1
|
Ríos A, Quirante-Botía AM, López-Navas AI, Iniesta-Sepúlveda M. Risk factors for posttraumatic stress disorder in trauma patients from bullfighting-related events in Spain. J Affect Disord 2024; 351:90-94. [PMID: 38296056 DOI: 10.1016/j.jad.2024.01.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Unintentional Trauma injuries are one of the leading causes of posttraumatic stress disorder development. However, screening for this condition is not typically included in routine medical care. Research on posttraumatic stress disorder after unintentional injuries sustained during entertainment activities involving risk, has been scarce. This study aimed to analyze the proportion of posttraumatic stress disorder and its risk factors in patients with trauma injuries sustained during bullfighting-related events in Spain. METHODS Two hundred and seventy-four patients were evaluated to determine the presence of posttraumatic stress disorder at least one month after the injury. Data about sociodemographic variables, injury circumstances, characteristics of the injury, and treatments were collected by the surgery team on-site or collected during the follow-up assessment. Diagnosis of posttraumatic stress disorder was made by a trained clinician using a structured clinical interview based on DSM criteria. RESULTS The estimated proportion of was 25.18 % (95 % CI: 20.18 %, 30.18 %). Residing in areas with a bullfighting tradition, female gender, referral to a medical center, hospitalization, events involving fighting bulls, and having been injured by the crowd were significant predictors. LIMITATIONS The short-term follow-up and the inability to evaluate some predictors of interest, including the body site of the injury, the presence of disfigurement, and comorbid anxiety and depression, were noted. CONCLUSION Posttraumatic stress disorder could have a high prevalence in individuals injured in these types of events, especially in women, those who are not familiar with the situation, and those who require medical attention. These results highlight the need for routine screening for posttraumatic stress disorder in individuals with trauma injuries for early symptom management.
Collapse
Affiliation(s)
- Antonio Ríos
- Department of Surgery, Pediatrics, Obstetrics y Gynecology, University of Murcia, Spain; Surgery Service, IMIB - Clinical University Hospital Virgen de la Arrixaca, Murcia, Spain.
| | | | | | | |
Collapse
|
2
|
Hinojosa CA, Liew A, An X, Stevens JS, Basu A, van Rooij SJH, House SL, Beaudoin FL, Zeng D, Neylan TC, Clifford GD, Jovanovic T, Linnstaedt SD, Germine LT, Rauch SL, Haran JP, Storrow AB, Lewandowski C, Musey PI, Hendry PL, Sheikh S, Jones CW, Punches BE, Kurz MC, Swor RA, Hudak LA, Pascual JL, Seamon MJ, Datner EM, Chang AM, Pearson C, Peak DA, Merchant RC, Domeier RM, Rathlev NK, Sergot P, Sanchez LD, Bruce SE, Miller MW, Pietrzak RH, Joormann J, Pizzagalli DA, Sheridan JF, Harte SE, Elliott JM, Kessler RC, Koenen KC, McLean SA, Ressler KJ, Fani N. Associations of alcohol and cannabis use with change in posttraumatic stress disorder and depression symptoms over time in recently trauma-exposed individuals. Psychol Med 2024; 54:338-349. [PMID: 37309917 PMCID: PMC10716364 DOI: 10.1017/s0033291723001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Several hypotheses may explain the association between substance use, posttraumatic stress disorder (PTSD), and depression. However, few studies have utilized a large multisite dataset to understand this complex relationship. Our study assessed the relationship between alcohol and cannabis use trajectories and PTSD and depression symptoms across 3 months in recently trauma-exposed civilians. METHODS In total, 1618 (1037 female) participants provided self-report data on past 30-day alcohol and cannabis use and PTSD and depression symptoms during their emergency department (baseline) visit. We reassessed participant's substance use and clinical symptoms 2, 8, and 12 weeks posttrauma. Latent class mixture modeling determined alcohol and cannabis use trajectories in the sample. Changes in PTSD and depression symptoms were assessed across alcohol and cannabis use trajectories via a mixed-model repeated-measures analysis of variance. RESULTS Three trajectory classes (low, high, increasing use) provided the best model fit for alcohol and cannabis use. The low alcohol use class exhibited lower PTSD symptoms at baseline than the high use class; the low cannabis use class exhibited lower PTSD and depression symptoms at baseline than the high and increasing use classes; these symptoms greatly increased at week 8 and declined at week 12. Participants who already use alcohol and cannabis exhibited greater PTSD and depression symptoms at baseline that increased at week 8 with a decrease in symptoms at week 12. CONCLUSIONS Our findings suggest that alcohol and cannabis use trajectories are associated with the intensity of posttrauma psychopathology. These findings could potentially inform the timing of therapeutic strategies.
Collapse
Affiliation(s)
- Cecilia A. Hinojosa
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Amanda Liew
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Xinming An
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Archana Basu
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Sanne J H. van Rooij
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Stacey L. House
- Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Francesca L. Beaudoin
- Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI, USA
| | - Donglin Zeng
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas C. Neylan
- Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, GA, USA
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Sarah D. Linnstaedt
- Institute for Trauma Recovery, Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Laura T. Germine
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- The Many Brains Project, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Scott L. Rauch
- Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, McLean Hospital, Belmont, MA, USA
| | - John P. Haran
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Alan B. Storrow
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Paul I. Musey
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Phyllis L. Hendry
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Sophia Sheikh
- Department of Emergency Medicine, University of Florida College of Medicine -Jacksonville, Jacksonville, FL, USA
| | - Christopher W. Jones
- Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Brittany E. Punches
- Department of Emergency Medicine, Ohio State University College of Medicine, Columbus, OH, USA
- Ohio State University College of Nursing, Columbus, OH, USA
| | - Michael C. Kurz
- Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL, USA
- Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL, USA
- Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robert A. Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Lauren A. Hudak
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Jose L. Pascual
- Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark J. Seamon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth M. Datner
- Department of Emergency Medicine, Einstein Healthcare Network, Philadelphia, PA, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna M. Chang
- Department of Emergency Medicine, Jefferson University Hospitals, Philadelphia, PA, USA
| | - Claire Pearson
- Department of Emergency Medicine, Wayne State University, Ascension St. John Hospital, Detroit, MI, USA
| | - David A. Peak
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Roland C. Merchant
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Robert M. Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI, USA
| | - Niels K. Rathlev
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA, USA
| | - Paulina Sergot
- Department of Emergency Medicine, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Leon D. Sanchez
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA
| | - Steven E. Bruce
- Department of Psychological Sciences, University of Missouri - St. Louis, St. Louis, MO, USA
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, USA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Robert H. Pietrzak
- National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Diego A. Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - John F. Sheridan
- Division of Biosciences, Ohio State University College of Dentistry, Columbus, OH, USA
- Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH, USA
| | - Steven E. Harte
- Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - James M. Elliott
- Kolling Institute, University of Sydney, St Leonards, New South Wales, Australia
- Faculty of Medicine and Health, University of Sydney, Northern Sydney Local Health District, New South Wales, Australia
- Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Samuel A. McLean
- Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Institute for Trauma Recovery, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA
| | - Negar Fani
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
3
|
Powers MB, Douglas ME, Driver S, Sikka S, Hamilton R, Swank C, Callender L, Ochoa C, Bennett M, Stewart N, Chauvin GV, Rothbaum BO, Warren AM. Prevention of posttraumatic stress during inpatient rehabilitation post spinal cord injury: Study protocol for a randomized controlled trial of Brief Prolonged Exposure Therapy (Brief PE). Contemp Clin Trials Commun 2022; 30:101030. [PMID: 36387992 PMCID: PMC9661669 DOI: 10.1016/j.conctc.2022.101030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Scant research has focused on posttraumatic stress disorder (PTSD) in the SCI population, despite high prevalence estimates. Fortunately, prolonged exposure therapy (PE) is a well-researched and highly effective treatment for PTSD. Our recent clinical trial showed that standard 12-session PE was effective for PTSD treatment among inpatients with SCI. Early intervention with brief PE (3-sessions) delivered in the emergency department has also been effective for PTSD prevention, but has not been tested among people post-SCI. Thus, we aim to conduct the first test of the Brief PE intervention to prevent PTSD among patients with SCI. Methods Adults who have experienced a SCI (N = 200) will be randomly assigned during inpatient rehabilitation to either: (a) 3 60-min sessions of Brief PE (intervention group) or (b) treatment as usual (control group). Results The primary outcome measure (PTSD symptoms measured by the PSSI-5) and secondary outcome measures (depression, anxiety, pain, quality of life, sleep disturbance, and resilience) will be assessed at baseline, 1-month, 3-months, and 6-months. Hierarchical linear modeling (HLM) will be used to evaluate the effectiveness of the PE intervention on PTSD and secondary outcomes. Descriptive statistics will examine feasibility and will include the number of participants enrolled, the number of sessions completed, fidelity of Brief PE delivery, and average scores for difficulty and helpfulness of the intervention scales for those randomized to intervention. Conclusions Successful completion of this study will provide an evidence-based program to alleviate posttraumatic distress post spinal cord injury and prevent long-term development of PTSD.
Collapse
Affiliation(s)
- Mark B. Powers
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Corresponding author. Baylor Scott & White Spinal Cord Injury Model System, USA.
| | - Megan E. Douglas
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Simon Driver
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Seema Sikka
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Rita Hamilton
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Chad Swank
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Librada Callender
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Christa Ochoa
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Monica Bennett
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Neil Stewart
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Gregory V. Chauvin
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Barbara O. Rothbaum
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Emory University School of Medicine, USA
| | - Ann Marie Warren
- Baylor Scott & White Spinal Cord Injury Model System, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| |
Collapse
|
4
|
Nguyen J, Whiteside LK, Bulger EM, Veach L, Moloney K, Russo J, Nehra D, Wang J, Zatzick DF. Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers. Trauma Surg Acute Care Open 2022; 7:e000913. [PMID: 35979039 PMCID: PMC9358953 DOI: 10.1136/tsaco-2022-000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients. Methods This investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity. Results The frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity. Discussion This multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities. Level of evidence Level II (epidemiological investigation of untreated controls from a multisite randomized clinical trial) Trial registration number NCT02655354.
Collapse
Affiliation(s)
- Jefferson Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Laura Veach
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Zatzick D, Jurkovich G, Heagerty P, Russo J, Darnell D, Parker L, Roberts MK, Moodliar R, Engstrom A, Wang J, Bulger E, Whiteside L, Nehra D, Palinkas LA, Moloney K, Maier R. Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial. JAMA Surg 2021; 156:430-474. [PMID: 33688908 DOI: 10.1001/jamasurg.2021.0131] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance To date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms. Objective To simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity. Design, Setting, and Participants A stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2018. Data analysis was performed from November 4, 2019, to December 8, 2020. Interventions The Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity. Main Outcomes and Measures The primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample. Results A total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, -2.57; 95% CI, -5.12 to -0.03; effect size, 0.18; P < .05) but not 12 months (difference, -1.27; 95% CI, -4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance. Conclusions and Relevance A brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria. Trial Registration ClinicalTrials.gov Identifier: NCT02655354.
Collapse
Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Gregory Jurkovich
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Michelle K Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.,Department of Psychology, University of California, Los Angeles
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lawrence A Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, Seattle
| |
Collapse
|
7
|
McMullan J, Droege C, Strilka R, Hart K, Lindsell C. Intranasal Ketamine as an Adjunct to Fentanyl for the Prehospital Treatment of Acute Traumatic Pain: Design and Rationale of a Randomized Controlled Trial. PREHOSP EMERG CARE 2020; 25:519-529. [PMID: 32772873 DOI: 10.1080/10903127.2020.1808746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective: Acute pain management is fundamental in prehospital trauma care. Early pain control may decrease the risk of developing post-traumatic stress disorder (PTSD) and chronic pain. Fentanyl and ketamine are frequently used off-label, but there is a paucity of comparative data to guide decision-making about treatment of prehospital severe, acute pain. This trial will determine whether the addition of single dose of intranasal ketamine to fentanyl is more effective for the treatment of acute traumatic pain than administration of fentanyl alone.Methods: This two-part study consists of prehospital and 90-day follow-up components (NCT02866071). The prehospital trial is a blinded, randomized, controlled trial of adult men (age 18-65 years) rating pain ≥7/10 after an acute traumatic injury of any type. Women will be excluded due to inability to confirm pregnancy status and unknown fetal risk. Paramedics will screen patients receiving standard of care fentanyl and, after obtaining standard informed consent, administer 50 mg intranasal ketamine or matching volume saline as placebo. Upon emergency department (ED) arrival, research associates will serially assess pain, concomitant treatments, and adverse side effects. Enrolled subjects will be approached for consent to participate in the 90-day follow-up study to determine rates of PTSD and chronic pain development. The primary outcome of the prehospital study is reduction in pain on the Verbal Numerical Rating Scale between baseline and 30-minutes after study drug administration. The proportion achieving a reduction of ≥2-points will be compared between study arms using a Chi-square test. Secondary outcomes of the prehospital trial include reduction in reported pain at the time of ED arrival and at 30 minutes intervals for up to three hours of ED care, the incidence of adverse events, and additional opiate requirements prior to ED arrival and within the first three hours of ED care. The outcomes in the follow-up study are satisfaction with life and development of PTSD or chronic pain at 90 days after injury. An intention-to-treat approach will be used.Conclusion: These studies will test the hypotheses that ketamine plus fentanyl, when compared to fentanyl alone, effectively manages pain, decreases opiate requirements, and decreases PTSD at 90 days.
Collapse
|
8
|
Shelley JK, Roden-Foreman JW, Vier D, McShan EE, Bennett MM, Jones AL, Warren AM. Relation of length of stay and other hospital variables to posttraumatic stress disorder and depression after orthopedic trauma. Proc AMIA Symp 2020; 34:28-33. [PMID: 33456140 PMCID: PMC7785185 DOI: 10.1080/08998280.2020.1801113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/14/2020] [Accepted: 07/20/2020] [Indexed: 12/17/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) and depression are common following orthopedic trauma. This study examined the relationship between injury- and hospital-related variables and PTSD and depression at baseline and 12 months after orthopedic trauma. This longitudinal, prospective cohort study examined adult orthopedic trauma patients admitted ≥24 hours to a level I trauma center. Non-English/Spanish-speaking and cognitively impaired patients were excluded. The Primary Care PTSD screen and PTSD Checklist-Civilian version assessed PTSD, and the Patient Health Questionnaire 8-Item assessed depression. Demographic and hospital-related variables were examined (e.g., hospital length of stay, Injury Severity Score, Glasgow Coma Scale). For 160 participants, PTSD prevalence was 23% at baseline and 21% at 12 months. Depression prevalence was 28% at baseline and 29% at 12 months. Ventilation (P = 0.023, P = 0.006) and prolonged length of stay (P = 0.008, P = 0.003) were correlated with baseline PTSD and depression. Injury etiology (P = 0.008) and Injury Severity Score (P = 0.013) were associated with baseline PTSD. Intensive care unit admission (P = 0.016, P = 0.043) was also correlated with PTSD at baseline and 12 months. Ventilation (P = 0.002, P = 0.040) and prolonged length of stay (P < 0.001, P = 0.001) were correlated with 12-month PTSD and depression. Early and continued screenings with potential interventions could benefit patients' physical and mental rehabilitation after orthopedic injury.
Collapse
Affiliation(s)
- Jordin K. Shelley
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Jacob W. Roden-Foreman
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - David Vier
- Department of Orthopaedic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Evan Elizabeth McShan
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Monica M. Bennett
- Office of the Chief Medical Officer, Baylor Scott & White Health, Dallas, Texas
| | - Alan L. Jones
- Department of Orthopaedic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| | - Ann Marie Warren
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center at Dallas, Dallas, Texas
| |
Collapse
|
9
|
Psychological morbidity and functional impairment following traumatic pelvic injury. Injury 2020; 51:978-983. [PMID: 32081393 DOI: 10.1016/j.injury.2020.02.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
Pelvic injuries often result from high-energy trauma and lead to significant functional impairment. While the physical outcomes of these injuries have been widely studied, the psychological consequences remain largely unexplored. The purpose of this study was to examine psychosocial and functional outcomes of patients with pelvic trauma in the year after injury. The sample (N = 32) consisted of adult patients with traumatic pelvic injures, as defined by ICD-9 codes, who were admitted to a Level I Trauma Center for at least 24 h. Participants were primarily female (53%) with a mean age of 48.7 years (SD = 17.9). Demographic, injury-related, and psychosocial data (e.g., posttraumatic stress disorder (PTSD), depression, alcohol use, quality of life, pain, return to work) were gathered at the time of hospitalization as well as at 3-, 6-, and 12 month follow-ups. Mixed regression models were used to examine the outcome variables over time. There were significant decreases in pain and alcohol use at each follow-up compared to baseline. However, despite the decrease, the levels of pain and alcohol use remained high. Physical and mental health also decreased significantly, indicating worsened functioning and lowered quality of life. Neither PTSD nor depression changed significantly over time, indicating that participants' symptoms were not likely to improve. These data suggest that sustaining a traumatic pelvic injury increases the risk of diminished quality of life, both mentally and physically. Even one-year post-injury, participants experienced moderate physical pain and higher levels of PTSD, depression, and problematic alcohol use than would be expected in the general population. These findings highlight the need for an interdisciplinary approach to treating patients with pelvic injuries, including psychological screening and intervention in acute care and throughout recovery.
Collapse
|
10
|
Fani N, Jain J, Hudak LA, Rothbaum BO, Ressler KJ, Michopoulos V. Post-trauma anhedonia is associated with increased substance use in a recently-traumatized population. Psychiatry Res 2020; 285:112777. [PMID: 31991282 PMCID: PMC7544530 DOI: 10.1016/j.psychres.2020.112777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 12/13/2022]
Abstract
Recreational substance use (SU) can emerge or worsen in the aftermath of psychological trauma. Anhedonia is one reason for this problematic SU. Symptoms of posttraumatic stress disorder (PTSD) that represent anhedonia (post-trauma anhedonia; PTA) have been consistently linked to SU disorders. However, no prospective studies have examined whether changes in PTA over time are associated with problematic SU in recently-traumatized people, which was the goal of this study. 165 men and women were recruited as part of a prospective PTSD study in the emergency department of a Level 1 trauma center. Clinical assessments of PTSD and SU were administered at three and six months post-trauma. Compared to participants with minimal SU at six months post-trauma, high substance users at six months post-trauma showed significant increases in PTA during the three to six month time period. This relationship was significant even after accounting for variance associated with other factors, including PTSD symptoms such as re-experiencing and hyperarousal. Participants who demonstrated increases in SU during this time also showed significant increases in PTA, unlike those who demonstrated consistently minimal/no SU during this time. These findings indicate that PTA may be a mechanism through which SU problems emerge in recently-traumatized individuals.
Collapse
Affiliation(s)
- Negar Fani
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA.
| | - Jahnvi Jain
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Lauren A Hudak
- Emory University School of Medicine, Department of Emergency Medicine, USA
| | - Barbara O Rothbaum
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA
| | - Kerry J Ressler
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA; McLean Hospital, Harvard Medical School, USA
| | - Vasiliki Michopoulos
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, USA; Yerkes National Primate Research Center, Atlanta, GA, USA
| |
Collapse
|
11
|
Harris T, Rhoades H, Duan L, Wenzel SL. Mental health change in the transition to permanent supportive housing: The role of housing and social networks. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1834-1849. [PMID: 31421655 DOI: 10.1002/jcop.22230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 07/01/2019] [Accepted: 07/04/2019] [Indexed: 06/10/2023]
Abstract
AIMS Permanent Supportive Housing (PSH) may improve homeless adults' mental health via housing stabilization and/or improved relational factors, however, the role of housing and social networks on PSH residents' mental health change is minimally understood. METHODS Interviews were conducted with a baseline sample of adults experiencing homelessness ( N = 421), across their initial year in PSH (3-months, 6-months, and 12-months). Generalized linear mixed models assessed changes in positive past-month psychiatric disability screenings (Modified-Colorado Symptom Index [MCSI]) and probable posttraumatic stress disorder (PC-PTSD) in controlled models, and between and within-subject effects of time-varying social network correlates on mental health changes. RESULTS Compared with baseline, positive MCSI screens continuously decreased over time (56%, 54%, and 50%) while PC-PTSD screens declined initially (40%) with marginal decreases at remaining follow-ups (39% and 38%). These differences remained significant in controlled models. Gaining a romantic partner was associated with a longitudinal increase in a positive MCSI screening. Between subjects, emotional health counselors and conflicting network members were associated with an increased likelihood in positive screenings, while doctors and case managers were protective. CONCLUSION Housing may facilitate positive changes in PSH residents' mental health, yet positive screenings remain high. Social network interventions that increase residents' positive interpersonal exchanges and prosocial relationships are warranted.
Collapse
Affiliation(s)
- Taylor Harris
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Harmony Rhoades
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Lei Duan
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | - Suzanne L Wenzel
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| |
Collapse
|
12
|
Do screening and a randomized brief intervention at a Level 1 trauma center impact acute stress reactions to prevent later development of posttraumatic stress disorder? J Trauma Acute Care Surg 2019; 85:466-475. [PMID: 29787532 DOI: 10.1097/ta.0000000000001977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Approximately 20% to 40% of trauma survivors experience posttraumatic stress disorder (PTSD). The American College of Surgeons Committee on Trauma reports that early screening and referral has the potential to improve outcomes and that further study of screening and intervention for PTSD would be beneficial. This prospective randomized study screened hospitalized patients for traumatic stress reactions and assessed the effect of a brief intervention in reducing later development of PTSD. METHODS The Primary Care PTSD (PC-PTSD) screen was administered to admitted patients. Patients with symptoms were randomized to an intervention or control group. The brief intervention focused on symptom education and normalization, coping strategies, and utilizing supports. The control group received a 3-minute educational brochure review. Both groups completed in-hospital interviews, then 45- and 90-day telephone interviews. Follow-up collected the PTSD checklist-civilian (PCL-C) assessment and qualitative data on treatment-seeking barriers. RESULTS The PC-PTSD screen was successful in predicting later PTSD symptoms at both 45 days (β = 0.43, p < 0.001) and 90 days (β = 0.37, p < 0.001) even after accounting for depression. Correlations of the intervention with the PCL-C scores and factor score estimates did not reach statistical significance at either time point (p = 0.827; p = 0.838), indicating that the brief intervention did not decrease PTSD symptoms over time. Of those at or above the PCL-C cutoff at follow-ups, a minority had sought treatment for their symptoms (43.2%). Primary barriers included focusing on their injury or ongoing rehabilitation, financial concerns, or location of residence. CONCLUSION The PC-PTSD screen identified patients who later assess positive for PTSD using the PCL-C. The brief intervention did not reduce 45- and 90-day PTSD development. Follow-up interviews revealed lack of treatment infrastructure in the community. It will be important for trauma centers to align with community resources to address the treatment needs of at-risk patients. LEVEL OF EVIDENCE Prospective randomized controlled trial, level II.
Collapse
|
13
|
Abstract
PURPOSE We aimed to produce comprehensive guidelines and recommendations that can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. METHODS A panel of 15 members with expertise in orthopaedic trauma, pain management, or both was convened to review the literature and develop recommendations on acute musculoskeletal pain management. The methods described by the Grading of Recommendations Assessment, Development, and Evaluation Working Group were applied to each recommendation. The guideline was submitted to the Orthopaedic Trauma Association (OTA) for review and was approved on October 16, 2018. RESULTS We present evidence-based best practice recommendations and pain medication recommendations with the hope that they can be utilized by orthopaedic practices as well as other specialties to improve the management of acute pain following musculoskeletal injury. Recommendations are presented regarding pain management, cognitive strategies, physical strategies, strategies for patients on long term opioids at presentation, and system implementation strategies. We recommend the use of multimodal analgesia, prescribing the lowest effective immediate-release opioid for the shortest period possible, and considering regional anesthesia. We also recommend connecting patients to psychosocial interventions as indicated and considering anxiety reduction strategies such as aromatherapy. Finally, we also recommend physical strategies including ice, elevation, and transcutaneous electrical stimulation. Prescribing for patients on long term opioids at presentation should be limited to one prescriber. Both pain and sedation should be assessed regularly for inpatients with short, validated tools. Finally, the group supports querying the relevant regional and state prescription drug monitoring program, development of clinical decision support, opioid education efforts for prescribers and patients, and implementing a department or organization pain medication prescribing strategy or policy. CONCLUSIONS Balancing comfort and patient safety following acute musculoskeletal injury is possible when utilizing a true multimodal approach including cognitive, physical, and pharmaceutical strategies. In this guideline, we attempt to provide practical, evidence-based guidance for clinicians in both the operative and non-operative settings to address acute pain from musculoskeletal injury. We also organized and graded the evidence to both support recommendations and identify gap areas for future research.
Collapse
|
14
|
Darnell DA, Parker LE, Wagner AW, Dunn CW, Atkins DC, Dorsey S, Zatzick DF. Task-shifting to improve the reach of mental health interventions for trauma patients: findings from a pilot study of trauma nurse training in patient-centered activity scheduling for PTSD and depression. Cogn Behav Ther 2018; 48:482-496. [PMID: 30499372 DOI: 10.1080/16506073.2018.1541928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Despite high rates of posttraumatic stress disorder (PTSD) and depression among traumatically injured patients, engagement in session-based psychotherapy early after trauma is limited due to various service utilization and readiness barriers. Task-shifting brief mental health interventions to routine trauma center providers is an understudied but potentially critical part of the continuum of care. This pilot study assessed the feasibility of training trauma nurses to engage patients in patient-centered activity scheduling based on a Behavioral Activation paradigm, which is designed to counteract dysfunctional avoidance/withdrawal behavior common among patients after injury. Nurses (N = 4) and patients (N = 40) were recruited from two level II trauma centers. A portion of a one day in-person workshop included didactics, demonstrations, and experiential activities to teach brief intervention delivery. Nurses completed pre- and posttraining standardized patient role-plays prior to and two months after training, which were coded for adherence to the intervention. Nurses also completed exit interviews to assess their perspectives on the training and addressing patient mental health concerns. Findings support the feasibility of training trauma nurses in a brief mental health intervention. Task-shifting brief interventions holds promise for reaching more of the population in need of posttrauma mental health care.
Collapse
Affiliation(s)
- Doyanne A Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Lea E Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Amy W Wagner
- Department of Mental Health, Portland Department of Veteran Affairs Medical Center , Portland , OR , USA
| | - Christopher W Dunn
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - David C Atkins
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington , Seattle , DC , USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington , Seattle , DC , USA
| |
Collapse
|
15
|
Skinner HK, Rahtz E, Korszun A. Interviews following physical trauma: A thematic analysis. Int Emerg Nurs 2018; 42:19-24. [PMID: 30262432 DOI: 10.1016/j.ienj.2018.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 08/22/2018] [Accepted: 08/29/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Mental health problems are common in trauma survivors. In particular, depression, anxiety, acute stress disorder and post-traumatic stress disorder. Yet little is known about how these can be brought to the early attention of medical professionals through patients' accounts of trauma within days of being admitted to emergency care. This study aims to understand how physical trauma patients with early signs of psychological distress, stemming from the trauma, might be supported through their communications with healthcare professionals. METHODS 42 semi-structured interviews with trauma victims attending the Royal London Hospital Trauma Clinic, taken as part of a larger project, were analysed using a qualitative thematic analysis method with a critical realist approach. RESULTS Four key themes were highlighted: Pain and Death, Positivity, Powerlessness, and Remembering and Blame, each with relating subthemes such as Facing Death, Heroism, Waiting Time and Self-blame. DISCUSSION The themes present within the data suggest that there are cues shared by trauma survivors that medical professionals should attend to with regard to the future mental health of their patients. Results may further equip nurses and clinical staff to spot early signs immediately and shortly after trauma.
Collapse
|
16
|
Kearns NT, Powers MB, Jackson WT, Elliott TR, Ryan T. Posttraumatic stress disorder symptom clusters and substance use among patients with upper limb amputations due to traumatic injury. Disabil Rehabil 2018; 41:3157-3164. [PMID: 30182759 DOI: 10.1080/09638288.2018.1485180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: Examining the relationship between posttraumatic stress disorder and posttraumatic stress disorder symptom clusters (re-experiencing, avoidance, hyperarousal, emotional numbing) on three substance use measures among individuals with upper limb amputation due to traumatic injury - an understudied population with high rates of posttraumatic stress disorder.Methods: Multi-site, cross-sectional design. Participants (N = 236) were recruited from seven prosthetic rehabilitation centres across the USA and completed measures of PTSD, alcohol use, prescription medication overuse, and illicit drug use.Results: Twenty-six percent of participants screened positive for posttraumatic stress disorder, 39% for problematic alcohol use, 12% for prescription medication overuse, and 7% for illicit drug use. No association was found between posttraumatic stress disorder or posttraumatic stress disorder symptoms clusters on problematic alcohol use. However, hyperarousal symptoms increased odds of overusing prescription medication (odds ratio = 3.30); further, a positive screen for posttraumatic stress disorder increased odds of illicit drug use (odds ratio = 2.95).Conclusions: These findings demonstrate the importance of assessing psychological well-being and a variety of substance use behaviours following amputation from traumatic injury. These findings may also provide clinically-relevant targets for prevention and intervention regarding prescription medication and illicit substance use, such as incorporating evidence-based treatment for posttraumatic stress disorder hyperarousal symptoms (e.g., prolonged exposure) and/or integrated treatment for posttraumatic stress-substance misuse (e.g., Seeking Safety) into patients' long-term inpatient/outpatient rehabilitation plans.Implications for rehabilitationPosttraumatic stress disorder hyperarousal symptoms increased odds of overusing prescription medication among individuals with upper limb amputation due to traumatic injury; a positive screen for posttraumatic stress disorder increased odds of illicit drug use.Psychological assessments should be incorporated into treatment and rehabilitation plans following amputation from traumatic injury.Rehabilitation specialists should consider adding or integrating evidence-based treatment for posttraumatic stress disorder into patients' long-term rehabilitation plan to reduce risk for problematic substance use.Findings support calls by the Centre for Disease Control and Prevention to overhaul prescription medication guidelines, including the need to assess risk and address harms concerning overuse of prescription medication.
Collapse
Affiliation(s)
- Nathan T Kearns
- Department of Psychology, University of North Texas, Denton, TX, USA
| | - Mark B Powers
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Warren T Jackson
- Division of Trauma, Critical Care, and Acute Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Timothy R Elliott
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Tiffany Ryan
- Therapeutic Services, Advanced Arm Dynamics, Redondo Beach, CA, USA
| |
Collapse
|
17
|
Craniofacial Trauma Is Associated With Significant Psychosocial Morbidity 1 Year Post-Injury. J Oral Maxillofac Surg 2018; 76:2610.e1-2610.e8. [PMID: 30216752 DOI: 10.1016/j.joms.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/10/2018] [Accepted: 08/10/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE The face and head play critical roles in one's sense of self and body image; as such, facial, head, and scalp injuries and potential associated disfigurement can lead to particular difficulties in coping. This study examined the psychosocial outcomes of patients with craniofacial (CF) trauma 1 year after injury and compared these outcomes with those of other traumatically injured patients who did not sustain such injuries. It was hypothesized that participants in the CF injury group would have worse outcomes than those without CF trauma. MATERIALS AND METHODS This prospective longitudinal study included patients at least 18 years of age admitted to the trauma service of a level I trauma center for at least 24 hours. Demographic and injury-related variables were collected. CF injury was determined by International Classification of Diseases, Ninth Revision codes. Outcomes were measured at baseline and at 12 months and included depression, post-traumatic stress disorder (PTSD), alcohol use, and pain severity. Paired t tests and logistic regression were used for analysis. RESULTS Fifteen percent (n = 35) of the study sample (N = 230) had CF injuries. Those with CF injuries had lower income, higher injury severity, and higher intensive care unit admission rates. The CF and non-CF trauma groups did not differ in rates of depression or PTSD at either time point. However, participants with CF trauma had higher odds of risky alcohol use than those without CF trauma at baseline and lower odds of a higher pain severity score at baseline and 12 months. CONCLUSIONS The groups did not differ in depression and PTSD. However, rates of depression, PTSD, alcohol use, and physical pain were higher than expected for the 2 groups. Given the high rate of psychological morbidity found after CF trauma, patients with these injuries should be screened for symptoms soon after injury and provided with resources for treatment.
Collapse
|
18
|
Jiang T, Webster JL, Robinson A, Kassam-Adams N, Richmond TS. Emotional responses to unintentional and intentional traumatic injuries among urban black men: A qualitative study. Injury 2018; 49:983-989. [PMID: 29248186 PMCID: PMC5932248 DOI: 10.1016/j.injury.2017.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 11/08/2017] [Accepted: 12/05/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The burden of injuries is disproportionately concentrated among Black men in the United States. Previous studies suggest that the mental health effects of trauma may vary by the intentionality of the injury (intentional vs. unintentional), yet little is known about this experience among Black men. We explored the emotional responses to traumatic injuries in the context of injury intentionality among Black men in an urban area. METHODS We conducted semi-structured, qualitative interviews with 74 Black men who were traumatically injured. The interviews took place three months after discharge from the hospital and they were audiotaped, transcribed, and de-identified. We used systematic thematic analysis to identify themes about post-trauma emotional responses to intentional and unintentional injuries. RESULTS The narratives of intentionally injured men revealed persistent exposure to neighborhood violence and their distrust of others including the people they knew and to whom they felt close. Survivors of unintentional injuries did not express a similar distrust of others. Our findings suggest that survivors of intentional injuries experience loss of social support following their injuries. CONCLUSIONS Emotional responses can differ by intentionality of traumatic injury among urban Black men. Intentional injuries may be a marker for chronic exposure to violence and limited social support for recovery. Additional resources should be targeted to survivors of intentional injury who return to disadvantaged communities after medical treatment to decrease risk of re-traumatization and adverse emotional responses.
Collapse
Affiliation(s)
- Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jessica L. Webster
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Andrew Robinson
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Nancy Kassam-Adams
- The Center for Injury Research and Prevention, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Therese S. Richmond
- Division of Biobehavioral and Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| |
Collapse
|
19
|
Roden-Foreman K, Robinson R, Bennett M, Roaten K, Petrey L, Powers MB, Warren AM. Posttraumatic growth in a heterogeneous sample of traumatically injured patients 1 year postinjury. J Clin Psychol 2017; 74:989-1003. [PMID: 29193058 DOI: 10.1002/jclp.22563] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 09/05/2017] [Accepted: 09/21/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Posttraumatic growth (PTG) describes positive change resulting from challenging life events. The current study examined factors associated with PTG in traumatically injured patients 1 year postinjury. METHOD Participants (N = 221) in this prospective cohort study included adults admitted to a Level I trauma center. Over half the participants (60%) were male, with a mean age of 47. Participants completed baseline measures during hospitalization. PTG was assessed at 12-month follow-up. RESULTS Greater PTG was associated with minority race/ethnicity, lower income, automotive collision, and premorbid psychological disorder other than depression or posttraumatic stress (PTS). These variables are also known to predict PTS in trauma patients. Analysis confirmed that greater PTS at follow-up was associated with more growth. CONCLUSION Participants with the most growth also experienced the most distress. This finding demonstrates the importance of implementing psychological screening and intervention for trauma patients in the acute care setting to reduce PTS and facilitate growth.
Collapse
|
20
|
Prospective Evaluation of Posttraumatic Stress Disorder and Depression in Orthopaedic Injury Patients With and Without Concomitant Traumatic Brain Injury. J Orthop Trauma 2017; 31:e275-e280. [PMID: 28832389 DOI: 10.1097/bot.0000000000000884] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Psychological morbidities after injury [eg, posttraumatic stress disorder (PTSD) and depression] are increasingly recognized as a significant determinant of overall outcome. Traumatic brain injury (TBI) negatively impacts outcomes of patients with orthopaedic injury, but the association of concurrent TBI, orthopaedic injury, and symptoms of PTSD and depression has not been examined. This study's objective was to examine symptoms of PTSD and depression in patients with orthopaedic trauma with and without TBI. DESIGN Longitudinal prospective cohort study. SETTING Urban Level I Trauma Center in the Southwest United States. PATIENTS/PARTICIPANTS Orthopaedic trauma patients older than 18 years admitted for ≥24 hours. MAIN OUTCOME MEASUREMENTS Questionnaires examining demographics, injury-related variables, PTSD, and depression were administered during hospitalization and 3, 6, and 12 months later. Orthopaedic injury and TBI were determined based on ICD-9 codes. Generalized linear models determined whether PTSD and depression at follow-up were associated with TBI. RESULTS Of the total sample (N = 214), 44 (21%) sustained a TBI. Those with TBI had higher rates of PTSD symptoms, 12 months postinjury (P = 0.04). The TBI group also had higher rates of depressive symptoms, 6 months postinjury (P = 0.038). CONCLUSIONS Having a TBI in addition to orthopaedic injury was associated with significantly higher rates of PTSD at 12 months and depression at 6 months postinjury. This suggests that sustaining a TBI in addition to orthopaedic injury places patients at a higher risk for negative psychological outcomes. The findings of this study may help clinicians to identify patients who are in need for psychological screening and could potentially benefit from intervention. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
21
|
The course, prediction, and treatment of acute and posttraumatic stress in trauma patients. J Trauma Acute Care Surg 2017; 82:1158-1183. [DOI: 10.1097/ta.0000000000001447] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
22
|
Ahl R, Lindgren R, Cao Y, Riddez L, Mohseni S. Risk factors for depression following traumatic injury: An epidemiological study from a scandinavian trauma center. Injury 2017; 48:1082-1087. [PMID: 28356197 DOI: 10.1016/j.injury.2017.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/04/2017] [Accepted: 03/17/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A significant proportion of patients suffer depression following traumatic injuries. Once manifested, major depression is challenging to overcome and its presence risks impairing the potential for physical rehabilitation and functional recovery. Risk stratification for early detection and intervention in these instances is important. This study aims to investigate patient and injury characteristics associated with an increased risk for depression. METHODS All patients with traumatic injuries were recruited from the trauma registry of an urban university hospital between 2007 and 2012. Patient and injury characteristics as well as outcomes were collected for analysis. Patients under the age of eighteen, prescribed antidepressants within one year of admission, in-hospital deaths and deaths within 30days of trauma were excluded. Pre- and post-admission antidepressant data was requested from the national drugs registry. Post-traumatic depression was defined as the prescription of antidepressants within one year of trauma. To isolate independent risk factors for depression a multivariable forward stepwise logistic regression model was deployed. RESULTS A total of 5981 patients met the inclusion criteria of whom 9.2% (n=551) developed post-traumatic depression. The mean age of the cohort was 42 [standard deviation (SD) 18] years and 27.1% (n=1620) were females. The mean injury severity score was 9 (SD 9) with 18.4% (n=1100) of the patients assigned a score of at least 16. Six variables were identified as independent predictors for post-traumatic depression. Factors relating to the patient were female gender and age. Injury-specific variables were penetrating trauma and GCS score of≤8 on admission. Furthermore, intensive care admission and increasing hospital length of stay were predictors of depression. CONCLUSION Several risk factors associated with the development of post-traumatic depression were identified. A better targeted in-hospital screening and patient-centered follow up can be offered taking these risk factors into consideration.
Collapse
Affiliation(s)
- Rebecka Ahl
- School of Medical Sciences, Orebro University, Orebro, Sweden; Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Stockholm, Sweden.
| | - Rickard Lindgren
- Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Orebro, Sweden.
| | - Yang Cao
- School of Medical Sciences, Orebro University, Orebro, Sweden; Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - Louis Riddez
- Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Stockholm, Sweden.
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden; Karolinska University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Stockholm, Sweden; Orebro University Hospital, Division of Trauma and Emergency Surgery, Department of Surgery, Orebro, Sweden.
| |
Collapse
|
23
|
Sullivan E, Shelley J, Rainey E, Bennett M, Prajapati P, Powers MB, Foreman M, Warren AM. The association between posttraumatic stress symptoms, depression, and length of hospital stay following traumatic injury. Gen Hosp Psychiatry 2017. [PMID: 28622816 DOI: 10.1016/j.genhosppsych.2017.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The present study examined the relationship between posttraumatic stress symptoms (PTSS) and depression symptoms with hospital outcome measures to explore how psychiatric factors relate to hospital length of stay (LOS). METHOD Participants were adults admitted to a large Level I Trauma Center for longer than 24h. Depression was assessed at hospitalization using the Patient Health Questionnaire (PHQ-8), and PTSS was measured by the Primary Care PTSD Screen (PC-PTSD). Hospital outcome information was collected from the hospital's trauma registry. Pearson correlations were performed. RESULTS 460 participants (mean age=44years, SD=16.8; 65.4% male) completed the study. Baseline PTSS and depression were significantly correlated with longer hospital LOS while controlling for demographics and injury severity (p=0.026; p=0.023). Both PTSS-positive and depression-positive groups had an average increased hospital LOS of two days. CONCLUSIONS A significant proportion of individuals who are admitted to the hospital following trauma may be at risk for depression and PTSS, which may then increase hospital LOS. As national attention turns to reducing healthcare costs, early screenings and interventions may aid in minimizing psychiatric symptoms in trauma patients, in turn reducing the cost and outcomes associated with total hospital LOS.
Collapse
Affiliation(s)
- Erin Sullivan
- University of North Texas, 1155 Union Circle, Denton, TX 76203, United States.
| | - Jordin Shelley
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Evan Rainey
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Monica Bennett
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Purvi Prajapati
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Mark B Powers
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Michael Foreman
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| | - Ann Marie Warren
- Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, United States.
| |
Collapse
|
24
|
Chang JC, Yen AMF, Chen HH, Chen SLS, Chiu SYH, Fann JCY, Lee CS. Comorbid diseases as risk factors for incident posttraumatic stress disorder (PTSD) in a large community cohort (KCIS no.PSY4). Sci Rep 2017; 7:41276. [PMID: 28128220 PMCID: PMC5269576 DOI: 10.1038/srep41276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 12/16/2016] [Indexed: 11/19/2022] Open
Abstract
Nature disasters and terrorist attacks have occurred globally in recent years. Posttraumatic stress disorder (PTSD) has gained increasing attention, but its incidence and comorbidities in the general population are different from those inside the disaster areas. The present study estimated incident PTSD and comorbid diseases for over a decade in a cohort from a community-based integrated screening program. Factors associated with the incidence of PTSD were analyzed using Cox regression models. PTSD incidence was estimated as 81 per 105 person-years. Incidence was higher in females than in males and one-year increments in age lowered the risk for PTSD by 3%. Adjusting for other factors, cardiovascular heart disease (adjusted hazard ratio (aHR) = 1.45, 95% confidence interval (CI): 1.03–2.04), bipolar disorder (aHR = 1.86, 95% CI: 1.07–3.24) and major depressive disorder (aHR = 7.03, 95% CI: 5.02–9.85) all significantly increased 45%, 86% and 603%, respectively, the risk of developing PTSD. The low rate of people with incident PTSD receiving treatment in this community health screening population implies there is room for improvement in terms of early detection and intervention. Clinical preventive efforts may be made for patients seeking general medical help, especially those with cardiovascular disorders or mood disorders.
Collapse
Affiliation(s)
- Jung-Chen Chang
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan; National Taiwan University Hospital, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care Management, College of Management, Chang Gung University, Taoyuan, Taiwan
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management, College of Healthcare Management, Kainan University, Taoyuan County, Taiwan
| | - Chau-Shoun Lee
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
25
|
Agtarap S, Boals A, Holtz P, Roden-Foreman K, Rainey EE, Ruggero C, Warren AM. The effect of depressive symptoms on social support one year following traumatic injury. J Affect Disord 2017; 207:398-405. [PMID: 27770732 DOI: 10.1016/j.jad.2016.08.067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 07/26/2016] [Accepted: 08/24/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND Depression is a common mental health outcome after traumatic injury, negatively impacting physical outcomes and increasing the cost of care. Research shows that the presence and quality of support is a leading protective factor against depression post-injury; however, research is vague on the directional effects of both factors over the course of recovery. METHODS 130 patients admitted to a Level I Trauma Center were recruited to a prospective study examining overall outcomes one-year after injury. Effects of social support and depression at baseline and 12-months post-injury were examined using correlational and cross-lagged path model analyses. Additional follow-up analyses were conducted for depression on specific types of social support. RESULTS Findings replicated previous research suggesting depression and social support were inversely related. Initial depression at time of traumatic injury was predictive of social support 12-months after their injury, but initial social support levels did not significantly predict depression at 12-months. Additionally, initial depression significantly predicted attachment, social integration, reassurance of worth, and guidance 12-months later. LIMITATIONS Findings of the analyses are limited by lack of experimentation and inability to control for other related variables. CONCLUSIONS Findings of the present study support the notion that initial depression predicts poorer social support in recovery, in lieu of prevailing theory (i.e., initial support buffers against later depression) in a sample of trauma patients. These findings highlight the need for medical staff to target specific factors during inpatient stay, such as addressing depressive symptoms and preparing family members and caregivers prior to discharge.
Collapse
Affiliation(s)
| | - Adriel Boals
- University of North Texas, Denton, TX, United States
| | - Pamela Holtz
- University of North Texas, Denton, TX, United States
| | | | - Evan E Rainey
- Baylor Research Institute, Dallas, TX, United States
| | | | | |
Collapse
|
26
|
Prospective Evaluation of Posttraumatic Stress Disorder in Injured Patients With and Without Orthopaedic Injury. J Orthop Trauma 2016; 30:e305-11. [PMID: 27253481 DOI: 10.1097/bot.0000000000000623] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The study purposes were to prospectively evaluate occurrence of posttraumatic stress (PTS) symptoms at hospital admission and 6 months later in patients with orthopaedic injury; to explore differences in PTS symptoms in those with and without orthopaedic injury; and to determine whether PTS symptoms are influenced by orthopaedic injury type. DESIGN Prospective, longitudinal observational study. SETTING Level 1 Trauma Center. PATIENTS/PARTICIPANTS Two hundred fifty-nine participants admitted for at least 24 hours. MAIN OUTCOME MEASUREMENTS The Primary Care Posttraumatic Stress Disorder (PTSD) Screen (PC-PTSD) measured PTSD symptoms during hospitalization. The PTSD Checklist-Civilian Version (PCL-C) measured PTS symptoms at 6 months. RESULTS In orthopaedic patients, 28% had PTS at 6 months, compared with 34% of nonorthopaedic patients. Odds ratios (ORs) were calculated to determine the influence of pain, physical and mental function, depression, and work status. At 6 months, if the pain score was 5 or higher, the odds of PTS symptoms increased to 8.38 (3.55, 19.8) (P < 0.0001). Those scoring below average in physical function were significantly more likely to have PTS symptoms [OR = 7.60 (2.99, 19.32), P < 0.0001]. The same held true for mental functioning and PTS [OR = 11.4 (4.16, 30.9), P < 0.0001]. Participants who screened positive for depression had a 38.9 (14.5, 104) greater odds (P < 0.0001). Participants who did not return to work after injury at 6 months were significantly more likely to have PTS [OR = 16.5 (1.87, 146), P = 0.012]. CONCLUSIONS PTSD is common in patients after injury, including those with orthopaedic trauma. At 6 months, pain of 5 or greater, poor physical and mental function, depression, and/or not returning to work seem to be predictive of PTSD. Orthopaedic surgeons should identify and refer for PTSD treatment given the high incidence postinjury. LEVEL OF EVIDENCE Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
27
|
Koleszar JC, Childs BR, Vallier HA. Frequency of Recidivism in Patients With Orthopedic Trauma. Orthopedics 2016; 39:300-6. [PMID: 27359281 DOI: 10.3928/01477447-20160623-05] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 04/20/2016] [Indexed: 02/03/2023]
Abstract
The goals of this study were to determine the frequency of trauma recidivism and to identify risk factors. The authors hypothesized that substance abuse and mental illness would be associated with recidivism. They performed a retrospective review of 879 patients who were treated surgically for high-energy fractures over a period of 4 years. Recidivism was defined as presentation to the trauma center for a new, unrelated injury. A recurrent recidivist was a repeat patient who returned for more than 1 additional injury. The study identified 164 (18.7%) patients who returned with a new injury. Mean age of recidivists was 37.1 years vs 40.7 years for nonrecidivists (P=.025). Of the recidivists, 80% were male, and this group was more likely to be unmarried (76.2% vs 67.2%, P=.044) and unemployed (40.4% vs 19.6%, P<.0001). Recidivists were also more likely to be uninsured (33.5% vs 17.8%, P<.0001) or to have Medicaid coverage (33.5% vs 23.2%, P<.0001). Recidivists were more likely to have used alcohol (47.2% vs 32.0%, P=.0007) or to be intoxicated (32.4% vs 21.2%, P=.005) and to use tobacco (66.2% vs 50.2%, P=.0003) or recreational drugs (59.1% vs 43.2%, P=.0004) at baseline. The rate of documented mental illness was also higher in repeat patients than in nonrepeat patients (28.1% vs 20.0%, P=.03). These findings showed that recidivism is common, occurring overall in 18.7% of the study sample within a mean of 2.9 years. Factors associated with recidivism included age younger than 40 years, unmarried status, substance use, unemployment, and lack of insurance coverage. The greatest independent risk factors for recidivism were Medicaid insurance or no insurance and a history of a gunshot wound or assault. [Orthopedics. 2016; 39(5):300-306.].
Collapse
|
28
|
Warren AM, Reynolds M, Foreman ML, Bennett MM, Weddle RJ, Austin JD, Roden-Foreman K, Petrey LB. Validation of a brief, two-question depression screen in trauma patients. J Trauma Acute Care Surg 2016; 80:318-23. [PMID: 26491807 DOI: 10.1097/ta.0000000000000898] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Increasingly, depression following traumatic injury is recognized as a complication of injury. Unlike mandated screening for risky alcohol use in trauma centers, screening for psychological risks is not required by the American College of Surgeons' Committee on Trauma. Limited resources and time constraints are commonly given reasons against routine screening. The purpose of this study was to determine if a two-item screen was as valid as an eight-question screen for depression. METHODS A total of 421 patients were given the Patient Health Questionnaire 8 (PHQ-8) during initial hospitalization to assess depression in a prospective study at a Level I trauma center. A cutoff score of 10 or higher (possible range, 0-24) on the PHQ-8 is used as diagnostic for depression. The PHQ-2 (possible range, 0-6) is derived from the first two questions of the PHQ-8 and contains items assessing sad mood and loss of interest/pleasure during the previous 2 weeks. A cutoff score of 3 or higher was considered to be a positive screen result. Discriminatory ability of the PHQ-2 was calculated. RESULTS The sample was predominantly male (65%) and white (67%). The majority (85%) sustained a blunt trauma, and the primary cause of injury was motor vehicle collision (37%), with a mean Injury Severity Score (ISS) of 11.6. A total of 142 patients (34%) were positive for depression on the PHQ-8. When comparing the PHQ-2 with the PHQ-8, a sensitivity of 76.1 and a specificity of 92.8 were found, as well as a positive predictive value of 84.4. CONCLUSION The result of our study confirms that depression is a frequent condition (34%) among individuals who sustain physical injury. The PHQ-2 seems to have acceptable sensitivity and specificity to identify depression in this population. The use of a two-item screening questionnaire is a minimal addition to the evaluation of patients after injury, allowing for earlier intervention and better outcomes. LEVEL OF EVIDENCE Diagnostic study, level IV; prognostic/epidemiologic study, level III.
Collapse
Affiliation(s)
- Ann Marie Warren
- From the Baylor University Medical Center, Division of Trauma (A.M.W., M.L.F., L.B.P.), and Baylor Research Institute (M.R., R.J.W., K.R.-F.), Baylor Research Institute and Baylor Scott & White Health (M.M.B., J.D.A.), Dallas, Texas
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Atwoli L, Platt J, Williams DR, Stein DJ, Koenen KC. Association between witnessing traumatic events and psychopathology in the South African Stress and Health Study. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1235-42. [PMID: 25773525 PMCID: PMC4747238 DOI: 10.1007/s00127-015-1046-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 03/06/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The high burden of witnessing traumatic events has been demonstrated in previous research in South Africa. However, previous work has focused on PTSD rather than a broader range of psychopathological outcomes. This study examined the association between witnessing trauma and multiple outcomes including mood, anxiety, and substance use disorders. METHODS Regression models measured the odds of mood, anxiety, and substance use disorders among those who reported witnessing in the South African Stress and Health Study. Discrete-time survival analysis was used to examine whether witnessing was associated with earlier onset of mental disorders. RESULTS Witnessing trauma was more commonly reported among males and those with low-average education. Posttraumatic stress disorder, mood, and anxiety disorders varied significantly with witnessing status, and witnessing was associated with exposure to a higher number of traumatic events compared to other types of traumatic events. Respondents reporting witnessing trauma had elevated odds of mood and anxiety disorders, but not substance use disorders. CONCLUSION Witnessing trauma is common in the South African population and results in increased risk of mood and anxiety disorders. Interventions aimed at reducing the burden of trauma and its outcomes must now increase their focus on bystanders and other observers, rather than just focusing on those directly affected.
Collapse
Affiliation(s)
- Lukoye Atwoli
- Department of Mental Health, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya,
| | - Jonathan Platt
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David R. Williams
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Dan J. Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Karestan C. Koenen
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| |
Collapse
|
30
|
Rainey EE, Petrey LB, Reynolds M, Agtarap S, Warren AM. Psychological factors predicting outcome after traumatic injury: the role of resilience. Am J Surg 2014; 208:517-23. [DOI: 10.1016/j.amjsurg.2014.05.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/29/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
|
31
|
Osenbach JE, Lewis C, Rosenfeld B, Russo J, Ingraham LM, Peterson R, Wang J, Zatzick DF. Exploring the longitudinal trajectories of posttraumatic stress disorder in injured trauma survivors. Psychiatry 2014; 77:386-97. [PMID: 25386778 DOI: 10.1521/psyc.2014.77.4.386] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The goal of this study was to examine the longitudinal trajectories of posttraumatic stress disorder (PTSD) symptoms in a sample of acutely injured hospitalized civilian trauma survivors who participated in a randomized clinical trial. Prior longitudinal descriptive research has shown that there are distinct trajectories of PTSD symptoms over time in trauma survivors. Limited clinical trial research exists that describes the patterns of the trajectories as well as the risk factors that influence the trajectories for seriously injured trauma-exposed patients. METHOD Semiparametric, group-based approach trajectory modeling was used to examine four group trajectories of a subset of data obtained from a previous longitudinal clinical trial. Trajectories examined included resilience, recovery, relapsing/remitting, and chronic symptom patterns. One hundred and ninety-four patients who participated in the randomized clinical trial were assessed at baseline in the days and weeks after injury and then randomized. The associations between previously identified PTSD risk factors and the four trajectories were examined. RESULTS The risk factors of ethnocultural minority status, psychiatric history, additional life stressors, and depressive symptoms, as well as intervention versus control group status, were found to significantly affect the probability of trajectory group membership for PTSD symptom severity. CONCLUSIONS These findings suggest that there is a need for early PTSD interventions that anticipate differences in injured patients' PTSD trajectory profiles. Stepped care intervention procedures may optimally address the diverse PTSD trajectory patterns observed in injured trauma survivors through the tailoring of intervention timing and dosing.
Collapse
|