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Karam JM, Bitar Z, Malaeb D, Fekih-Romdhane F, Hallit S, Obeid S. Perceived social competencies as moderators: examining the relationship between psychological distress and aggression, hostility, and anger in Lebanese adults. BMC Psychol 2024; 12:212. [PMID: 38632648 PMCID: PMC11025173 DOI: 10.1186/s40359-024-01694-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION The majority of people experience anger at some point in their lives when confronted with unpleasant situations. In social settings, anger can lead to aggressive and hostile in the absence of adequate social competences. Our study aims to examine the moderating role of perceived social competences in the association between psychological distress and anger expression (trait anger, hostility, physical aggression, and verbal aggression) among a sample of Lebanese adults. METHODS 403 participants above 18 years (the mean age was 24.56 ± 8.46) were enrolled in the cross-sectional study with 73% female participants. The candidates were asked to complete a structured questionnaire including the following scales: (1) Buss-Perry Aggression Questionnaire-Short Form (BPAQ-SF), (2) the Depression Anxiety Stress Scale (DASS-8), (3) Perceived Social Competencies (PSC), and (4) The De Jong-Gierveld Loneliness Scale. RESULTS The interaction psychological distress by perceived social competence was not significantly associated with physical aggression, verbal aggression, or hostility but was significantly associated with anger. After adjusting the results over variables that showed a p <.25 in the bivariate analysis, this association was significant at low (Beta = 0.24; p <.001), moderate (Beta = 0.20; p <.001) and high (Beta = 0.16; p <.001) levels of perceived social competencies, where higher psychological distress was significantly associated with more anger. On another note, with higher perceived social competence, we find a decrease in levels of psychological distress in our sample. CONCLUSION This study provided evidence that perceived social competencies such as communication skills, empathy and prosocial behaviors act as moderators in the association between psychological distress and anger. In future works, investigating and building advanced program in order to develop social competences of individuals might prove important. It is crucial to implement such strategies and projects in schools: this educational setting could be fruitful in a way that social skills could be instilled during childhood and anger-aggressive behaviors could be managed throughout adulthood.
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Affiliation(s)
| | - Zeinab Bitar
- Rennes University, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
| | - Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi hospital, 2010, Manouba, Tunisia
- Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon.
- Applied Science Research Center, Applied Science Private University, Amman, Jordan.
| | - Sahar Obeid
- School of Arts and Sciences, Social and Education Sciences Department, Lebanese American University, Jbeil, Lebanon.
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Kravets V, McDonald M, DeRosa J, Hernandez-Irizarry R, Parker R, Lamis DA, Powers A, Schenker ML. Early Identification of Post-Traumatic Stress Disorder in Trauma Patients: Development of a Multivariable Risk Prediction Model. Am Surg 2023; 89:4542-4551. [PMID: 35981543 DOI: 10.1177/00031348221121549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to build a risk prediction model to identify trauma patients at the time of injury who are at high risk for post-traumatic stress disorder (PTSD) 1 year later. METHODS Patients 18+ with operative orthopedic trauma injuries were enrolled in prospective social determinants of health cohort. Data were collected through initial surveys, medical records at time of injury, and 1-year follow-up phone screenings. Univariate analysis examined associations between factors and PTSD at 1 year. The best fit multivariable logistic regression model led to a novel PTSD risk prediction tool based on weights assigned similar to the Charlson index methods. RESULTS Of 329 enrolled patients, 87 (26%) completed follow-up surveys; 58% screened positive for chronic PTSD. The best fit model predicting PTSD included age, insurance, violent mechanism, and 2 acute stress screening questions (AUC .89). Using these parameters, the maximum possible TIPPS index was 19. Those with PTSD at 1 year had a mean TIPPS index of 12.9 ± 4.0, compared to 5.9 ± 4.2 for those who did not (P < .001). DISCUSSION Traumatic injury often leads to PTSD, which can be predicted by a novel risk score incorporating age, insurance status, violent injury mechanism, and acute stress reaction symptoms. Stability in life and relationships with primary care physicians may be protective of PTSD. LEVEL OF EVIDENCE Diagnostic level II.
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Affiliation(s)
- Victoria Kravets
- Department of Orthopaedic Surgery, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Michael McDonald
- Department of Orthopaedic Surgery, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Joel DeRosa
- Department of Orthopaedic Surgery, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | | | - Ruth Parker
- Department of Orthopaedic Surgery, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
| | - Mara L Schenker
- Department of Orthopaedic Surgery, Emory University and Grady Memorial Hospital, Atlanta, GA, USA
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The Posttaumatic Adjustment Scale (PAS) is an effective measure in predicting psychological distress in patients following major trauma. Injury 2023; 54:502-507. [PMID: 36437165 DOI: 10.1016/j.injury.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 10/07/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022]
Abstract
AIMS To determine whether a psychological screening tool - the Posttraumatic Adjustment Scale (PAS), predicts later psychological distress for admissions to a Major Trauma Centre (MTC) and to identify whether there was an unmet need in relation to the psychological support offered. METHODS Patient demographics and details of their injuries were retrieved from the Trauma Audit & Research Network (TARN) database. All patients admitted to Leeds General Infirmary MTC were approached for inclusion in the study over a three-month period. The PAS was administered to all participants at baseline. Following discharge, patients were sent two validated psychological measures via post, the Impact of Events Scale - Revised (IES-R) and the Clinical Outcomes in Routine Evaluation System (CORE-10). Relationships between continuous variables were examined using a Spearman's rank test (SR). The diagnostic accuracy of the different psychological screening systems was examined and compared using Receiver Operator Characteristic (ROC) analysis. RESULTS Eighty-two patients completed the PAS, 26 of whom had been referred to clinical psychology and 56 who were not. Fifty-seven of these patients (70%) returned follow-up IES-R and CORE-10 data, 20 who had been referred to psychology and 37 who had not. The PAS-P score recorded shortly after admission correlated strongly with the CORE-10 (SR rs 0.54, p<0.0001) and IES-R (SR rs 0.63, p<0.0001) scores recorded at early follow up. A PAS-P of more than 10 predicted the development of PTSD symptoms (IES-R 33 or more) or moderate global psychological distress (CORE-10 15 or more) with 72% sensitivity and 71% specificity. To identify patients who went on to develop psychological symptoms according to either measure (IES-R 33 or more or CORE-10 15 or more), the PAS-P was more sensitive than clinician referral (71% vs 52%, p<0.05) with similar specificity (72% vs 75%, p=0.78). CONCLUSIONS In an unselected group of trauma inpatients treated in a MTC, the PAS is an effective means of identifying those who are likely to go on to suffer PTSD symptoms or psychological distress. It may useful to use the PAS as a measure to formalise psychology referrals.
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Olive P, Hives L, Ashton A, O’Brien MC, Taylor A, Mercer G, Horsfield C, Carey R, Jassat R, Spencer J, Wilson N. Psychological and psychosocial aspects of major trauma care: A survey of current practice across UK and Ireland. TRAUMA-ENGLAND 2023. [DOI: 10.1177/14604086221145529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Introduction Psychological and psychosocial impacts of major trauma, defined as any injury that has the potential to be life-threatening and/or life changing, are common, far-reaching and often enduring. There is evidence that these aspects of major trauma care are often underserved. The aim of this research was to gain insight into the current provision and operationalisation of psychological and psychosocial aspects of major trauma care across the UK and Ireland. Methods A cross-sectional online survey, open to health professionals working in major trauma network hospitals was undertaken. The survey had 69 questions across six sections: Participant Demographics, Psychological First Aid, Psychosocial Assessment and Care, Assessing and Responding to Distress, Clinical Psychology Services, and Major Trauma Keyworker (Coordinator) Role. Results There were 102 respondents from across the regions and from a range of professional groups. Survey findings indicate a lack of formalised systems to assess, respond and evaluate psychological and psychosocial aspects of major trauma care, most notably for patients with lower-level distress and psychosocial support needs, and for trauma populations that don't reach threshold for serious injury or complex health need. The findings highlight the role of major trauma keyworkers (coordinators) in psychosocial aspects of care and that although major trauma clinical psychology services are increasingly embedded, many lack the capacity to meet demand. Conclusion Neglecting psychological and psychosocial aspects of major trauma care may extend peritraumatic distress, result in preventable Years Lived with Disability and widen post-trauma health inequalities. A stepped psychological and psychosocial care pathway for major trauma patients and their families from the point of injury and continuing as they move through services towards recovery is needed. Research to fulfil knowledge gaps to develop and implement such a model for major trauma populations should be prioritised along with the development of corresponding service specifications for providers.
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Affiliation(s)
- P Olive
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - L Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - A Ashton
- Psychology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - MC O’Brien
- Neuropsychology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - A Taylor
- Trauma Orthopaedics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - G Mercer
- Acute Rehabilitation Trauma Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - C Horsfield
- West Yorkshire Critical Care & Major Trauma Operational Delivery Networks and South Yorkshire & Bassetlaw Critical Care ODN, Leeds, UK
| | - R Carey
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - R Jassat
- School of Medicine, University of Central Lancashire, Preston, UK
| | - J Spencer
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - N Wilson
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
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Walshaw EG, Taylor R, Anderson J, Sexton P, Parmar JD, Carter LM. The psychological sequelae of maxillofacial trauma: a scoping review of the literature. Br J Oral Maxillofac Surg 2022; 60:1303-1320. [PMID: 36446645 DOI: 10.1016/j.bjoms.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
Abstract
Managing the physical sequelae of facial trauma is routine for the maxillofacial surgeon. However, managing the psychological consequences is more challenging. The often violent mechanism of injury, changes in appearance, altered self-perception, and self-confidence can significantly impact daily life. This review summarises the literature regarding post-traumatic stress disorder (PTSD) and facial trauma, highlighting evidence to guide clinical practice. PubMed and MEDLINE were searched for relevant keywords and MeSH headings. Articles between 2000-2022 were independently reviewed by two authors. Articles were excluded if the full text was not available in English, did not relate to facial trauma, or was not related to PTSD/psychological sequelae. A total of 211 articles were retrieved. The most common reasons for exclusion were papers not reporting psychological outcomes (n = 68) or not relating to facial trauma (n = 35). Articles were sub-categorised to enable evaluation of key themes. Categories included children and adolescents, cross sectional, longitudinal studies, and interventional studies. Whilst there were potential confounders such as socioeconomic factors, overall, patients who had experienced facial trauma (regardless of the mechanism of injury) had an increased risk of PTSD and anxiety/depression. PTSD following facial injury is increasingly recognised as an important issue. A robust evidence base is desirable to inform clinical practice and provide holistic care to often vulnerable patients. Identifying those at increased risk of negative psychological sequelae is essential. We have appraised the literature relevant to OMFS trauma clinicians.
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Affiliation(s)
- Emma G Walshaw
- University of Leeds, Worsley Building, University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom.
| | - Richard Taylor
- University of Leeds, Worsley Building, University of Leeds, Woodhouse, Leeds LS2 9JT, United Kingdom.
| | - Jane Anderson
- University of Huddersfield, Queensgate, Huddersfield HD1 3DH, United Kingdom.
| | - Paul Sexton
- Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
| | - Jiten D Parmar
- Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
| | - Lachlan M Carter
- Leeds Teaching Hospitals Trust, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
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Gross DP, Rachor GS, Krebs BK, Yamamoto SS, Dick BD, Brown CA, Asmundson GJG, Straube S, Els C, Jackson TD, Brémault-Phillips S, Voaklander D, Stastny J, Berry T. Risk Factors for Developing Concurrent Posttraumatic Stress Injury After Work-Related Musculoskeletal Injury: A Case-Control Study. J Occup Environ Med 2022; 64:e579-e584. [PMID: 35901517 PMCID: PMC9426736 DOI: 10.1097/jom.0000000000002621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to study risk factors for developing concurrent posttraumatic stress injury (PTSI) among workers experiencing work-related musculoskeletal injury (MSI). METHODS A case-control study was conducted using workers' compensation data on injured workers undergoing rehabilitation programs for concurrent MSI and PTSI (cases) and MSI only (controls). A variety of measures known at the time of the compensable injury were entered into logistic regression models. RESULTS Of the 1948 workers included, 215 had concurrent MSI and PTSI. Concurrent MSI and PTSI were predicted by type of accident (adjusted odds ratio [OR], 25.8), experiencing fracture or dislocation fracture or dislocation (adjusted OR, 3.7), being public safety personnel (adjusted OR, 3.1), and lower level of education (adjusted OR, 1.9). CONCLUSIONS Experiencing a concurrent PTSI diagnosis with MSI after work-related accident and injury appears related to occupation, type of accident, and educational background.
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Roberts DC, Jose RM, Duraku LS, Wordsworth M, Foster M, Mortiboy D, Sellon E, Stapley SA, Power DM. Management of conflict injuries to the upper limb. Part 2: reconstruction and managing complications. J Hand Surg Eur Vol 2022; 47:787-797. [PMID: 35701990 DOI: 10.1177/17531934221105225] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This is the second of a two-part review article on the management of conflict injuries, focused on the reconstructive strategies for bone, nerve and soft tissue and to provide guidance on assessing and managing common complications associated with complex upper limb injuries. Following assessment and early surgical management, the conflict casualty will require further wound evaluation and planning prior to definitive reconstruction of limb injuries. Surgical management of the upper limb injury should aim, where possible, to preserve the limb and allow functional reconstruction. The principles of the second look procedure are to assess wound progression, further reduce the risk of infection and plan definitive reconstruction with adequate soft tissue cover. The prerequisites for successful surgical reconstruction are a stable patient, combined orthoplastic surgery expertise supported by physiotherapists and hand therapists.
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Affiliation(s)
- Darren C Roberts
- Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Rajive M Jose
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Liron S Duraku
- The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Matthew Wordsworth
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Mark Foster
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Deborah Mortiboy
- Department of Microbiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Edward Sellon
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarah A Stapley
- Queen Alexandra Hospital Hand Unit, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.,The Royal Centre for Defence Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Dominic M Power
- The Birmingham Hand Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,The Peripheral Nerve Injury Service, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Olive P, Hives L, Wilson N, Ashton A, O’Brien MC, Mercer G, Jassat R, Harris C. Psychological and psychosocial aspects of major trauma care in the United Kingdom: A scoping review of primary research. TRAUMA-ENGLAND 2022. [DOI: 10.1177/14604086221104934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction More people are surviving major trauma, often with life changing injuries. Alongside physical injury, many survivors of major trauma experience psychological and psychosocial impacts. Presently, there is little guidance at the UK national level for psychological and psychosocial aspects of major trauma care. Set in the context of the regional model of major trauma care implemented in the UK in 2012, the purpose of this review was to identify and bring together primary research about psychological and psychosocial aspects of major trauma care in the UK to produce an overview of the field to date, identify knowledge gaps and set research priorities. Methods A scoping review was undertaken. Seven electronic databases (MEDLINE, Cochrane Library, CINAHL, Embase, PsycINFO, SocINDEX with Full Text and PROSPERO) were searched alongside a targeted grey literature search. Data from included studies were extracted using a predefined extraction form and underwent bibliometric analysis. Included studies were then grouped by type of research, summarised, and synthesised to produce a descriptive summary and overview of the field. Results The searches identified 5,975 articles. Following screening, 43 primary research studies were included in the scoping review. The scoping review, along with previous research, illustrates that psychological and psychosocial impacts are to be expected following major trauma. However, it also found that these aspects of care are commonly underserved and that there are inherent inequities across major trauma care pathways in the UK. Conclusion Though the scoping review identified a growing body of research investigating psychological and psychosocial aspects of major trauma care pathways in the UK, significant gaps in the evidence base remain. Research is needed to establish clinically effective psychological and psychosocial assessment tools, corresponding interventions, and patient-centred outcome measures so that survivors of major trauma (and family members or carers) receive the most appropriate care and intervention.
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Affiliation(s)
- Philippa Olive
- School of Nursing, Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lucy Hives
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Neil Wilson
- Research Facilitation and Delivery Unit, Applied Health Research Hub, University of Central Lancashire, Preston, UK
| | - Amy Ashton
- Clinical Health Psychology Service, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Marie Claire O’Brien
- Neuropsychology Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Gemma Mercer
- Acute Rehabilitation Trauma Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Raeesa Jassat
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Catherine Harris
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, Applied Health Research Hub, University of Central Lancashire, Preston, UK
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Screening tools for predicting posttraumatic stress disorder in acutely injured adult trauma patients: A systematic review. J Trauma Acute Care Surg 2022; 92:e115-e126. [PMID: 34991124 DOI: 10.1097/ta.0000000000003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adult trauma patients are at risk of developing posttraumatic stress disorder (PTSD). Early intervention reduces the development of PTSD, but few trauma patients seek and obtain care. Valid and reliable screening tools are needed to identify patients at risk of developing PTSD. The objective of this review is to identify existing screening tools and evaluate their accuracy for predicting PTSD outcomes. METHODS PubMed, PsychInfo, and ClinicalTrials.gov were searched for studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians. Eligible studies assessed patients during acute hospitalization and at least 1 month following injury to measure PTSD outcome. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following the Agency for Healthcare Research and Quality guidelines. RESULTS Forty-nine studies were included evaluating the predictive accuracy of 38 screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen, Posttraumatic Adjustment Screen, the PTSD Checklist for DSM-5, and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75-100%) and specificity (67-94%). Common sources of bias were selection bias due to high attrition rate and using nondiagnostic tools to assess PTSD symptoms at follow-up. CONCLUSION Although sensitivity and specificity of PTSD predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for screening programs and future intervention studies. LEVEL OF EVIDENCE Systematic review, level III.
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The Psychological and Somatic Consequences of Digital Amputation. Plast Reconstr Surg Glob Open 2022; 10:e4387. [PMID: 35747254 PMCID: PMC9208886 DOI: 10.1097/gox.0000000000004387] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/28/2022] [Indexed: 11/27/2022]
Abstract
Major limb amputation is a devastating potential outcome of trauma, tumor, or disease. Much has been written about the physical, functional, economic, and psychological consequences of major limb loss. In contradistinction, considerably less has been written concerning the consequences of "minor" limb loss, specifically single partial digit amputations. Are minor limb (partial single digit) amputations associated with symptoms of psychological disorder similar to those reported for major limb amputations? Methods We conducted a clinical research study through interview and examination of 25 adult patients (average age: 45 years) who had suffered a single partial digit amputation to determine if symptoms of depression, anxiety, anger, or posttraumatic stress disorder newly occurred, and if such symptoms correlated with the surgical outcome. Questionnaires for Quick-DASH, Michigan Hand Score, and Diagnostic and Statistical Manual of Mental Disorders-5 Psychological Profile testing were completed. Results All but one of the patients suffered from psychological symptoms for a minimum of 3 months. Symptom resolution time averaged 6 months for seven of the 25 patients. For 18 of the 25 patients, both psychological disturbance and neuroma pain were ongoing. The Psychological Profile scores suggesting pathology were inversely related to the scores on the Quick-Dash and Michigan Hand (somatic) questionnaires indicating wellness (P < 0.03). Conclusions (1) Even minor partial amputations of single digits can trigger significant psychological disturbance; the study hypothesis is validated. (2) Psychological and somatic outcomes are directly correlative. (3) Mitigating neuroma pain and verbally offering psychological support services early in the postamputation period should improve the clinical outcome of digital amputations.
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Irwin E, Chapman T, Johanson E, Robinson L. Early Intervention Eye Movement Desensitization and Reprocessing Following Major Musculoskeletal Trauma: How Soon Is Too Soon? JOURNAL OF EMDR PRACTICE AND RESEARCH 2022. [DOI: 10.1891/emdr-2021-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Major trauma centers have increased survival following serious physical injury, resulting in increased demand for specialist multidisciplinary rehabilitation. We aimed to explore the feasibility of using early intervention eye movement desensitization and reprocessing (EMDR) therapy in an acute inpatient setting, using a non-concurrent, multiple-baseline, pre-post test case-series design. Unfortunately, no patients were recruited. This paper sets out the challenges and reflections of setting up a psychological intervention study in this setting and provides suggestions for further research.
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Age and Emotional Distress during COVID-19: Findings from Two Waves of the Norwegian Citizen Panel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189568. [PMID: 34574491 PMCID: PMC8466671 DOI: 10.3390/ijerph18189568] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 12/22/2022]
Abstract
Older adults face the highest risk of COVID-19 morbidity and mortality. We investigated a one-year change in emotions and factors associated with emotional distress immediately after the onset of the pandemic, with emphasis on older age. Methods: The online Norwegian Citizen Panel includes participants drawn randomly from the Norwegian Population Registry. Emotional distress was defined as the sum score of negative (anxious, worried, sad or low, irritated, and lonely) minus positive emotions (engaged, calm and relaxed, happy). Results: Respondents to both surveys (n = 967) reported a one-year increase in emotional distress, mainly driven by elevated anxiety and worrying, but we found no difference in change by age. Multilevel mixed-effects linear regression comparing older age, economy-, and health-related factors showed that persons in their 60s (ß −1.87 (95%CI: −3.71, −0.04)) and 70s/80s (ß: −2.58 (−5.00, −0–17)) had decreased risk of emotional distress relative to persons under 60 years. Female gender (2.81 (1.34, 4.28)), expecting much lower income (5.09 (2.00, 8.17)), uncertainty whether infected with SARS-Cov2 (2.92 (1.21, 4.63)), and high self-rated risk of infection (1.77 (1.01, 2.53)) were associated with high levels of emotional distress. Conclusions: Knowledge of national determinants of distress is crucial to tailor accurate public health interventions in future outbreaks.
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Richardson AE, Derrett S, Samaranayaka A, Wyeth EH. Prevalence and predictors of psychological distress following injury: findings from a prospective cohort study. Inj Epidemiol 2021; 8:41. [PMID: 34154660 PMCID: PMC8215821 DOI: 10.1186/s40621-021-00337-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Research examining psychological distress in people who have experienced an injury has focused on those with serious injuries or specific injury types, and has not involved long-term follow up. The aims of this investigation were to describe the prevalence of, and factors contributing to, psychological distress in a cohort of people with a broad range of injuries. METHODS The Prospective Outcomes of Injury Study (POIS) is a longitudinal cohort study of 2856 injured New Zealanders recruited from a national insurance entitlement claims register between 2007 and 2009. Participants were interviewed approximately 3, 12, and 24 months after their injury. The Kessler Psychological Distress Scale (K6) was used to measure psychological distress at each interview. RESULTS 25% of participants reported clinically relevant distress (K6 ≥ 8) 3 months post-injury, 15% reported distress at 12 months, and 16% reported distress at 24 months. Being 45 years or older, Māori or Pacific ethnicity, experiencing pre-injury mental health conditions, having inadequate pre-injury income, reporting poor pre-injury health or trouble accessing healthcare, having a severe injury or an injury resulting from assault, and reporting clinically relevant distress 3 months post-injury were independently associated with an increased risk of distress 12 months post-injury. The majority of these associations were also evident with respect to distress 24 months post-injury. CONCLUSIONS Distress is common after injury among people with a broad range of injury types and severities. Screening for distress early after injury is important to identify individuals in need of targeted support.
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Affiliation(s)
- Amy E. Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Ariyapala Samaranayaka
- Biostatistics Centre, Division of Health Sciences, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
| | - Emma H. Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054 New Zealand
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14
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Abstract
BACKGROUND Impaired psychological state, such as anxiety and depressive symptoms, occurs in up to 40% of patients hospitalized for traumatic injury. These symptoms, in the acute period, may delay engagement in activity, such as ambulation, following injury. The purpose of this study was to determine whether baseline anxiety and depressive symptoms predicted delayed (>48 hr from admission) ambulation in patients hospitalized for major traumatic injury. METHODS Adults (n = 19) admitted for major trauma (Injury Severity Score [ISS] = 15) provided a baseline measure of anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]). Logistic regression was used to determine the predictive power of baseline HADS Anxiety and HADS Depression subscale scores for delayed ambulation while controlling for ISS. RESULTS At baseline, anxiety was present in 32% of patients; 21% reported depressive symptoms. Baseline HADS Anxiety score did not predict the ambulation group. However, for each 1 point increase in baseline HADS Depression score, the likelihood of patients ambulating after 48 hr from admission increased by 67% (odds ratio = 1.67; 95% CI [1.02, 2.72]; p = .041). CONCLUSION Worsening depressive symptoms were associated with delayed ambulation in the acute period following injury. Future, larger scale investigations are needed to further elucidate the relationship between psychological symptoms and the acute recovery period from trauma to better inform clinicians and guide development of interventions to improve patient outcomes.
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