Prevalence rate, predictors and long-term course of probable posttraumatic stress disorder after major trauma: a prospective cohort study
BMC Psychiatry
Prevalence rate, predictors and long-term course of probable posttraumatic stress disorder after major trauma: a prospective cohort study
Juanita A Haagsma 0
Akkie N Ringburg 2 3
Esther MM van Lieshout 2
Ed F van Beeck 0
Peter Patka 2
Inger B Schipper 1
Suzanne Polinder 0
0 Department of Public Health, Erasmus MC, University Medical Center Rotterdam , P.O. Box 2040, Rotterdam 3000, CA , The Netherlands
1 Department of Surgery-Traumatology, Leiden University Medical Center , P.O. Box 9600, Leiden 2300, RC , the Netherlands
2 Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam , P.O. Box 2040, Rotterdam 3000, CA , the Netherlands
3 Department of Surgery, Ikazia Hospital , Montessoriweg 1, Rotterdam 3083, AN , The Netherlands
Background: Among trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. To identify opportunities for prevention and early treatment, predictors and course of PTSD need to be investigated. Long-term follow-up studies of injury patients may help gain more insight into the course of PTSD and subgroups at risk for PTSD. The aim of our long-term prospective cohort study was to assess the prevalence rate and predictors, including pre-hospital trauma care (assistance of physician staffed Emergency Medical Services (EMS) at the scene of the accident), of probable PTSD in a sample of major trauma patients at one and two years after injury. The second aim was to assess the long-term course of probable PTSD following injury. Methods: A prospective cohort study was conducted of 332 major trauma patients with an Injury Severity Score (ISS) of 16 or higher. We used data from the hospital trauma registry and self-assessment surveys that included the Impact of Event Scale (IES) to measure probable PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of probable PTSD. Results: One year after injury measurements of 226 major trauma patients were obtained (response rate 68%). Of these patients 23% had an IES-score of 35 or higher, indicating probable PTSD. At two years after trauma the prevalence rate of probable PTSD was 20%. Female gender and co-morbid disease were strong predictors of probable PTSD one year following injury, whereas minor to moderate head injury and injury of the extremities (AIS less than 3) were strong predictors of this disorder at two year follow-up. Of the patients with probable PTSD at one year follow-up 79% had persistent PTSD symptoms a year later. Conclusions: Up to two years after injury probable PTSD is highly prevalent in a population of patients with major trauma. The majority of patients suffered from prolonged effects of PTSD, underlining the importance of prevention, early detection, and treatment of injury-related PTSD.
Major trauma; Posttraumatic stress disorder; Follow-up study
Background
Major trauma, which can be defined as an injury with an
Injury Severity Score (ISS) of 16 or higher, has a large
impact, not in the least because of the relatively young
age of the average severely injured patient [
1
]. A large
proportion of the severely injured patients report
significantly reduced health-related quality of life with functional
limitations years after trauma [
2-4
]. In rehabilitation, the
main focus lies in the treatment of physical injuries.
Nonetheless, over the past decades the importance of
psychological morbidity continued to gain attention,
specifically concerning posttraumatic stress disorder (PTSD).
PTSD may result from any event that involves an
injury, or threatened or actual death (of others). PTSD
symptoms are characterized by re-experiencing,
avoidance and hyper arousal, and may either appear
immediately after the event or have a delayed onset [
5
]. In
the general population PTSD prevalence rates between
2-4% have been found [
6,7
]. Trauma patients have
relatively high prevalence rates of PTSD; prevalence rates
up to 39% have been found one to four months after
the injury [8]. At long-term follow-up (>1 year) PTSD
prevalence rates vary from 5% among traffic injury
victims [
9
] to 32% among major trauma patients [
10
].
Predictors of PTSD following major trauma are
gender, age, presence of chronic illnesses, cause of injury,
coping style, pain, cognitive functioning when
discharged from the hospital and employment [
11-13
]. To
our knowledge, the effect of pre-hospital trauma care
(i.e. assistance of physician staffed Emergency Medical
Services (EMS) at the scene of the accident) on the risk
of developing PTSD has not yet been studied. Identifying
subgroups at risk for PTSD is important for the
targeting of PTSD prevention and to facilitate early treatment
when PTSD has developed. Research has shown that
PTSD can be effectively treated at an early stage [
14
].
However, symptoms of PTSD may not always develop
immediately after the injury. In some cases, symptoms
develop relatively long after sustai (...truncated)