Traumatic injury is strongly associated with long-term mental health disorders, but the risk factors for developing these disorders are poorly understood. We report on a multi-institutional collaboration to collect long-term patient-centered outcomes after trauma, including screening for post-traumatic stress disorder. The objective of this study is to determine the prevalence of and risk factors for the development of post-traumatic stress disorder after traumatic injury.
Adult trauma patients (aged 18–64) with moderate to severe injuries (Injury Severity Score ≥ 9) admitted to 3 level I trauma centers were screened between 6 and 12 months after injury for post-traumatic stress disorder. Patients were divided by mechanism: fall, road traffic injury, and intentional injury. Multiple logistic regression models were used to determine the association between baseline patient and injury-related characteristics and the development of post-traumatic stress disorder for the overall cohort and by mechanism of injury.
A total of 450 patients completed the screen. Overall 32% screened positive for post-traumatic stress disorder, but this differed significantly by mechanism, with the lowest being after a fall (25%) and highest after intentional injury (60%). Injury severity was not associated with post-traumatic stress disorder for any group, but lower educational level was associated with post-traumatic stress disorder within all the groups. Only 21% of patients who screened positive for post-traumatic stress disorder were receiving treatment at the time of the survey.
Post-traumatic stress disorder is common after traumatic injury, and the prevalence varies significantly by injury mechanism but is not associated with injury severity. Only a small proportion of patients who screen positive for post-traumatic stress disorder are currently receiving treatment.
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Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. 2015 [cited 2017 Aug 5]. Available from www.cdc.gov/injury/wisqars.
- NTDB Annual Report 2016.American College of Surgeons, ChicagoIL2016
- Estimated lifetime medical and work loss costs of emergency department treated nonfatal injuries—United States 2013.MMWR Morb Mortal Wkly Rep. 2015; 64: 1078-1082
- Return to work and functional outcomes after major trauma: who recovers, when, and how well?.Ann Surg. 2016; 263: 623-632
- American Psychiatric Association, Arlington (VA)2013: 372-378 5th ed.
- A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury.Ann Surg. 2008; 248: 429-437
- Prevalence of PTSD and major depression following trauma-center hospitalization.J Trauma. 2010; 69: 1560-1566
- Seeking support after hospitalization for injury: a nested qualitative study of the role of primary care.Br J Gen Pract. 2016; : e24-e31
- Routine inclusion of long-term functional and patient reported outcomes (PROs) into trauma registries: the FORTE project.J Trauma Acute Care Surg. 2017; 83: 97-104
- Short screening scale for DSM-IV posttraumatic stress disorder.Am J Psychiatry. 1999; 156: 908-911
- Predictors of acute posttraumatic stress disorder symptoms following civilian trauma: highest incidence and severity of symptoms after assault.J Trauma. 2012; 72: 629-637
- Long-term psychological outcomes of workers after occupational injury: prevalence and risk factors.J Occup Rehabil. 2014; 24: 1-10
- Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.J Consult Clin Psychology. 2000; 68: 748-766
- Post-traumatic stress disorder associated with life-threatening motor vehicle collisions in WHO World Mental Health Surveys.BMC Psychiatry. 2016; 16: 257
- Long-term health status and trajectories of seriously injured patients: a population-based longitudinal study.PLoS Med. 2017; 14 (e1002322)
- Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups.J Consult Clin Psychol. 1992; 60: 409-418
- Psychological resilience after disaster: New York City in the aftermath of the September 11th terrorist attack.Psychol Sci. 2006; 17: 181-186
- The psychiatric sequelae of civilian trauma.Compr Psychiatry. 2000; 41: 19-23
- Long-term posttraumatic stress disorder persists after major trauma in adolescents: new data on risk factors and functional outcome.J Trauma. 2005; 58: 764-771
- Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men.J Trauma. 2002; 53: 882-888
- Predictors of psychological distress following serious injury.J Trauma Stress. 2000; 13: 681-692
- Resiliency and quality of life trajectories after injury.J Trauma Acute Care Surg. 2017; 82: 939-945
Published online: August 29, 2018
Accepted: July 18, 2018
Received in revised form: July 3, 2018
Received: April 1, 2018
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