Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

BMC Psychiatry, Jan 2012

Background Among injury victims relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL). Previous studies that addressed the latter were restricted to injuries at the higher end of the severity spectrum. This study examined the association between PTSD symptoms and health-related quality of life (HRQoL) in a comprehensive population of injury patients of all severity levels and external causes. Methods We conducted a self-assessment survey which included items regarding demographics of the patient, accident type, sustained injuries, EuroQol health classification system (EQ-5D) and Health Utilities Index (HUI) to measure functional outcome and HRQoL, and the Impact of Event Scale (IES) to measure PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of PTSD. The survey was completed by 1,781 injury patients two years after they were treated at the Emergency Department (ED), followed by either hospital admission or direct discharge to the home environment. Results Symptoms indicative of PTSD were associated with more problems on all EQ-5D and HUI3 domains of functional outcome and a considerable utility loss in both hospitalized (0.23-0.24) and non-hospitalized (0.32-0.33) patients. Differences in reported problems between patients with IES scores higher or lower than 35 were largest for EQ-5D health domains pain/discomfort (82% versus 28%) and anxiety/depression (53% versus 11%) and HUI domains emotion (92% versus 33%) and pain (84% versus 38%). After adjusting for potential confounders, PTSD remained strongly associated with adverse HRQoL. Conclusions Among patients treated at an ED posttraumatic stress symptoms indicative of PTSD were associated with a considerable decrease in HRQoL in both hospitalized and non-hospitalized patients. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity.

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Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

BMC Psychiatry Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department Juanita A Haagsma 0 Suzanne Polinder 0 Miranda Olff 2 Hidde Toet 1 Gouke J Bonsel 0 Ed F van Beeck 0 0 Department of Public Health, Erasmus Medical Center, Erasmus University Rotterdam , The Netherlands 1 Consumer Safety Institute , The Netherlands 2 Center for Psychological Trauma, Department of Psychiatry, Academic Medical Center/de Meren, University of Amsterdam , The Netherlands Background: Among injury victims relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL). Previous studies that addressed the latter were restricted to injuries at the higher end of the severity spectrum. This study examined the association between PTSD symptoms and health-related quality of life (HRQoL) in a comprehensive population of injury patients of all severity levels and external causes. Methods: We conducted a self-assessment survey which included items regarding demographics of the patient, accident type, sustained injuries, EuroQol health classification system (EQ-5D) and Health Utilities Index (HUI) to measure functional outcome and HRQoL, and the Impact of Event Scale (IES) to measure PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of PTSD. The survey was completed by 1,781 injury patients two years after they were treated at the Emergency Department (ED), followed by either hospital admission or direct discharge to the home environment. Results: Symptoms indicative of PTSD were associated with more problems on all EQ-5D and HUI3 domains of functional outcome and a considerable utility loss in both hospitalized (0.23-0.24) and non-hospitalized (0.32-0.33) patients. Differences in reported problems between patients with IES scores higher or lower than 35 were largest for EQ-5D health domains pain/discomfort (82% versus 28%) and anxiety/depression (53% versus 11%) and HUI domains emotion (92% versus 33%) and pain (84% versus 38%). After adjusting for potential confounders, PTSD remained strongly associated with adverse HRQoL. Conclusions: Among patients treated at an ED posttraumatic stress symptoms indicative of PTSD were associated with a considerable decrease in HRQoL in both hospitalized and non-hospitalized patients. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity. posttraumatic stress disorder; injury; functional outcome; quality of life - Background Posttraumatic stress disorder (PTSD) may result from any event that involves an injury, or threatened or actual death. Regarding injury victims PTSD prevalence rates up to 37% have been found three months after the injury [1]. At long-term follow-up (> 1 year) PTSD prevalence rates from 5% [2] to 32% [3] have been reported. A substantial share of studies that investigated prevalence rates and predictors of PTSD following injury addressed certain injury subgroups, such as victims of motor vehicle accidents [4-7], burn victims [8-10] or patients who required admission to hospital or the Intensive Care Unit [3,11-15]. Those previous studies were mainly conducted in clinical patient populations and were therefore restricted to accidents and injuries at the higher end of the severity spectrum. PTSD generally originates from cumulative exposure to traumatic stressors, which also influence the probability of spontaneous remission from PTSD [16,17]. The level of traumatic stressors in the population of study may therefore affect to a large extent the prevalence rates found in studies on injury victims and which focus on a single stressor. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL) [18,19]. In one of the scarce studies addressing the latter, Holbrook et al. [20] showed that in a subgroup of injury patients admitted to a trauma centre PTSD has a substantial impact on health-related quality of life. Similar results were found among adolescents and children [21,22]. However, these studies were again restricted to victims at the higher end of the severity spectrum and the association between PTSD and health-related quality of life among a comprehensive population of injury patients has yet to be studied. The objective of this study was to assess the association between posttraumatic stress symptoms indicative of PTSD and HRQoL among this comprehensive injury population. Methods Study design A patient-follow-up study, which was previously published [23], was conducted among a population-based sample of injury patients of all severity levels. This study followed injury patients aged 15 years and older who attended the ED of the Dutch Injury Surveillance System (a representative continuous registry of intentional and unintentio (...truncated)


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Juanita A Haagsma, Suzanne Polinder, Miranda Olff, Hidde Toet, Gouke J Bonsel, Ed F van Beeck. Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department, BMC Psychiatry, 2012, pp. 1, 12, DOI: 10.1186/1471-244X-12-1