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Prevalence and Prognostic Factors for Psychological Distress After Trauma

Published:December 21, 2019DOI:https://doi.org/10.1016/j.apmr.2019.10.196

      Abstract

      Objective

      To describe the prevalence and prognostic factors of symptoms of anxiety and depression and posttraumatic stress symptoms (PTSS) after injury in the clinical trauma population.

      Design

      Multicenter, prospective, observational cohort study.

      Setting

      Ten hospitals in Noord-Brabant, The Netherlands.

      Participants

      Four thousand two hundred thirty-nine adult patients (N=4239) admitted due to injury between August 2015 and December 2016.

      Interventions

      Patients were asked to complete a questionnaire at 1 week and at 1, 3, 6, and 12 months after injury.

      Main Outcome Measures

      The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive symptoms and the Impact of Event Scale was used to assess PTSS.

      Results

      The prevalence of symptoms of anxiety and depression decreased from 10% and 12%, respectively, at 1 week after injury to 7% and 7% at 12 months after injury. Acute traumatic stress symptoms were present in 13% at 1 week and PTSS was prevalent in 10% of the participants at 12 months after injury. Strong prognostic factors for poor psychological outcome in multivariable logistic mixed models were preinjury frailty, psychological complaints and nonworking status preinjury, female sex, low educational level, and accident category (ie, traffic accident, work-related accident, or accidents at home compared to sport injuries).

      Conclusions

      Psychological distress is a common health problem during the first year after injury. Important prognostic factors for psychological distress include psychological complaints before injury and frailty. Early recognition of psychological problems after injury could facilitate discussion between caregivers and patients and improve recovery.

      Keywords

      List of Abbreviations:

      AIS (Abbreviated Injury Scale), ASA (American Society of Anesthesiologists), BIOS (Brabant Injury Outcome Surveillance), CI (confidence interval), HADS (Hospital Anxiety and Depression Scale), ICU (intensive care unit), IES (Impact of Events Scale), LOS (length of stay), OR (odds ratio), PTSS (posttraumatic stress symptoms)
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