Outcomes after traffic injury: mental health comorbidity and relationship with pain interference

Abstract

Background: Mental health symptoms, like depressive mood (DM) and post-traumatic stress (PTS), and pain interference (PI) with daily functioning often co-occur following traffic injury and their comorbidity can complicate recovery. This study aimed to map the course and overlapping trajectories of mental health symptoms, and associations with PI in a traffic injury population. Methods: In total, 2019 adults sustaining minor-to-moderate traffic injury were recruited within 28 days post-injury and assessed using phone interviews at 1, 6 and 12-months post-injury. Trajectories of DM, PTS and PI were established and relationships between DM, PTS and PI trajectories were explored using dual trajectory modelling. Bio-psychosocial predictors (e.g. pre-injury health, catastrophizing, acute distress, quality of life, social support) of mental health trajectories were investigated.Results: Up to five typical post-trauma trajectories were identified for DM, PTS and PI. Most people were in a resilient mental health trajectory (over 60%, DM or PTS), or in a chronic PI trajectory (almost 60%) 12 months post-injury. While recovery/resilient mental health trajectories were strongly interrelated (73.4% joint probability and >94% conditional probabilities), DM/PTS comorbidity in chronic trajectories was not straightforward, suggesting a possibly asymmetric relationship. That is, persistent DM was more likely associated with persistent PTS (90.4%), than vice versa (31.9%), with a 22.5% probability that persistent PTS was associated with none or milder depression (i.e. following a recovery/resilient DM trajectory). An asymmetrical relationship was also found between mental health and PI. The majority of those with persistent PI were likely to be in a recovery/resilient DM/PTS trajectory (almost 70%), but those in a non-resilient DM/PTS trajectory showed a high risk of persistent PI. Predictors of non-resilient mental health trajectories included poorer pre-injury health and social support, and shared factors like acute psychological distress and pain catastrophizing. Conclusions: Strong interrelations were confirmed between mental health symptoms and PI following traffic injury. However, persistent DM was more strongly linked to persistent PTS, than vice versa. Persistent PI was only linked with persistent DM/PTS in vulnerable subgroups. Early psychiatric/psychological interventions should target elevated psychological distress and negative appraisals in vulnerable individuals, to reduce long-term mental health morbidity/comorbidity and PI. Trial registration: ACTRN12613000889752.

Prior histories of posttraumatic stress disorder and major depression and their onset and course in the three months after a motor vehicle collision in the AURORA study

“…In addition, pre‐MVC lifetime comorbid probable PTSD‐MDE was both the strongest predictor of the 3‐month outcome in univariable analyses and had the highest mediator RRs at both 2 and 8 weeks. These results are consistent with prior research showing that comorbid MDE is a strong predictor of PTSD persistence and severity (Pozzato et al, 2020; Schindel‐Allon et al, 2010).…”

“…Although it is known that prior history of posttraumatic stress disorder (PTSD; Beliveau et al, 2019; Breslau et al, 2008; Kessler et al, 2018) and major depressive episode (MDE; Bedaso et al, 2020; Heron‐Delaney et al, 2013) both strongly predict adjustment after subsequent traumas (Ikin et al, 2010; Pozzato et al, 2020) and are highly comorbid (Kenardy et al, 2018), a better understanding of these associations is needed to inform early intervention targeting. Are these histories important because they are associated with peritraumatic symptoms that can be assessed in the immediate aftermath of a subsequent trauma?…”

Socio-demographic and trauma-related predictors of depression within eight weeks of motor vehicle collision in the AURORA study

“…Previous research suggests that a number of sociodemographic variables (most notably, sex, race-ethnicity, and socioeconomic status) and diverse indicators of trauma severity predict anxiety and depression in the aftermath of trauma exposure (Hruska, Irish, Pacella, Sledjeski, & Delahanty, 2014;Kazantzis et al, 2012;Lowe, Sampson, Gruebner, & Galea, 2015;Pozzato et al, 2020a;Tang, Liu, Liu, Xue, & Zhang, 2014). An important aim of the current study is to examine whether these variables predict depression 8 weeks after an MVC.…”

“…This focus on depression is important because even though depression is significantly elevated post-trauma (Breslau, Davis, Peterson, & Schultz, 2000;Fergusson, Horwood, Boden, & Mulder, 2014;Pozzato et al, 2020a), the emphasis of most posttrauma studies is on PTSD. Importantly, there are ongoing debates whether post-traumatic predictors of depression and PTSD are the same or different (Breslau et al, 2000;McFarlane & Papay, 1992;Tracy, Norris, & Galea, 2011), an issue we will address in future AURORA analyses and that was examined recently by Pozzato et al (2020a), who found high rates of co-occurrence and evidence for shared vulnerability factors in participants recruited within 28 days after an MVC and followed for one year (see also Pozzato et al, 2020b).…”

How Is the Probability of Reporting Various Levels of Pain 12 Months After Noncatastrophic Injuries Associated with the Level of Peritraumatic Distress?

“…In addition, psychological factors including depression, anxiety, catastrophic beliefs about pain, low expectations of recovery, and heightened levels of distress have also been shown to be associated with persistent pain [16,26,29,34]. Although these factors are often reported to occur after severe injuries [28], they can also feature in benign injuries such as an ankle inversion injury [30,36], suggesting injury severity is not the prevailing factor underlining adverse and persistent psychological sequelae. Research on the experience of peri-or posttraumatic distress has been increasing because of its potential role in persistent pain from musculoskeletal injury.…”