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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
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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)