed by small sample sizes and single sites. This study addresses these limitations by conducting a large-scale and multisite study to evaluate the extent to which ASD predicts subsequent PTSD.

Method: Between April 2004 and April 2005, patients admitted consecutively to 4 major trauma hospitals across Australia (N = 597) were randomly selected and assessed for ASD (DSM-IV criteria) during hospital admission (within 1 month of trauma exposure) and were subsequently reassessed for PTSD 3 months after the initial assessment (N = 507).

Results: Thirty-three patients (6%) met criteria for ASD, and 49 patients (10%) met criteria for PTSD at the 3-month follow-up assessment. Fifteen patients (45%) diagnosed with ASD and 34 patients (7%) not diagnosed with ASD subsequently met criteria for PTSD. The positive predictive power of PTSD criteria in the acute phase (0.60) was a better predictor of chronic PTSD than the positive predictive power of ASD (0.46).

Conclusions: The majority of people who develop PTSD do not initially meet criteria for ASD. These data challenge the proposition that the ASD diagnosis is an adequate tool to predict chronic PTSD.


(J Clin Psychiatry 2008;69:923-929. Online Ahead of Print April 15, 2008.)

Received July 22, 2007; accepted Oct. 25, 2007. From the School of Psychology (Dr. Bryant) and Psychiatry Research and Teaching Unit and Centre for Population Mental Health Research, School of Psychiatry (Dr. Silove), University of New South Wales, Sydney; Australian Centre for Posttraumatic Mental Health (Dr. Creamer) and Department of Psychiatry (Dr. O'Donnell), University of Melbourne; and Queen Elizabeth Hospital, University of Adelaide (Dr. McFarlane), Australia.

This research was supported by a National Health and Medical Research Council Program Grant (300304).

The authors report no additional financial or other relationships relevant to the subject of this article.

Corresponding author and reprints: Richard A. Bryant, Ph.D., School of Psychology, University of New South Wales, Sydney, NSW 2052, Australia (e-mail: