Predictors of persistent affective disability in bank employees exposed to violent bank robberies.

Subjects exposed to violent bank robberies are at risk for developing posttraumatic stress disorder (PTSD). Early detection of subjects at high risk may prevent long-term disability. We, therefore, attempted to identify predictors of PTSD in the early stage after trauma exposure. In a 10-year observation period, a number of 117 employees were identified who had been exposed to bank robbery. Complete data sets were assessed in 53 subjects. In 19 % of the cases (n = 10) a full PTSD diagnosis was confirmed. The predictive value of the following variables was assessed: age, time period since index event, threat appraisal, peritraumatic dissociation symptoms (PDS) and symptoms of an acute stress disorder during the first four weeks after exposure. In univariate analysis, age and threat appraisal did not correlate significantly with PTSD, whereas the factor "time period since robbery" was of borderline significance (p = 0,055). Presence of an acute stress disorder (p < 0,002) and PDS (p = 0,028) were significantly associated with subsequent PTSD. In a multivariate analysis, only PDS was highly significant (p = 0,017). In this model, acute stress disorder did not add any further value to predicting PTSD. The study revealed that PDS which is associated with the appraisal of threat during the traumatic event, is significantly related to later PTSD, and, therefore, identifies subjects at risk. PDS can easily be assessed immediately after exposure