Quality of Life after Traumatic Injury: A Latent Trajectory Modeling Approach

Abstract

Background: It is largely unknown how quality of life (QoL) changes following accidental injuries. Equally, the mechanisms underlying such changes have not yet been identified in detail. This study of injured accident survivors aimed to: (1) detect a model of change which best explains the observed course of QoL, and (2) identify potential predictor variables. Methods: 323 injured accident survivors were interviewed within 2 weeks of the trauma, and followed up at 6 and 12 months. Latent trajectory modeling was used to analyze the fit of three potential trajectories regarding the observed course of general QoL as measured by the Questions on Life Satisfaction questionnaire. Results: The trajectory model adopting a negative square-root change fitted the observed data best, meaning that shortly after the accident, general QoL decreased strongly with diminishing negative changes occurring later on. Early and prolonged QoL impairment was largely attributable to the initial level of posttraumatic stress as measured by the Clinician-Administered PTSD Scale. To a lesser extent, depressive symptoms also predicted change in subjective QoL, while injury severity showed no direct effect; rather, its impact on QoL was mediated by initial posttraumatic stress. By contrast, reduced occupational functioning was attributable to injury severity rather than psychopathology. Conclusions: When treating injured accident survivors, clinicians should consider symptoms of posttraumatic stress and comorbid depression in order to prevent or mitigate negative changes in QoL.

The Effect of Postinjury Depression on Quality of Life following Minor Injury

“…Importantly, type, mechanism, and severity of physical injury were not significantly associated with QoL in the postinjury year. This finding is consistent with a recent report of more seriously injured patients, which showed posttraumatic stress and depression negatively affects QoL but severity of physical injury does not (Moergeli, Wittmann, & Schnyder, ). Given that 1 in 10 adults in the United States seeks care in an ED for injury and that 18% of our sample were diagnosed with depression after injury, this finding has significant implications for the public's health.…”

The effect of mental health on long-term health-related quality of life following a road traffic crash: Results from the UQ SuPPORT study

“…This finding suggests injury severity may not predict later QoL, as has been found elsewhere 8 . Other research with serious injury cohorts has also found QoL reductions over time.…”

Psychological distress trajectories in chronic physical health conditions.

“…better mental health). On the other hand, factors such as past adverse life events (Brewin, Andrews, & Valentine, 2000;Butler, Koopman, Classen, & Spiegel, 1999), sex (Ginzburg & Ein-Dor, 2011;Moergeli, Wittmann, & Schnyder, 2012;Zhu et al, 2014), age (Havik, 1990;Moergeli et al, 2012), income (Lyons, Heywood, & Rozbroj, 2016), civil status (Havik, 1990;Moergeli et al, 2012;Morris, Yelin, Panopalis, Julian, & Katz, 2011), or education (Morris et al, 2011;Van Leeuwen et al, 2012), have been inconsistently associated to psychological adaptation following CHC. Using a sample with different types of CHCs could lead to the identification of the most important factors that are related to psychological adaptation to physical CHC overall.…”