Posttraumatic Stress Disorder Following Injury: Trajectories and Impact on Health-Related Quality of Life

Abstract

Background:Little is known about posttraumatic stress disorder (PTSD) trajectories of injury patients of all severity levels and external causes. The aim of our study was to assess prevalence rates, predictors, trajectories and impact on health-related quality of life (HRQoL) of PTSD 2.5, 5, 12 and 24 months post-injury.Methods:We selected a sample of 8,057 patients aged 15 years and older who attended the Emergency Department (ED) followed by either hospital admission or discharge to the home environment. The sample received postal questionnaires 2.5, 5, 12 and 24 months after treatment at the ED. The questionnaires included items regarding socio-demographics, EQ-5D to measure HRQoL, and the Impact of Event Scale-Revised (IESR). An IESR-score ≥ 33 was used as indication for the presence of PTSD.Results: 2,918 (36%) injury patients completed the 2.5 months follow-up survey. PTSD prevalence rate at 2.5 month follow-up was 9%. At 5, 12 and 24 month follow-up PTSD prevalence rates were 7%, 6% and 5% respectively. Comorbid disease, female gender and low educational level were the strongest independent predictors of PTSD. One in ten patients had PTSD at some point during 24 month follow-up. PTSD was associated with a significantly decreased HRQoL. Conclusions:We conclude that almost one in ten injury patients of all causes and severity levels treated at an ED suffer from PTSD symptoms, which is associated with a considerable decrease in HRQoL. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity.

Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

“…The duration for treated cases of injuries was determined by information in the Dutch Injury Surveillance System follow-up studies of 2001–04 and 2007–10. 71,73 We used expert opinion to estimate a multiplier for the duration of short-term disability from untreated injuries and used the estimates of access to care by country and year as we have described for the long-term disability.…”

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

“…[12] Depressive mood (DM) and post-traumatic stress (PTS) are very common mental health symptoms following an accident or injury [5,[13][14][15], however, most studies have investigated PTS rather than depression. If these DM and PTS symptoms remain elevated, there is an increased risks of disability [16][17][18] and progression to serious mental disorders (as per Diagnostic and Statistical Manual (DSM) of Mental Disorders criteria), like major depressive disorder (MDD), post-traumatic stress disorder (PTSD), panic disorder and generalized anxiety disorder [5,19]. Post-injury rates of mental disorder have been reported in the range of 30%-50%.…”

“…[5,14,20,21] Individual course and relationships over time between multiple problems are best captured by personcentred analysis, such as growth mixture models. [11,22] A few studies have now examined trajectories of mental health following injury [18,[23][24][25][26][27]. Bryant et al, (2015) used latent class analysis (n= 1,084) to establish trajectories of PTSD severity over a period of six years post-injury.…”

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

“…[12] Depressive mood (DM) and post-traumatic stress (PTS) are very common mental health symptoms following an accident or injury [5,13,14], however, most studies have investigated PTS rather than depression. If these DM and PTS symptoms remain elevated, there is an increased risks of disability [15][16][17] and serious mental disorders (as per Diagnostic and Statistical Manual (DSM) of Mental Disorders criteria), like major depressive disorder (MDD), post-traumatic stress disorder (PTSD), panic disorder and generalized anxiety disorder [5,18]. Post-injury rates of mental disorder have been reported in the range of 30%-50%.…”

“…[5,14,19,20] Individual course and relationships over time between multiple problems are best captured by personcentred analysis, such as growth mixture models. [11,21] A few studies have now examined trajectories of mental health following injury [17,[22][23][24][25][26]. Bryant et al, (2015) used latent class analysis (n= 1,084) to establish trajectories of PTSD severity over a period of six years post-injury.…”