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Tomas CW, Timmer-Murillo S, Kallies KJ, Snowden AJ, Borisy-Rudin F, Busalacchi M, Mackenzie R, Kostelac CA, Cassidy LD, deRoon-Cassini TA. Examining the role of social vulnerability, neighborhood characteristics, and geospatial patterns of firearm-related injuries and clinical outcomes in Milwaukee county. Soc Sci Med 2024; 352:117035. [PMID: 38850675 DOI: 10.1016/j.socscimed.2024.117035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/17/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Previous work has shown socioenvironmental factors can influence firearm injury. Milwaukee County, Wisconsin is a diverse midwestern county with historic disinvestment in marginalized communities yielding stark segregation along racial and ethnic lines. It is also one of the many U.S. counties burdened by surging firearm injuries. The differences among communities within Milwaukee County provides a unique opportunity to explore the intersection of socioenvironmental factors that may affect clinical outcomes and geospatial patterns of firearm injury. METHODS The trauma registry from the regional adult level 1 trauma center was queried for patients who sustained a firearm-related injury from 2015 to 2022 (N = 2402). The Social Vulnerability Index (SVI) ranking was derived using patient residence addresses to evaluate its association with traumatic injury clinical outcomes (i.e., in-hospital mortality, length of hospital stay, ICU or ventilator treatment, or injury severity score) and risk screening results for alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and depression. We evaluated hotspots of firearm injury density over time for patient residences and injury locations and distances between locations. A spatially lagged regression model tested the association between firearm injury density and SVI domains, alcohol outlet types, and park coverage. RESULTS Most firearm injury patients were younger, male, racial or ethnic minorities from disadvantaged neighborhoods (SVI total; M = 0.86, SD = 0.15). SVI was not associated with any clinical outcomes. Of those screened, 12.9% screened positive for AUD and 44.5% screened at risk for PTSD, depression, or both. Hotspot analysis indicated consistent concentrations of firearm injury density. There were no differences in clinical outcomes between those injured inside or outside the home. Census tracts with lower socioeconomic status, greater off-premises and lower on-premises alcohol outlet density were associated with greater firearm injury density. CONCLUSIONS In Milwaukee County, firearm injury patients are injured in and often return to the same disadvantaged neighborhoods that may hamper recovery. Results replicate and expand previous work and implicate specific socioenvironmental factors for intervention and prevention of firearm injury.
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Affiliation(s)
- C W Tomas
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA; Comprehensive Injury Center, Medical College of Wisconsin, USA.
| | - S Timmer-Murillo
- Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, USA
| | - K J Kallies
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA
| | - A J Snowden
- Department of Social and Cultural Sciences, Marquette University, USA
| | - F Borisy-Rudin
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, USA; Wisconsin Alcohol Policy Project, Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - M Busalacchi
- Wisconsin Alcohol Policy Project, Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - R Mackenzie
- Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - C A Kostelac
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA; Comprehensive Injury Center, Medical College of Wisconsin, USA
| | - L D Cassidy
- Division of Epidemiology and Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, USA
| | - T A deRoon-Cassini
- Comprehensive Injury Center, Medical College of Wisconsin, USA; Division of Trauma and Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, USA
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2
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Brandolino A, Biesboer EA, Leissring M, Weber R, Timmer-Murillo S, deRoon-Cassini TA, Schroeder ME. A comparison of the psychometric properties of a person-administered vs. automated screening tool for posttraumatic stress disorder (PTSD) in traumatically injured patients. Injury 2024; 55:111507. [PMID: 38531719 DOI: 10.1016/j.injury.2024.111507] [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: 09/12/2023] [Revised: 02/08/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND The American College of Surgeons Committee on Trauma (ACS-CoT) mandated that trauma centers have mental health screening and referral protocols in place by 2023. This study compares the Injured Trauma Survivor Screen (ITSS) and the Automated Electronic Medical Record (EMR) Screen to assess their performance in predicting risk for posttraumatic stress disorder (PTSD) within the same sample of trauma patients to inform trauma centers' decision when selecting a tool to best fit their current clinical practice. METHODS This was a secondary analysis of three prospective cohort studies of traumatically injured patients (N = 255). The ITSS and Automated EMR Screen were compared using receiver operating characteristic curves to predict risk of subsequent PTSD development. PTSD diagnosis at 6-month follow-up was assessed using the Clinician Administered PTSD Scale for DSM-5. RESULTS Just over half the sample screened positive on the ITSS (57.7%), while 67.8% screened positive on the Automated EMR Screen. The area under the curve (AUC) for the two screens was not significantly different (ITSS AUC = 0.745 versus Automated EMR Screen AUC = 0.694, p = 0.21), similar performance in PTSD risk predication within the same general trauma population. The ITSS and Automated EMR Screen had similar sensitivities (86.5%, 89.2%), and specificities (52.5%, 40.9%) respectively at their recommended cut-off points. CONCLUSION Both screens are psychometrically comparable. Therefore, trauma centers considering screening tools for PTSD risk to comply with the ACS-CoT 2023 mandate should consider their local resources and patient population. Regardless of screen selection, screening must be accompanied by a referral process to address the identified risk.
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Affiliation(s)
- Amber Brandolino
- Data Analytics & Informatics, Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, United States; Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Elise A Biesboer
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Morgan Leissring
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Rachel Weber
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Sydney Timmer-Murillo
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Terri A deRoon-Cassini
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Mary E Schroeder
- Division of Trauma & Acute Care Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.
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Mauck MC, Zhao Y, Goetzinger AM, Tungate AS, Spencer AB, Lal A, Barton CE, Beaudoin F, McLean SA. Incidence of persistent opioid use following traumatic injury. Reg Anesth Pain Med 2024; 49:79-86. [PMID: 37364919 DOI: 10.1136/rapm-2022-103662] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/11/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION Major traumatic injuries are a known risk factor for persistent opioid use, but data describing the relationship between specific traumatic injuries and opioid use is lacking. METHODS We used insurance claims data from January 1, 2001 to December 31, 2020 to estimate the incidence of new persistent opioid use in three hospitalized trauma populations: individuals hospitalized after burn injury (3809, 1504 of whom required tissue grafting), individuals hospitalized after motor vehicle collision (MVC; 9041), and individuals hospitalized after orthopedic injury (47, 637). New persistent opioid use was defined as receipt of ≥1 opioid prescriptions 90-180 days following injury in an individual with no opioid prescriptions during the year prior to injury. RESULTS New persistent opioid use was observed in 12% (267/2305) of individuals hospitalized after burn injury with no grafting, and 12% (176/1504) of burn injury patients requiring tissue grafting. In addition, new persistent opioid use was observed in 16% (1454/9041) of individuals hospitalized after MVC, and 20% (9455/47, 637) of individuals hospitalized after orthopedic trauma. In comparison, rates of persistent opioid use in all trauma cohorts (19%, 11, 352/60, 487) were greater than the rates of persistent opioid use in both non-traumatic major surgery (13%) and non-traumatic minor surgery (9%). CONCLUSIONS These data demonstrate that new persistent opioid use frequently occurs in these common hospitalized trauma populations. Improved interventions to reduce persistent pain and opioid use in patients hospitalized after these and other traumas are needed.
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Affiliation(s)
- Matthew C Mauck
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Ying Zhao
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Amy M Goetzinger
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Andrew S Tungate
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Alex B Spencer
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Asim Lal
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Chloe E Barton
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Anesthesiology, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Francesca Beaudoin
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| | - Samuel A McLean
- Institute for Trauma Recovery, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Emergency Medicine, The University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Davidson TM, Espeleta HC, Ridings LE, Witcraft S, Bravoco O, Higgins K, Houchins R, Kitchens D, Manning B, Jones S, Crookes B, Hanson R, Ruggiero KJ. Implementation of a Stepped Care Program to Address Emotional Recovery among Traumatic Injury Patients. J Am Coll Surg 2023; 237:810-825. [PMID: 37815166 PMCID: PMC10914157 DOI: 10.1097/xcs.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
BACKGROUND Annually, over 600,000 adults served in US trauma centers (≥20%) develop posttraumatic stress disorder (PTSD) and/or depression in the first year after injury. American College of Surgeons guidelines include screening and addressing mental health recovery in trauma centers. Yet, many trauma centers do not monitor and address mental health recovery, and it is a priority to learn how to implement evidence-informed mental health programs in trauma centers. STUDY DESIGN This report describes our application of the Exploration, Preparation, Implementation, Sustainment model to implement the Trauma Resilience and Recovery Program (TRRP) in 3 Level I and II trauma centers to address patients' mental health needs. TRRP is a scalable and sustainable stepped model of care-one of the few in the US-that provides early intervention and direct services after traumatic injury. RESULTS Trauma centers are well positioned to accelerate patients' mental health recovery via early identification, education, screening, and referrals to mental health agencies that provide best-practice care. We found that TRRP was acceptable to the 3 partnering trauma centers we studied. Early engagement of patient, provider, and hospital administration stakeholders enhanced buy-in during the early stages of the implementation process and promoted sustainability. Active processes to support monitoring, evaluation, and adaptation were critical. CONCLUSIONS Our work demonstrates the feasibility of implementing and adapting TRRP, a cost-efficient and sustainable stepped care intervention, in Level I and II trauma centers. Several factors should be carefully considered by trauma centers seeking to integrate behavioral health interventions into their trauma program.
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Affiliation(s)
- Tatiana M Davidson
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Hannah C Espeleta
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Leigh E Ridings
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Sara Witcraft
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Olivia Bravoco
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Kristen Higgins
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Rachel Houchins
- Prisma Health Midlands, Level I Trauma Center, Columbia, SC (Houchins)
| | - Debra Kitchens
- Prisma Health Upstate, Level I Trauma Center, Greeneville, SC (Kitchens, Manning)
| | - Benjamin Manning
- Prisma Health Upstate, Level I Trauma Center, Greeneville, SC (Kitchens, Manning)
| | - Seon Jones
- Trident Medical Center, Level II Trauma Center, Charleston, SC (Jones)
| | - Bruce Crookes
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Rochelle Hanson
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Kenneth J Ruggiero
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
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Turner E, Robinson DM, Roaten K. Psychological Issues. Phys Med Rehabil Clin N Am 2023; 34:849-866. [PMID: 37806702 DOI: 10.1016/j.pmr.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Psychological distress is common following a burn injury, and many burn survivors have pre-morbid psychiatric illnesses including mood and trauma-related disorders, and substance and alcohol use. This article is intended to be used by all interdisciplinary health care team members to improve the identification and treatment of common psychological concerns experienced by survivors and is organized to follow the general recovery timeline.
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Affiliation(s)
- Emma Turner
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Diana M Robinson
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
| | - Kimberly Roaten
- The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Suite CS6.104B, Dallas, TX 75390, USA.
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Brier ZMF, Hidalgo JE, Espeleta HC, Davidson T, Ruggiero KJ, Price M. Assessment of Traumatic Stress Symptoms During the Acute Posttrauma Period. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2023; 21:239-246. [PMID: 37404969 PMCID: PMC10316216 DOI: 10.1176/appi.focus.20230001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
A substantial majority of adults in the United States will experience a potentially traumatic event (PTE) in their lifetime. A considerable proportion of those individuals will go on to develop posttraumatic stress disorder (PTSD). Distinguishing between those who will develop PTSD and those who will recover, however, remains as a challenge to the field. Recent work has pointed to the increased potential of identifying individuals at greatest risk for PTSD through repeated assessment during the acute posttrauma period, the 30-day period after the PTE. Obtaining the necessary data during this period, however, has proven to be a challenge. Technological innovations such as personal mobile devices and wearable passive sensors have given the field new tools to capture nuanced in vivo changes indicative of recovery or nonrecovery. Despite their potential, there are numerous points for clinicians and research teams to consider when implementing these technologies into acute posttrauma care. The limitations of this work and considerations for future research in the use of technology during the acute posttrauma period are discussed.
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Affiliation(s)
- Zoe M F Brier
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Johanna E Hidalgo
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Hannah C Espeleta
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Tatiana Davidson
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Kenneth J Ruggiero
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington (Brier, Hidalgo, Price); Department of Psychiatry and Behavioral Sciences (Brier) and College of Nursing (Espeleta, Davidson, Ruggiero), Medical University of South Carolina, Charleston
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7
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Stevens SK, Timmer-Murillo SC, Tomas CW, Boals A, Larson CL, deRoon-Cassini T, Larsen SE. Event centrality and posttraumatic stress symptoms after traumatic injury: A longitudinal investigation. J Trauma Stress 2022; 35:1734-1743. [PMID: 36104984 DOI: 10.1002/jts.22877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/14/2022] [Accepted: 07/25/2022] [Indexed: 12/24/2022]
Abstract
The development of posttraumatic stress symptoms (PTSS) can occur following a traumatic injury, which may include an increase in negative cognitions. One cognitive construct shown to be associated with the development of PTSS is event centrality, or the degree to which an individual views a traumatic experience as central to their life story. Although cross-sectional work has demonstrated a robust connection between event centrality and PTSS, the directionality of this association remains unclear. Most previous work has investigated centrality as a predictor of PTSS, although one recent study suggests that PTSS may, in fact, predict event centrality. The current longitudinal study enrolled adult civilian participants (N = 191) from a Level 1 trauma center following a traumatic injury and assessed both event centrality and PTSS at three points posttrauma (3, 12, and 18 months). A time-constrained random intercept cross-lagged panel analysis showed that PTSS predicted event centrality over the 18-month follow-up period, B = 0.16, p = .021, but event centrality did not predict PTSS, B = -0.27, p = .340. These findings suggest that the development of PTSS following trauma exposure may lead to the perception of the traumatic event as central to an individual's story over time. Further longitudinal research is necessary to determine what variables may influence the connection between PTSS and event centrality.
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Affiliation(s)
- Sarah K Stevens
- Department of Psychological Science, University of California-Irvine, Irvine, California, USA
| | - Sydney C Timmer-Murillo
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Carissa W Tomas
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adriel Boals
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | - Christine L Larson
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Terri deRoon-Cassini
- Department of Surgery, Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Sadie E Larsen
- Department of Psychiatry, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Milwaukee VA Medical Center, Milwaukee, Wisconsin, USA
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Kishawi SK, Badrinathan A, Thai AP, Benuska SE, Breslin MA, Hendrickson SB, Ho VP. Are trauma surgical societies adequately addressing mental health after injury? Surgery 2022; 172:1549-1554. [PMID: 35981920 PMCID: PMC9942601 DOI: 10.1016/j.surg.2022.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/11/2022] [Accepted: 06/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Survivors of physical trauma, their home caregivers, and their medical providers all have an increased risk of developing psychological distress and trauma-related psychiatric disease. The purpose of this study was to describe the frequency and change over time of trauma society research presentations regarding mental health to identify opportunities for growth. METHODS Archives from 2018 to 2020 from the American Association for the Surgery of Trauma, the Eastern Association for the Surgery of Trauma, and the Western Trauma Association were reviewed. The studies that measured mental illness, psychosocial distress, and other psychosocial factors were assessed: for (1) the use of patient-reported outcome measures ; (2) the association of psychosocial variables with outcomes; and (3) the interventions investigated. Change over time was assessed using χ2 analysis. RESULTS Of 1,239 abstracts, 57 (4.6%) addressed at least 1 mental health-related factor. Mental health was more frequently studied over time (2018 [3.2%]; 2019 [3.5%]; 2020 [7.7%]; P = .003). The most frequently measured factors were post-traumatic stress disorder, quality of life, general mental health, and depression. Seventeen (29.8%) abstracts addressed substance abuse, most commonly opioid abuse. Seven (12.3%) abstracts measured mental health in caregivers or medical providers. Patient-reported outcome measures were used in 32 studies (56.1%). Two-thirds of studies reported findings suggesting that mental illness impairs trauma-related outcomes. Only 5 (8.8%) investigated interventions designed to reduce adverse outcomes. CONCLUSION Although academic discussion of mental health after trauma increased from 2018 to 2020, the topic remains a limited component of annual programs, patient-reported outcome measures remain underutilized, and intervention studies are rare.
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Affiliation(s)
- Sami K Kishawi
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio; Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University, School of Medicine, Cleveland, Ohio. http://www.twitter.com/skkishawi
| | - Avanti Badrinathan
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio; Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Anthony P Thai
- Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - Sarah E Benuska
- Department of Psychiatry, MetroHealth Medical Center, Cleveland, Ohio
| | - Mary A Breslin
- Institute for H.O.P.E.(TM), Center for Health Resilience, The MetroHealth System, Cleveland, Ohio. http://www.twitter.com/MaryA_Breslin
| | - Sarah B Hendrickson
- Institute for H.O.P.E.(TM), Center for Health Resilience, The MetroHealth System, Cleveland, Ohio; Department of Counselor Education and Supervision, Ohio University, Athens, Ohio. http://www.twitter.com/SHendricksonCLE
| | - Vanessa P Ho
- Department of Surgery, Division of Trauma Surgery, Acute Care Surgery, Critical Care, and Burns, MetroHealth Medical Center, Cleveland, Ohio; Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio.
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Trevino CM, Shorey RC, Bergner C, Brandolino A, deRoon-Cassini T, France CR. Association of Gender, Race, Mechanism of Injury on Alcohol Use, Posttraumatic Stress Disorder, and Depression in Trauma. J Trauma Nurs 2022; 29:228-234. [DOI: 10.1097/jtn.0000000000000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Screening tools for predicting posttraumatic stress disorder in acutely injured adult trauma patients: A systematic review. J Trauma Acute Care Surg 2022; 92:e115-e126. [PMID: 34991124 DOI: 10.1097/ta.0000000000003524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adult trauma patients are at risk of developing posttraumatic stress disorder (PTSD). Early intervention reduces the development of PTSD, but few trauma patients seek and obtain care. Valid and reliable screening tools are needed to identify patients at risk of developing PTSD. The objective of this review is to identify existing screening tools and evaluate their accuracy for predicting PTSD outcomes. METHODS PubMed, PsychInfo, and ClinicalTrials.gov were searched for studies evaluating the predictive accuracy of PTSD screening tools among traumatically injured adult civilians. Eligible studies assessed patients during acute hospitalization and at least 1 month following injury to measure PTSD outcome. Eligible outcomes included measures of predictive accuracy, such as sensitivity and specificity. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to assess the risk of bias of each study, and the strength of evidence was assessed following the Agency for Healthcare Research and Quality guidelines. RESULTS Forty-nine studies were included evaluating the predictive accuracy of 38 screening tools. Most tools were assessed in a single study. Questionnaire-style tools had more favorable predictive ability than diagnostic interview assessments. The Injured Trauma Survivor Screen, Posttraumatic Adjustment Screen, the PTSD Checklist for DSM-5, and the Richmond et al. tool demonstrated the most favorable predictive accuracy, with high sensitivity (75-100%) and specificity (67-94%). Common sources of bias were selection bias due to high attrition rate and using nondiagnostic tools to assess PTSD symptoms at follow-up. CONCLUSION Although sensitivity and specificity of PTSD predictive tools varied widely, several emerged with favorable predictive accuracy. Further research is needed to define the ability of screening and intervention to prevent PTSD in injured trauma survivors. The results of this review can inform screening tool options for screening programs and future intervention studies. LEVEL OF EVIDENCE Systematic review, level III.
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11
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Traumatic Stress and Depression Risk Screening at an ACS Verified Trauma Center. J Trauma Nurs 2022; 29:142-151. [PMID: 35536343 DOI: 10.1097/jtn.0000000000000640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Physiological trauma that requires admission to an emergency department may result in psychological distress. As many as 20%-40% of civilians who experience trauma develop traumatic stress disorders and depression postinjury. Yet, less than 10% of trauma centers implement screening for traumatic stress and depression risk. OBJECTIVE This project aimed to develop, implement, and evaluate a traumatic stress and depression risk screening policy. METHODS Twelve trauma advanced practice providers implemented the newly developed traumatic stress and depression risk screening policy at an American College of Surgeons verified Level II trauma center. Trauma patients admitted for greater than 24 hr, 14 years of age or older, with a Glasgow Coma Scale score greater than 13 were eligible for screening using the Injured Trauma Survivor Screen. RESULTS During the 6-week data collection period, 114 trauma patients presented to the emergency department. Of those, 82 (72%) met inclusion criteria, 77 (94%) eligible trauma patients were screened, and seven (9%) patients screened positive. Patients not eligible for screening were discharged within 24 hr or were too confused to answer questions. An evaluation survey revealed that the advanced practice providers thought that the screening policy was easy to use, feasible, not very time-consuming, and should be continued in the future. CONCLUSION This project demonstrated the ease and effectiveness of implementing a traumatic stress and depression risk screening policy and that only minor changes are needed to make it sustainable.
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Timmer-Murillo SC, Schramm A, deRoon-Cassini TA. Life threat during assaultive trauma: Critical posttraumatic stress disorder risk factors for injured patients. J Trauma Acute Care Surg 2022; 92:848-854. [PMID: 35468115 PMCID: PMC9181289 DOI: 10.1097/ta.0000000000003543] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rates of posttraumatic stress disorder (PTSD) among injury survivors are higher relative to the general population, supporting the need to identify those most at risk for PTSD following injury given negative impact of PTSD on recovery. Perceived life threat and assaultive trauma are consistent risk factors for subsequent PTSD development, although less work has explored them in combination. The current study evaluated whether trauma type (assaultive vs. nonassaultive) and perceived life threat, together, led to greater PTSD symptoms 1 month and 6 months postinjury. METHODS Participants included adult injured trauma survivors admitted to a level 1 trauma center. While hospitalized, perceived life threat during trauma was assessed and mechanism of injury was collected via record review and was collapsed into two categories: assaultive and nonassaultive. The Clinician-Administered PTSD Scale (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) was administered at 1 month (N = 137) and 6 months (N = 220) after injury. RESULTS The four symptoms clusters of PTSD (intrusions, avoidance, hyperarousal, and negative mood/cognitions) were examined using four 2 (time) × 2 (life threat) × 2 (trauma type) mixed methods analyses of variance to assess differences based on risk factors and time. Results showed significant interaction effects of life threat, trauma type, and time for intrusive symptoms and avoidance symptoms. Individuals with life threat during assaultive traumas maintained heightened intrusive symptoms across time and increased avoidance at 6 months. On the other hand, participants with either life threat or assaultive traumas had decreased symptoms at 6 months. CONCLUSION Experiencing assaultive trauma and life threat led to greater symptoms of PTSD. Individuals with assaultive traumas who experienced life threat may represent a specific at-risk group following injury. Avoidance can protract functional impairment and impede access to care, negatively impacting recovery. This study highlights a need to assess for these peritrauma factors during hospitalization and supports early intervention targeting avoidance and intrusive symptoms in this group. LEVEL OF EVIDENCE Prognostic/Epidemiologic, Level IV.
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Affiliation(s)
- Sydney C Timmer-Murillo
- From the Division of Trauma and Acute Care Surgery, Medical College of Wisconsin, Wauwatosa, Wisconsin
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Kumodzi T, Kassam-Adams N, Vargas L, Reilly PM, Richmond TS. Comparison of two screeners predicting the future development of depression and posttraumatic stress disorder in Black men after serious injury. Injury 2022; 53:1678-1683. [PMID: 35042600 PMCID: PMC9086140 DOI: 10.1016/j.injury.2022.01.016] [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] [Received: 09/12/2021] [Revised: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 02/02/2023]
Abstract
Background To assess the predictive performance of two established, short clinical screeners in predicting the future development of post-injury depression and PTSD. Methods This was a prospective, cohort design with a 3-month follow-up. Black adult male trauma patients were enrolled at an urban, Level 1 trauma center. The Penn Richmond Screener and the Posttraumatic Adjustment Scale (PAS) were collected in-hospital. Participants were categorized as depressed using the Quick Inventory of Depressive Symptoms-Self Report and as positive for PTSD using the PTSD Check List - 5 (PCL-5) at 3-months post-discharge. Sensitivity, specificity, PPV and NPV of each screener were calculated. We used receiver operating curve (ROC) analyses to calculate the area under the curve (AUC) with 95% CI to assess predictive performance of each screener. Results A cohort of 623 hospitalized, injured Black men were enrolled during acute hospitalization. 503 participants (80.6%) were retained at 3-months and formed the analytic sample. Mean age was 36.8 years (SD 15.4), 53.1% of injuries were intentional; median injury severity score was 9. At 3 months, 35.3% had moderate to severe depression, 32.7% had significant PTSD symptoms, and 22.4% met criteria for both depression and PTSD. Penn Richmond Screener: sensitivity 0.68, specificity 0.56, and AUC 0.62 for PTSD, and sensitivity 0.64, specificity 0.63, and AUC 0.64 for depression. PAS: sensitivity 0.59, specificity 0.73, and AUC 0.66 for PTSD, and sensitivity 0.75, specificity 0.49, and AUC 0.62 for depression. Conclusions This study validated the performance of both screeners within the same population, allowing a direct comparison. Two predictive screeners, developed through different methods and in different countries, showed comparable predictive ability. These findings indicate that risk markers for adverse psychological consequences of traumatic injury share some core similarities across populations and countries.
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Affiliation(s)
- Trina Kumodzi
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, 418 Curie Blvd. Fagin Hall, Philadelphia, PA 19104 United States; Penn Injury Science Center, University of Pennsylvania, 418 Curie Blvd. Fagin Hall, Philadelphia, PA 19104 United States; Firearm Injury among Children and Teens Consortium, University of Michigan North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI 48109, United States.
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, 13th Floor Philadelphia, PA 19146, United States; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania 2716 South Street, 13th Floor Philadelphia, PA 19146, United States.
| | - Laura Vargas
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, 418 Curie Blvd. Fagin Hall, Philadelphia, PA 19104 United States; Penn Injury Science Center, University of Pennsylvania, 418 Curie Blvd. Fagin Hall, Philadelphia, PA 19104 United States.
| | - Patrick M Reilly
- Penn Injury Science Center, University of Pennsylvania, 418 Curie Blvd. Fagin Hall, Philadelphia, PA 19104 United States; Department of Surgery, Perelman School of Medicine, University of Pennsylvania 3440 Market Street, Suite 101 Philadelphia, PA 19104, United States.
| | - Therese S Richmond
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, 418 Curie Blvd. Fagin Hall, Philadelphia, PA 19104 United States; Penn Injury Science Center, University of Pennsylvania, 418 Curie Blvd. Fagin Hall, Philadelphia, PA 19104 United States.
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"Did You Think You Would Die?": Fear of Death and Its Relationship to the Development of Posttraumatic Stress Disorder After Traumatic Injury. J Am Acad Orthop Surg 2022; 30:e272-e278. [PMID: 34669650 DOI: 10.5435/jaaos-d-20-01438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 09/12/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Patient-specific factors may influence posttraumatic stress disorder (PTSD) development and warrant further examination. This study investigates potential association between patient-reported fear of death at the time of injury and development of PTSD. METHODS Over 35 months, 250 patients were screened for PTSD at their first posthospitalization clinic visit and were asked "Did you think you were going to die from this injury?" (yes or no). PTSD screening was conducted using the PTSD checklist for DSM-5 questionnaire. A score ≥33 was considered positive for PTSD, and patients were offered ancillary psychiatric services. Retrospectively, medical records were reviewed for baseline demographics and injury information. RESULTS Forty-three patients (17%) indicated a fear of death. The mean age was 46 years, with patients who feared death being younger (36 versus 48, P < 0.001), and 62% were male. The most common mechanisms of injury were motor vehicle or motorcycle collisions (30%) and ground-level falls (21%). Gunshot wounds were more common among patients who feared death from trauma (44% versus 7%, P < 0.001). PTSD questionnaires were completed a median of 26 days after injury, with an average score of 12.6. PTSD scores were higher for patients with fear of death (32.7 versus 8.5), and these patients required more acute interventions (47% versus 7%), both P < 0.001. After multivariable logistic regression, patients who thought that they would die from their trauma had >13 times higher odds of developing PTSD (odds ratios: 13.42, P < 0.0001). Apart from positive psychiatric history (OR: 5.46, P = 0.001), no factors (ie, age, sex, mechanism, or any injury or treatment characteristic) were predictive of positive PTSD scores on regression. DICUSSION Patients who reported fear of death at the time of injury were 13 times more likely to develop PTSD. Simply asking patients whether they thought that they would die at the time of injury may prospectively identify PTSD risk. LEVEL OF EVIDENCE Prognostic Level II.
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Hunt JC, Herrera-Hernandez E, Brandolino A, Jazinski-Chambers K, Maher K, Jackson B, Smith RN, Lape D, Cook M, Bergner C, Schramm AT, Brasel KJ, de Moya MA, deRoon-Cassini TA. Validation of the Injured Trauma Survivor Screen: An American Association for the Surgery of Trauma multi-institutional trial. J Trauma Acute Care Surg 2021; 90:797-806. [PMID: 33797497 DOI: 10.1097/ta.0000000000003079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychological distress is common following a traumatic injury event. The Injured Trauma Survivor Screen (ITSS) was developed at a level 1 trauma center to assess for posttraumatic stress disorder (PTSD) and major depressive episode (MDE) following admission for a traumatic injury. The ITSS sensitivity and specificity were analyzed 1 to 3 and 6 to 9 months postinjury to test the validity across trauma centers. METHOD Four level 1 trauma centers from the East, Midwest, South, and West in the United States recruited 375 eligible adult inpatients (excluded participants included those with moderate or severe traumatic brain injury, whose injury was self-inflicted, were noncommunicative, or were non-English speaking). Baseline sample (White/Caucasian, 63.2%; male, 62.4%; mean (SD) age, 45 (17.11) years; injured by motor vehicle collision, 42.4%) measurements were conducted during index hospitalization. At first follow-up, 69.6% (n = 261) were retained; at second follow-up, 61.3% (n = 230) were retained. Measurements included the ITSS, PTSD Checklist for DSM-5, Center for Epidemiologic Studies Depression Scale-Revised, and Clinician-Administered PTSD Scaled for DSM 5. RESULTS At follow-up 1, the ITSS PTSD subscale had a sensitivity of 75% and specificity of 78.8%, and the MDE subscale had a sensitivity of 80.4% and specificity of 65.6%. At follow-up 2, the PTSD subscale had a sensitivity of 72.7% and specificity of 83.1%, and the MDE subscale had a sensitivity of 76.1% and specificity of 68.3%. A combined risk group using two symptom based measures administered at baseline produced increased specificity. CONCLUSION The nine-item ITSS continues to be an efficient and effective risk screen for PTSD and MDE following traumatic injury requiring hospitalization. This multi-institutional validation study creates a solid foundation for further exploration of the generalizability of this screen's psychometric properties in distinct populations. LEVEL OF EVIDENCE Prognostic study, level III.
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Affiliation(s)
- Joshua C Hunt
- From the Mental Health Division (J.C.H.), Milwaukee VA Medical Center, Milwaukee, Wisconsin; Division of Trauma and Acute Care Surgery, Department of Surgery (E.H.-H., A.B., K.J.-C., A.T.S., M.A.d.M., T.A.d.R.-C.), Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Psychiatry (K.M., B.J.), Virginia Commonwealth University, Richmond, Virginia; Department of Surgery (R.N.S.), School of Medicine, Emory University, Atlanta, Georgia; Department of Surgery (D.L., M.C., K.J.B.), Oregon Health & Science University, Portland, Oregon; and Comprehensive Injury Center (C.B.), Medical College of Wisconsin, Milwaukee, Wisconsin
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Rahmat S, Velez J, Farooqi M, Smiley A, Prabhakaran K, Rhee P, Khan M, Dornbush R, Ferrando S, Smolin Y. Post-traumatic stress disorder can be predicted in hospitalized blunt trauma patients using a simple screening tool. Trauma Surg Acute Care Open 2021; 6:e000623. [PMID: 33880413 PMCID: PMC7993304 DOI: 10.1136/tsaco-2020-000623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) has debilitating psychiatric and medical consequences. The purpose of this study was to identify whether PTSD diagnosis and PTSD symptom scale score (PTSD severity) could be predicted by assessing peritraumatic experiences using a single question or screening tools at different time points in patients hospitalized after admission to the hospital after significant physical trauma, but with stable vitals (level II trauma). METHODS Patients completed the 'initial question' and the National Stressful Events Survey Acute Stress Disorder Scale (NSESSS) at 3 days to 5 days after trauma (NSESSS-1). The same scale was administered 2 weeks to 4 weeks after trauma (NSESSS-2). The Posttraumatic Stress Disorder Symptoms Scale Interview for DSM-5 (PSSI-5) was administered 2 months after trauma. PTSD diagnosis and PTSD severity were extracted from the PSSI-5. Linear multivariate regression analyses were used to establish whether scores for NSESSS-1 or NSESSS-2 predicted PTSD diagnosis/PTSD severity. Non-linear multivariate regression analyses were performed to better understand the relationship between NSESSS-1/NSESSS-2 and PTSD diagnosis/PTSD severity. RESULTS A single question assessing the experience of fear, helplessness, or horror was not an effective tool for determining the diagnosis of PTSD (p=0.114) but can be a predictor of PTSD severity (p=0.039). We demonstrate that administering the NSESSS after either 3 days to 5 days (p=0.008, p<0.001) or 2 weeks to 4 weeks (p=0.039; p<0.001) can predict the diagnosis of PTSD and PTSD severity. Scoring an NSESSS above 14/28 (50%) increases the chance of experiencing a higher PTSD severity substantially and linearly. DISCUSSION Our initial question was not an effective predictor of PTSD diagnosis. However, using the NSESSS at both 3 days to 5 days and 2 weeks to 4 weeks after trauma is an effective method for predicting PTSD diagnosis and PTSD severity. Additionally, we show that patients who score higher than 14 on the NSESSS for acute stress symptoms may need closer follow-up. LEVEL OF EVIDENCE Level III, prognostic.
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Affiliation(s)
- Saad Rahmat
- Department of Psychiatry and Behavioral Sciences, Westchester Medical Center, Valahlla, NY, USA
| | - Jessica Velez
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Muhammad Farooqi
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Abbas Smiley
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Kartik Prabhakaran
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Peter Rhee
- Department of Surgery, Westchester Medical Center Health Network, Valhalla, New York, USA
- Department of Surgery, New York Medical College, Valhalla, New York, USA
| | - Maria Khan
- New York Medical College, St. Vincent's Medical Center, Yonkers, New York, USA
| | - Rhea Dornbush
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Stephen Ferrando
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
| | - Yvette Smolin
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, New York, USA
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Larsen SE, Hunt JC, Geier T, Heyrman K, Schumann N, Brandolino A, Timmer-Murillo S, Bergner C, Larson C, deRoon-Cassini TA. A Randomized Trial of Modified Prolonged Exposure to Prevent the Development of Posttraumatic Stress Disorder in Patients Hospitalized With Traumatic Injuries. J Trauma Stress 2021; 34:104-115. [PMID: 33269808 DOI: 10.1002/jts.22580] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 04/13/2020] [Accepted: 05/05/2020] [Indexed: 11/11/2022]
Abstract
Individuals who require hospitalization after traumatic injuries are at increased risk for developing posttraumatic stress disorder (PTSD); however, few early behavioral interventions have been effective at preventing PTSD within this population. The aim of this pilot study was to assess the feasibility and effectiveness of modified prolonged exposure therapy (mPE) to prevent PTSD and depression symptoms among patients hospitalized after a DSM-5 single-incident trauma. Hospitalized patients were eligible if they screened positive for PTSD risk. Participants (N = 74) were randomly assigned in a parallel-groups design to receive mPE (n = 38) or standard of care treatment (SoC; n = 36) while admitted to the hospital after a traumatic injury. Individuals randomized to the intervention condition received one (42.1%), two (36.8%), or three sessions (15.8%) of mPE, mainly depending on length of stay. There were no significant differences between groups regarding PTSD or depression severity at 1- or 3-months posttrauma, except for more PTSD diagnoses in the intervention group after 1 month, ϕ = -.326. Intervention differences were nonsignificant when we took baseline PTSD symptoms and the nonindependence of the repeated measurements within the data into account. No adverse events were reported. Overall, mPE was no more effective than SoC for hospitalized, traumatic injury survivors with a high PTSD risk. The results may point to a need for a stepped-care approach, where intervention protocols focus on first briefly treating individuals who are actively exhibiting acute stress reactions, then extensively treating those whose symptoms do not decrease over time.
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Affiliation(s)
- Sadie E Larsen
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Wauwatosa, Wisconsin, USA.,Milwaukee VA Medical Center, Milwaukee, Wisconsin, USA
| | - Joshua C Hunt
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Tim Geier
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katelyn Heyrman
- Department of Educational Psychology, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Nicholas Schumann
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amber Brandolino
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Carisa Bergner
- Medical College of Wisconsin, Comprehensive Injury Center, Milwaukee, WI, USA
| | - Christine Larson
- Department of Psychology, University of Wisconsin Milwaukee, Milwaukee, Wisconsin, USA
| | - Terri A deRoon-Cassini
- Department of Surgery, Division of Trauma & Critical Care, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Visser E, Den Oudsten BL, Traa MJ, Gosens T, De Vries J. Patients' experiences and wellbeing after injury: A focus group study. PLoS One 2021; 16:e0245198. [PMID: 33411828 PMCID: PMC7790403 DOI: 10.1371/journal.pone.0245198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 12/27/2020] [Indexed: 01/07/2023] Open
Abstract
Background Injury can have physical, psychological and social consequences. It is unclear which factors have an impact on patients’ wellbeing after injury. This study aimed to explore, using focus groups, patients’ experiences and wellbeing after injury and which factors, impede or facilitate patients’ wellbeing. Methods Trauma patients, treated in the shock room of the Elisabeth-TweeSteden Hospital, the Netherlands, participated in focus groups. Purposive sampling was used. Exclusion criteria were younger than 18 years old, severe traumatic brain injury, dementia, and insufficient knowledge of the Dutch language. The interviews were recorded, transcribed verbatim, and analyzed using coding technique open, axial, and selective coding, based on phenomenological approach. Results Six focus groups (3 to 7 participants) were held before data saturation was reached. In total, 134 patients were invited, 28 (21%) agreed to participate (Median age: 59.5; min. 18 –max. 84). Main reasons to decline were fear that the discussion would be too confronting or patients experienced no problems regarding the trauma or treatment. Participants experienced difficulties on physical (no recovery to pre-trauma level), psychological (fear of dying or for permanent limitations, symptoms of posttraumatic stress disorder, cognitive dysfunction), social (impact on relatives and social support) wellbeing. These are impeding factors for recovery. However, good communication, especially clarity about the injury and expectations concerning recovery and future perspectives could help patients in surrendering to care. Patients felt less helpless when they knew what to expect. Conclusions This is the first study that explored patients’ experiences and wellbeing after injury. Patients reported that their injury had an impact on their physical, psychological, and social wellbeing up to 12 months after injury. Professionals with the knowledge of consequences after injury could improve their anticipation on patients’ need.
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Affiliation(s)
- Eva Visser
- Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
- * E-mail:
| | - Brenda Leontine Den Oudsten
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Marjan Johanna Traa
- Department of Medical Psychology; ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopaedics, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Tilburg, The Netherlands
| | - Jolanda De Vries
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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Pacella-LaBarbara M, Larsen SE, Jaramillo S, Suffoletto B, Callaway C. Event centrality following treatment for physical injury in the emergency department: Associations with posttraumatic outcomes. Gen Hosp Psychiatry 2020; 67:77-82. [PMID: 33065405 PMCID: PMC7722005 DOI: 10.1016/j.genhosppsych.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The relationship between event centrality (i.e., the degree to which a stressful event is integrated into one's identity) and acute posttraumatic outcomes after relatively minor physical injury is unknown. We examined pre-injury and Emergency Department (ED) predictors of event centrality at 6-weeks post-injury, and whether event centrality is uniquely associated with 6-week posttraumatic outcomes. METHODS In the EDs of two Level I trauma centers, 149 patients completed surveys regarding demographic, psychological and injury-related factors within 24 h post-injury; 84 patients (51% male) completed 6-week surveys of event centrality, posttraumatic stress symptoms (PTSS) and trauma-specific QOL (T-QoL). Data were analyzed using linear regression modeling. RESULTS At least 20% of patients agreed or strongly agreed that the injury changed their life. Hospitalization status and peritraumatic dissociation were significant predictors of event centrality at 6-weeks. After controlling for demographics, ED-related factors and pre-injury PTSS, event centrality was uniquely associated with PTSS (p < .001) and T-QOL (p < .001) at 6 weeks. CONCLUSION Over and above the effects of the injury itself, event centrality conveyed important information for posttraumatic outcomes at 6 weeks post-injury. The centrality scale is brief and feasible to administer; future work is needed to determine the predictive utility of event centrality on post-injury outcomes.
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Affiliation(s)
- Maria Pacella-LaBarbara
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
| | - Sadie E Larsen
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America.
| | - Stephany Jaramillo
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
| | - Brian Suffoletto
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
| | - Clifton Callaway
- Clement J Zablocki VA Medical Center, Department of Psychiatry, Medical College of Wisconsin, Behavioral Health Center, 1155 North Mayfair Road, Wauwatosa, WI 53226, United States of America
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Meneses E, Kinslow K, McKenney M, Elkbuli A. Post-Traumatic Stress Disorder in Adult and Pediatric Trauma Populations: A Literature Review. J Surg Res 2020; 259:357-362. [PMID: 33070994 DOI: 10.1016/j.jss.2020.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 01/30/2023]
Abstract
Each year, traumatic injuries affect 2.6 million adults in the United States leading to significant health problems. Although many sequelae stem directly from physical manifestations of one's sustained injuries, mental health may also be affected in the form of post-traumatic stress disorder (PTSD). PTSD can lead to decreased physical recovery, social functioning, and quality of life. Several screening tools such as the Injured Trauma Survivor Screen, PTSD CheckList, Primary Care PTSD, and Clinician-Administered PTSD Scale for DSM-5 have been used for initial PTSD screening of the trauma patient. Early screening is important as it serves as the first step in delivering the appropriate mental health care to those in need. Factors that increase the likelihood of developing PTSD include younger age, nonwhite ethnicity, and lower socioeconomic status. Current data on male or female predominance of PTSD in trauma populations is inconsistent. Cognitive behavioral therapy, hypnosis, and psychoeducation have been used to treat symptoms of PTSD. This review discusses the impact PTSD has on the trauma patient and the need for universal screening in this susceptible population. Ultimately, trauma centers should implement such universal screening protocols as to avoid absence, or undertreatment of PTSD, both of which having longstanding consequences.
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Affiliation(s)
- Evander Meneses
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Kyle Kinslow
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Mark McKenney
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida.
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Timmer-Murillo SC, Hunt JC, Geier T, Brasel KJ, deRoon-Cassini TA. Identification of risk for posttraumatic stress disorder symptom clusters early after trauma. J Health Psychol 2020; 26:2794-2800. [PMID: 32538162 DOI: 10.1177/1359105320934192] [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] [Indexed: 11/17/2022] Open
Abstract
The current study examined how the injured trauma survivor screen (ITSS), a hospital-administered screener of posttraumatic stress disorder (PTSD) and depression, differentially predicted PTSD symptom cluster severity. Participants from a Level 1 trauma center (n = 220) completed the ITSS while inpatient and PTSD symptoms were assessed one-month post discharge. Perceived life threat and intentionality of injury were key predictors of avoidance, re-experiencing, and hyperarousal symptom clusters. However, negative alterations in mood and cognition cluster seemed best predicted by mood and cognitive risk factors. Therefore, the ITSS provides utility in differentially predicting symptom clusters and treatment planning after traumatic injury.
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Maples-Keller JL, Post LM, Price M, Goodnight JM, Burton MS, Yasinski CW, Michopoulos V, Stevens JS, Hinrichs R, Rothbaum AO, Hudak L, Houry D, Jovanovic T, Ressler K, Rothbaum BO. Investigation of optimal dose of early intervention to prevent posttraumatic stress disorder: A multiarm randomized trial of one and three sessions of modified prolonged exposure. Depress Anxiety 2020; 37:429-437. [PMID: 32248637 PMCID: PMC7347250 DOI: 10.1002/da.23015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/04/2019] [Accepted: 01/03/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is linked to a specific event, providing the opportunity to intervene in the immediate aftermath of trauma to prevent the development of this disorder. A previous trial demonstrated that trauma survivors who received three sessions of modified prolonged exposure therapy demonstrated decreased PTSD and depression prospectively compared to assessment only. The present study investigated the optimal dosing of this early intervention to test one versus three sessions of exposure therapy in the immediate aftermath of trauma. METHODS Participants (n = 95) recruited from a Level 1 Trauma Center were randomly assigned in a 1.5:1.5:1 ratio in a parallel-group design to the three conditions: one-session exposure therapy, three-session exposure therapy, and assessment only. Follow-up assessments were conducted by study assessors blind to study condition. RESULTS Mixed-effects model results found no significant differences in PTSD or depression symptoms between the control condition and those who received one or three exposure therapy sessions across 1-12-month follow-up assessment. Results indicate that the intervention did not interfere with natural recovery. Receiver operating characteristic curve analyses on the screening measure used for study inclusion (Predicting PTSD Questionnaire; PPQ) in the larger sample from which the treatment sample was drawn (n = 481) found that the PPQ was a poor predictor of likely PTSD at all follow-up time points (Area under the curve's = 0.55-0.62). CONCLUSIONS This likely impacted study results as many participants demonstrated natural recovery. Recommendations for future early intervention research are reviewed, including strategies to identify more accurately those at risk for PTSD and oversampling more severe trauma types.
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Affiliation(s)
- Jessica L. Maples-Keller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Loren M. Post
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Matthew Price
- Department of Psychological Science, University of Vermont, Burlington, Vermont
| | - Jessica M. Goodnight
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Mark S. Burton
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Carly W. Yasinski
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia,Developmental and Cognitie Neuroscience, Yerkes National Primate Research Center, Atlanta, Georgia
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Alex O. Rothbaum
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio
| | - Lauren Hudak
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Debra Houry
- Division of Injury Prevention, National Center for Injury Control and Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
| | - Kerry Ressler
- Department of Psychiatry, Mclean Hospital, Harvard Medical School, Belmont, Massachusetts
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, Atlanta, Georgia
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Moodliar R, Russo J, Bedard-Gilligan M, Moloney K, Johnson P, Seo S, Vaziri N, Zatzick D. A Pragmatic Approach to Psychometric Comparisons between the DSM-IV and DSM-5 Posttraumatic Stress Disorder (PTSD) Checklists in Acutely Injured Trauma Patients. Psychiatry 2020; 83:390-401. [PMID: 32762319 PMCID: PMC7858198 DOI: 10.1080/00332747.2020.1762396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Prior investigations suggest the relative equivalence of the DSM-IV and DSM-5 versions of the Posttraumatic Stress Disorders (PTSD) Checklist, yet no investigations have assessed the psychometric properties of the scales in pragmatic trials of acutely injured trauma survivors. Method: DSM-IV and DSM-5 versions of the PTSD Checklist were included in follow-up interviews of physically injured patients enrolled longitudinally in a pragmatic clinical trial; pragmatic trials aim to efficiently implement research procedures to inform healthcare system policy changes. Psychometric comparisons of the DSM-IV, DSM-5, and a 20-item blended version of the scale included evaluations of internal consistency, correlational assessments, evaluation of item level agreements, and estimation of DSM-5 cutoffs that optimize electronic health record screening protocols. Results: 128 patients were included in the pragmatic psychometric study. Cronbach's alphas for the 3 versions of the PTSD Checklist ranged from 0.93 to 0.95. Correlations between the 3 scales ranged from 0.79 to 0.99. All 3 measures demonstrated excellent convergent and discriminant properties. Item level agreement ranged from 70-80%. For the DSM-5 and blended versions of the scale, a score of 30 and 24, respectively, best approximated the DSM-IV cutoff of ≥35 that had previously optimized PTSD detection in conjunction with EHR screening. Conclusions: Among injured trauma survivors, the psychometric performance of the DSM-IV PTSD Checklist with the addition of the 4 new DSM-5 PTSD Checklist items is nearly equivalent to the DSM-5 PTSD Checklist. The investigation also suggests that pragmatic psychometric methods can catalyze the rapid translation of research findings into real-world practice settings.
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Affiliation(s)
- Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA;,
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Michele Bedard-Gilligan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Peyton Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Sara Seo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Natalie Vaziri
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA;,Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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26
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Jaramillo S, Suffoletto B, Callaway C, Pacella-LaBarbara M. Early Screening for Posttraumatic Stress Disorder and Depression Among Injured Emergency Department Patients: A Feasibility Study. Acad Emerg Med 2019; 26:1232-1244. [PMID: 31179590 PMCID: PMC7294865 DOI: 10.1111/acem.13816] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 06/03/2019] [Accepted: 06/05/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few emergency departments (EDs) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive and brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks postinjury. METHODS In the EDs of two Level I trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and trauma-specific QOL (T-QoL). RESULTS Our retained sample at 6 weeks was 84 adults (51.2% male; mean ± SD age = 33 ± 11.88 years); 38% screened positive for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a positive ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92 to 15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20 to 7.74), respectively. Further, a positive ED screen for depression (p = 0.043, 95% CI = -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL. CONCLUSIONS These results suggest that it is feasible to identify patients at risk for postinjury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring.
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Affiliation(s)
- Stephany Jaramillo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian Suffoletto
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Clifton Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Maria Pacella-LaBarbara
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Giupponi G, Thoma H, Lamis D, Forte A, Pompili M, Kapfhammer HP. Posttraumatic stress reactions of underground drivers after suicides by jumping to arriving trains; feasibility of an early stepped care outpatient intervention. J Trauma Dissociation 2019; 20:495-510. [PMID: 30963791 DOI: 10.1080/15299732.2019.1597810] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Underground drivers face a considerable risk of running over suicide jumpers on the tracks during their career. These traumatic exposures may lead to major psychological sequelae. Methods: Within an outpatient setting, 50 drivers were consecutively enrolled in a prospective non-controlled trial. A low-intensity, stepped-care approach included: emergency care immediately after the critical accident, comprehensive assessment with a structured clinical interview using the following scales within three days: Composite International Diagnostic Interview (CIDI), Impact of Event Scale (IES), Screening for Somatoform Disorders (SOMS), and Cologne Trauma Inventory (KTI). Results: During a 2-year period, 50 subway drivers were exposed to 66 serious critical accidents (deaths: 39, severe injuries: 27). Rate of acute stress reactions was 48%; rate of acute stress disorders was 30%. Scores of IES and SOMS were significantly increased correspondingly. At 1-month follow-up, PTSD was diagnosed in 24 (ICD-10) and in 9 drivers (DSM-IV), respectively. Major depression (n = 15) and somatoform disorder (n = 10) were diagnosed as coexistent to PTSD. Acute stress reaction/acute stress disorder, IES- and SOMS-scores, and previous traumatic exposures during adulthood, but not during childhood, were significantly associated with the risk of PTSD. A majority of drivers (n = 43) succeeded in reaching complete symptomatic remission and returning to work again within a 6-month period. Seven drivers suffered from long-lasting posttraumatic symptoms causing severe social impairment. Conclusions: A low-intensity, outpatient stepped-care approach may provide support to traumatized underground drivers in their process of posttraumatic remission and recovery.
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Affiliation(s)
| | - Heike Thoma
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University , Munich , Germany
| | - Dorian Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine , Atlanta , Georgia , USA
| | - Alberto Forte
- Department of Neuroscience, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic, Medical University Graz , Graz , Austria
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McBain SA, Sexton KW, Palmer BE, Landes SJ. Barriers to and facilitators of a screening procedure for PTSD risk in a level I trauma center. Trauma Surg Acute Care Open 2019; 4:e000345. [PMID: 31467988 PMCID: PMC6699788 DOI: 10.1136/tsaco-2019-000345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 11/20/2022] Open
Abstract
Background Patients admitted to the hospital after an injury are at a greater risk for developing post-traumatic stress disorder (PTSD) due to the nature of the injury and the traumatic nature of necessary medical interventions. Many level I trauma centers have yet to implement screening protocols for PTSD risk. The goal of the study was to characterize the barriers to and facilitators of implementation of a screening procedure for PTSD risk in a level I trauma center. Methods We conducted semistructured qualitative interviews with multidisciplinary academic medical center stakeholders (N=8) including those with clinical, research, teaching, and administrative roles within an urban academic medical center’s Department of Surgery, Division of Acute Care Surgery. We analyzed the qualitative data using summative template analysis to abstract data related to participants’ opinions about implementation of a screener for PTSD. Results Participants’ general perception of screening for PTSD risk after injury was positive. Identified challenges to implementation included timing of screening, time burden, care coordination, addressing patients with traumatic brain injury or an altered mental status, and ensuring appropriate care after screening. Reported facilitators included existing psychosocial screening tools and protocols that would support inclusion of a PTSD screener, a patient-centered culture that would facilitate buy-in from providers, a guideline-driven culture, and a commitment to continuity of care. Conclusions This study offers concrete preliminary information on barriers to and facilitators of PTSD screening that can be used to inform planning of implementation efforts within a trauma center. Level of evidence Level V, qualitative.
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Affiliation(s)
- Sacha A McBain
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, Eugene J Towbin Healthcare Center, North Little Rock, Arkansas, USA
| | - Kevin W Sexton
- Department of Surgery, Division of Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brooke E Palmer
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Sara J Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, Eugene J Towbin Healthcare Center, North Little Rock, Arkansas, USA
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deRoon-Cassini TA, Hunt JC, Geier TJ, Warren AM, Ruggiero KJ, Scott K, George J, Halling M, Jurkovich G, Fakhry SM, Zatzick D, Brasel KJ. Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression. J Trauma Acute Care Surg 2019; 87:440-450. [PMID: 31348404 PMCID: PMC6668348 DOI: 10.1097/ta.0000000000002370] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Traumatic injury affects over 2.6 million U.S. adults annually and elevates risk for a number of negative health consequences. This includes substantial psychological harm, the most prominent being posttraumatic stress disorder (PTSD), with approximately 21% of traumatic injury survivors developing the disorder within the first year after injury. Posttraumatic stress disorder is associated with deficits in physical recovery, social functioning, and quality of life. Depression is diagnosed in approximately 6% in the year after injury and is also a predictor of poor quality of life. The American College of Surgeons Committee on Trauma suggests screening for and treatment of PTSD and depression, reflecting a growing awareness of the critical need to address patients' mental health needs after trauma. While some trauma centers have implemented screening and treatment or referral for treatment programs, the majority are evaluating how to best address this recommendation, and no standard approach for screening and treatment currently exists. Further, guidelines are not yet available with respect to resources that may be used to effectively screen and treat these disorders in trauma survivors, as well as who is going to bear the costs. The purpose of this review is: (1) to evaluate the current state of the literature regarding evidence-based screens for PTSD and depression in the hospitalized trauma patient and (2) summarize the literature to date regarding the treatments that have empirical support in treating PTSD and depression acutely after injury. This review also includes structural and funding information regarding existing postinjury mental health programs. Screening of injured patients and timely intervention to prevent or treat PTSD and depression could substantially improve health outcomes and improve quality of life for this high-risk population. LEVEL OF EVIDENCE: Review, level IV.
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Affiliation(s)
- Terri A deRoon-Cassini
- From the Division of Trauma and Acute Care Surgery, Department of Surgery (T. A. d-C., T. D., T.J.G., M.H.), Milwaukee, Wisconsin; Baylor University Medical Center (A.M.W.), Baylor Scott and White Medical Psychology Consultants, Dallas, Texas; Medical University of South Carolina (K.J.R.), Departments of Nursing and Psychiatry, Charleston, South Carolina; University of Florida College of Medicine-Jacksonville, Department of Surgery, Division of Acute Care Surgery, Critical Care, TraumaOne (K.S.), Jacksonville, Florida; Parkland Health and Hospital System (J.G.), Rees-Jones Trauma Center, Dallas, Texas; University of California Davis Health (G.J.), Department of Surgery, Sacramento, California; Reston Hospital Center (S.M.F.), Trauma Surgery, Reston, Virginia; University of Washington School of Medicine (D.Z.), Department of Psychiatry and Behavioral Sciences, Seattle, Washington; and Oregon Health and Science University (K.J.B.), Department of Surgery, Portland, Oregon
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Hung YW, Musci R, Tol W, Aketch S, Bachani AM. Longitudinal depressive and anxiety symptoms of adult injury patients in Kenya and their risk factors. Disabil Rehabil 2019; 42:3816-3824. [PMID: 31081392 DOI: 10.1080/09638288.2019.1610804] [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: 10/26/2022]
Abstract
Background: Injuries account for a significant proportion of the health and economic burden for populations in low- and middle-income countries. However, little is known about psychological distress trajectories amongst injury survivors in low- and middle-income countries.Methods: Adult injury patients (n = 644) admitted to Kenyatta National Hospital in Nairobi, Kenya, were enrolled and interviewed in the hospital, and at 1, 2-3, and 4-7 months after hospital discharge through phone to assess depressive and anxiety symptoms and level of disability. Growth mixture modeling was applied to identify latent trajectories of depressive and anxiety symptoms.Results: Elevated depressive and moderate-level anxiety symptoms (13%) and low depressive and anxiety symptoms (87%) trajectories were found between hospitalization and up to seven months after hospital discharge. Being female, prior trauma experience, longer hospitalization, worse self-rated health status while in the hospital, and lack of monetary assistance during hospitalization were associated with the elevated symptoms trajectory. The higher symptoms trajectory associated with higher disability levels after hospital discharge and significantly lower proportion of resuming daily activities and work.Conclusion: The persistence of elevated depressive symptoms and associated reduced functioning several months after physical injury underscores the importance of identifying populations at risk for preventive and early interventions.Implications for RehabilitationHealth providers following up with injury survivors should screen for depressive and anxiety symptomsSpecial attention to women and people with a potential traumatic exposure historyIncorporation of evidence-based culturally adapted psychosocial interventions in rehabilitation and outpatient clinics.
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Affiliation(s)
- Yuen W Hung
- Department of Health Sciences, Wilfred Laurier University, Waterloo, Canada
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Wietse Tol
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Abdulgafoor M Bachani
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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Six-month follow-up of the injured trauma survivor screen: Clinical implications and future directions. J Trauma Acute Care Surg 2019; 85:263-270. [PMID: 29672441 DOI: 10.1097/ta.0000000000001944] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The injured trauma survivor screen (ITSS) has been shown to predict posttraumatic stress disorder (PTSD) and depression risk at 1 month after traumatic injury. This study explored the ability of the ITSS to predict chronic distress after injury, as well as the impact of combining the ITSS with an additional screening measure. METHODS Patients were enrolled following admission to a Level I trauma center. Baseline measurements were collected during initial hospitalization, and follow-up measures were collected an average of 6.5 months after injury. Receiver operating characteristic (ROC) curve analyses were run to determine predictive accuracy, controlling for participants who had mental health intervention and for those who experienced additional potentially psychologically traumatic events since their injury event. RESULTS Utilizing a cut score of 2, the ITSS PTSD scale had a sensitivity of 85.42%, specificity of 67.35%, negative predictive value (NPV) of 91.9% and positive predictive value (PPV) of 51.4%. The combined PTSD risk group (risk positive on the baseline ITSS and the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) had a sensitivity of 72.92%, specificity of 81.63%, NPV of 88.2%, and PPV of 61.6%. Also using a cut score of 2, the ITSS Depression Scale had a sensitivity of 72.50%, specificity of 70.29%, NPV of 91.1%, and PPV of 37.9%. CONCLUSION The nine-item ITSS, which takes approximately 5 minutes to administer, is a stable screening tool for predicting those most at risk for PTSD and/or depression 6 months after admission to a Level I trauma center following traumatic injury. The combined PTSD risk group data provide evidence that symptom evaluation by a psychologist can improve specificity. These results further inform the recommendation of the American College of Surgeons Committee on Trauma regarding PTSD and depression screening in trauma centers. LEVEL OF EVIDENCE Prognostic study, level III.
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Ophuis RH, Olij BF, Polinder S, Haagsma JA. Prevalence of post-traumatic stress disorder, acute stress disorder and depression following violence related injury treated at the emergency department: a systematic review. BMC Psychiatry 2018; 18:311. [PMID: 30253782 PMCID: PMC6156976 DOI: 10.1186/s12888-018-1890-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 09/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In order to gain insight into the health impact of violence related injury, the psychological consequences should be taken into account. There has been uncertainty regarding the prevalence of posttraumatic stress disorder (PTSD), acute stress disorder (ASD), and depression among patients with violence related injury. An overview of prevalence rates may inform our understanding of both prognosis and recovery for these patients. Therefore, we aim to provide an overview of the published literature reporting the prevalence rates and trajectories of PTSD, ASD, and depression following violence related injury, and to assess the quality of the studies included. METHODS A systematic review was conducted in order to provide an overview of the published literature reporting the prevalence of PTSD, ASD and depression following violence related injury treated at the emergency department or hospital. The EMBASE, MEDLINE, Cochrane Central, PubMed, and PsycINFO databases were searched systematically. The quality of the included studies was assessed. RESULTS We included sixteen studies reporting the prevalence rates of PTSD, ASD, or depression. Clear prevalence trajectories could not be identified because the range of prevalence rates was diverse at each time point. Heterogeneity resulting from the use of different diagnostic instruments limited comparability. The included studies were susceptible to bias due to low response rates and loss to follow-up. CONCLUSIONS The differences in diagnostic instruments limited comparability of the prevalence rates. Therefore, clear prevalence trajectories could not be identified. Study participation and loss to follow-up require more attention in future studies. Uniformity in diagnostic procedures is needed in order to draw general conclusions on the prevalence of PTSD, ASD, and depression following violence related injury.
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Affiliation(s)
- Robbin H. Ophuis
- 000000040459992Xgrid.5645.2Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Branko F. Olij
- 000000040459992Xgrid.5645.2Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Suzanne Polinder
- 000000040459992Xgrid.5645.2Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Juanita A. Haagsma
- 000000040459992Xgrid.5645.2Department of Public Health, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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McKenzie DP, Downing MG, Ponsford JL. Key Hospital Anxiety and Depression Scale (HADS) items associated with DSM-IV depressive and anxiety disorder 12-months post traumatic brain injury. J Affect Disord 2018; 236:164-171. [PMID: 29738951 DOI: 10.1016/j.jad.2018.04.092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 04/18/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND Anxiety and depression are common problems following traumatic brain injury (TBI), warranting routine screening. Self-report rating scales including the Hospital Anxiety and Depression Scale (HADS) are associated with depression and anxiety diagnoses in individuals with TBI. The relationship between individual HADS symptoms and structured clinical interview methods (SCID) requires further investigation, particularly in regard to identifying a small number of key items that can potentially be recognised by clinicians and carers of individuals with TBI. METHODS 138 individuals sustaining a complicated-mild to severe TBI completed the HADS, and the Structured Clinical Interview for DSM-IV, Research Version (SCID) at 12-months post-injury. The associations between individual HADS items, separately and in combination, as well as overall depression and anxiety subscale scores, and SCID-diagnosed depressive and anxiety disorders were analysed. RESULTS CART (Classification and Regression Tree) analysis found HADS depression item 2 "I still enjoy the things I used to enjoy" and a combination of two anxiety items, 3 "I get a sort of frightened feeling as if something awful is about to happen" and 5 "worrying thoughts go through my mind", performed similarly to total depression and anxiety subscales in terms of their association with depressive and anxiety disorders respectively, at 12-months post-injury. LIMITATIONS Patients were predominantly injured in motor vehicle accidents and received comprehensive care within a no-fault accident compensation system and so may not be representative of the wider TBI population. CONCLUSIONS Although validation is required, a small number of self-report items are highly associated with 12-month post-injury diagnoses.
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Affiliation(s)
- Dean P McKenzie
- Research and Development, Epworth HealthCare, Richmond, Victoria, Australia; Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
| | - Marina G Downing
- Research and Development, Epworth HealthCare, Richmond, Victoria, Australia; Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jennie L Ponsford
- Research and Development, Epworth HealthCare, Richmond, Victoria, Australia; Monash-Epworth Rehabilitation Research Centre, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
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Spijker EE, Jones K, Duijff JW, Smith A, Christey GR. Psychiatric comorbidities in adult survivors of major trauma: findings from the Midland Trauma Registry. J Prim Health Care 2018; 10:292-302. [DOI: 10.1071/hc17091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT
INTRODUCTION
Information for primary care providers about the outcomes of adult survivors of major medical trauma in the first year of recovery is not widely available. In particular, risks of impairment across multiple domains of functioning are poorly understood.
AIM
To determine the extent to which adults’ experience impaired health-related quality of life (QoL), symptoms of post-traumatic stress disorder, depression, chronic pain and harmful alcohol use during the year following major trauma, and to identify factors associated with outcomes.
METHODS
Adults (aged ≥16 years) admitted to Waikato Hospital following major trauma sustained in Waikato District between 1 June 2010 and 1 July 2011 were sent a questionnaire in their first year of recovery. They were asked about their QoL, mental health, experiences of pain, post-traumatic stress disorder symptoms and use of alcohol.
RESULTS
Sixty-five questionnaires were completed (40% response rate). In the year following major trauma, trauma survivors met criteria for post-traumatic stress disorder (45%), harmful alcohol use (26%), moderate to severe chronic pain (23%) and depression (18%). Reports of poor health-related QoL were common, ranging from self-care difficulties (31%) to pain and discomfort (72%). Younger age, previous psychiatric illness, substance use, intensive care unit admission and length of hospitalisation were associated with symptoms. Thirty-seven adults (57%) reported symptoms in at least two domains.
DISCUSSION
A significant proportion of adults experience adverse psychosocial outcomes in the first year following major trauma. Screening and management of potentially comorbid psychosocial needs could improve care and outcomes for survivors.
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Lasting impression of violence: Retained bullets and depressive symptoms. Injury 2018; 49:135-140. [PMID: 28882377 PMCID: PMC5771869 DOI: 10.1016/j.injury.2017.08.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 08/17/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Over 70,000 nonfatal firearm injuries occur in the US annually, frequently leaving victims injured with retained bullets. The long-term psychological risks associated with retained bullets remains unstudied. By serving as a constant reminder of injury, we hypothesized that the presence of retained bullets after firearm injury is associated with increased PTSD and depression symptom severity. METHODS We conducted a prospective cohort study (2013-2015) of Black male survivors of firearm injury at an urban Level I trauma center. Interviews, questionnaires and validated survey tools for PTSD (PCL-5) and depression (QIDS-SR16) to assess severity of symptoms were administered 3 months post-injury. Clinical characteristics and symptom severity scores were compared with respect to retained bullets using Wilcoxon Rank Sum tests and linear regression. RESULTS Of 139 participants, 101(73%) had retained bullets. The cohort was young (mean age 26 years), educated (82% high school or greater) yet unemployed (53%) and with multiple injuries (median [IQR] no. of GSWs 2 [1-3]). There was no difference in age, education, employment status, number of gunshot wounds, operative procedures, pain, hospital or ICU LOS between groups (p>0.05). Patients with retained bullets less often rated their health as "very good" or "excellent" (10% vs 29%, p=0.046). Of those working prior to injury (n=47), 61% with retained bullets had not returned to work compared to 33% without retained bullets (p=0.027). No difference in PCL-5 scores [30.9 (SD 18.9) vs 27.9 (SD 18.6), p=0.470] was observed, but patients with retained bullets had greater mean QIDS-SR16 scores [10.7 (SD 6.2) vs 7.8 (SD 6.1), p=0.038] than those without. After controlling for injury severity, number of wounds, marital status and education level, multiple linear regression analysis determined that retained bullets (β=3.52; p=0.017) were associated with more severe depressive symptoms. CONCLUSION Retained bullets are associated with adverse psychological consequences after firearm injury. To improve recovery and to aid in clinical management decisions, clinicians should consider both the psychological and physical effects of retained bullets in survivors of firearm injury.
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