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Bernardo C, Hoon E, Gonzalez-Chica DA, Frank O, Black-Tiong S, Stocks N. Management of physical and psychological trauma resulting from motor vehicle crashes in Australian general practice: a mixed-methods approach. BMC PRIMARY CARE 2024; 25:167. [PMID: 38755534 PMCID: PMC11100075 DOI: 10.1186/s12875-024-02421-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND In Australia, motor vehicle crashes (MVC)-related health data are available from insurance claims and hospitals but not from primary care settings. This study aimed to identify the frequency of MVC-related consultations in Australian general practices, explore the pharmacological management of health conditions related to those crashes, and investigate general practitioners' (GPs) perceived barriers and enablers in managing these patients. METHODS Mixed-methods study. The quantitative component explored annual MVC-related consultation rates over seven years, the frequency of chronic pain, depression, anxiety or sleep issues after MVC, and management with opioids, antidepressants, anxiolytics or sedatives in a sample of 1,438,864 patients aged 16 + years attending 402 Australian general practices (MedicineInsight). Subsequently, we used content analysis of 81 GPs' qualitative responses to an online survey that included some of our quantitative findings to explore their experiences and attitudes to managing patients after MVC. RESULTS MVC-related consultation rates remained stable between 2012 and 2018 at around 9.0 per 10,000 consultations. In 2017/2018 compared to their peers, those experiencing a MVC had a higher frequency of chronic pain (48% vs. 26%), depression/anxiety (20% vs. 13%) and sleep issues (7% vs. 4%). In general, medications were prescribed more after MVC. Opioid prescribing was much higher among patients after MVC than their peers, whether they consulted for chronic pain (23.8% 95%CI 21.6;26.0 vs. 15.2%, 95%CI 14.5;15.8 in 2017/2018, respectively) or not (15.8%, 95%CI 13.9;17.6 vs. 6.7%, 95% CI 6.4;7.0 in 2017/2018). Qualitative analyses identified a lack of guidelines, local referral pathways and decision frameworks as critical barriers for GPs to manage patients after MVC. GPs also expressed interest in having better access to management tools for specific MVC-related consequences (e.g., whiplash/seatbelt injuries, acute/chronic pain management, mental health issues). CONCLUSION Chronic pain, mental health issues and the prescription of opioids were more frequent among patients experiencing MVC. This reinforces the relevance of appropriate management to limit the physical and psychological impact of MVC. GPs identified a lack of available resources (e.g. education, checklists and management support tools) for managing MVC-related consequences, and the need for local referral pathways and specific guidelines to escalate treatments.
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Affiliation(s)
- Carla Bernardo
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817.01, Adelaide, SA, 5000, Australia.
| | - Elizabeth Hoon
- Adelaide Medical School, School of Public Health, The University of Adelaide, 115 Grenfell St, Level 8, Room 818.01, Adelaide, SA, 5000, Australia
| | - David Alejandro Gonzalez-Chica
- Adelaide Medical School, Adelaide Rural Clinical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 811C.02, Adelaide, SA, 5000, Australia
| | - Oliver Frank
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817.09, Adelaide, SA, 5000, Australia
| | - Sean Black-Tiong
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 817, Adelaide, SA, 5000, Australia
| | - Nigel Stocks
- Adelaide Medical School, The University of Adelaide, 115 Grenfell St, Level 8, Room 823.01, Adelaide, SA, 5000, Australia
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Sabahi Z, Hasani P, Salehi-Pourmehr H, Beheshti R, Sadeghi-Bazargani H. What Are the Predictors of Post-traumatic Stress Disorder Among Road Traffic Accident Survivors: A Systematic Review. J Nerv Ment Dis 2024; 212:104-116. [PMID: 38290103 DOI: 10.1097/nmd.0000000000001739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
ABSTRACT Traffic accidents put tremendous burdens on the psychosocial aspects of communities. Post-traumatic stress disorder (PTSD), after an accident, is one of the most prevalent and incapacitating psychiatric conditions worldwide. In this systematic review, we aimed to investigate the predictors of PTSD in traffic accident victims. Primary search was conducted in November 2021 and updated in 2023. Studies were excluded if they used any analysis except regression for predictors. Cumulatively, primary and update searches retrieved 10,392 articles from databases, and of these, 87 studies were systematically reviewed. The predictors were categorized into sociodemographics, pretrauma, peritrauma, and post-trauma factors. The PTSD assessment time varied between 2 weeks and 3 years. Being a woman, having depression and having a history of road traffic accidents pretraumatically, peritraumatic dissociative experiences, acute stress disorder diagnosis, rumination, higher injury severity, and involvement in litigation or compensation after the trauma were significant predictors of PTSD.
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Affiliation(s)
- Zahra Sabahi
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parham Hasani
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Rasa Beheshti
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A JBI Centre of Excellence, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Neurobiochemical biomarkers and other risk factors for post-traumatic acute stress disorder. J Psychiatr Res 2023; 157:276-284. [PMID: 36527741 DOI: 10.1016/j.jpsychires.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/07/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
Trauma is a leading cause of mortality and morbidity around the world and many trauma patients could suffer from a series of cognitive and mental disorders including acute stress disorder (ASD). Yet, little research has been done to investigate the influencing factors and pathogenesis of post-traumatic ASD. Therefore, this study investigated main influencing factors and neurobiochemical biomarkers of ASD in trauma patients with a purpose of early clinical identification and intervention. The patients were followed up by general questionnaire and Acute Stress Disorder scale (ASDS). Using the diagnostic criteria of ASD, the study participants were divided into ASD group and non-ASD group. The generalized estimating equation (GEE) multivariate analysis suggested that life stress, sleep less than 8 h, trauma from road traffic crash, overall pain intensity, injury severity, overall fear after trauma were risk factors for ASD. Neutrophil to lymphocyte ratio (NLR) showed a downward trend in both groups (P < 0.05), and the ASD group was higher than the non-ASD group (P = 0.015). Glu to GABA ratio (GGR) in the ASD group were higher than the non-ASD group (P < 0.001). Both patient demographics and patient's condition could impact the risk of developing ASD after a major injury.
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Daddah D, Glèlè Ahanhanzo Y, Kpozehouen A, Hounkpe Dos Santos B, Ouendo EM, Levêque A. Prevalence and Risk Factors of Post-Traumatic Stress Disorder in Survivors of a Cohort of Road Accident Victims in Benin: Results of a 12-Month Cross-Sectional Study. J Multidiscip Healthc 2022; 15:719-731. [PMID: 35411148 PMCID: PMC8994593 DOI: 10.2147/jmdh.s358395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Post-traumatic stress disorder (PTSD) is a frequent psychiatric complication in road accident survivors. However, it remains under-explored and is not taken into account in health policies in Benin. The purpose of this study was to determine the prevalence and risk factors of PTSD after a road traffic accident. This will help to improve its diagnosis and management in Benin hospitals. Materials and Methods An institution-based cross-sectional study was conducted from November 2020 to January 2021. Consenting victims of road traffic accidents from three hospitals across Benin, aged 18 years and above, living in the south of the country, were administered various questionnaires at 12-month follow-up. Data on PTSD were collected using a pre-tested, structured and standardized post-traumatic stress disorder questionnaire, the PTSD Checklist (specific version) (PCL-S). A logistic regression model was fitted to identify factors associated with PTSD. An adjusted odds ratio (AOR) followed by a 95% confidence interval was calculated to determine the level of significance with a p-value less than 0.05. Results Out of 865 patients in the cohort eligible for the 12-month follow-up, 734 (85%) participated in the study. The prevalence of PTSD was 26.43% (95% CI: 23.36–29.75). Factors associated with PTSD on multivariate analysis were female gender (adjusted odds ratio (AOR) = 2.14, 95% CI: 1.38–3.33), hospitalization (AOR = 1.87, 95% CI 1.21–2.89), negative impact of the accident on income (AOR = 4.22, 95% CI: 2.16–8.25), and no return to work (AOR = 3.17, 95% CI: 1.99–5.06). Conclusion The prevalence of PTSD is high in road accident survivors in Benin. The results of this study highlight the need for early diagnosis and a multidisciplinary approach to the management of PTSD patients in Benin’s hospitals.
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Affiliation(s)
- Donatien Daddah
- Epidemiology and Biostatistics Department, Regional Institute of Public Health, Ouidah, Benin
- Center for Research in Epidemiology, Biostatistics and Clinical Research, Public Health School, (Université Libre de Bruxelles), Brussels, Belgium
- Correspondence: Donatien Daddah, Epidemiology and Biostatistics Department, Regional Institute of Public Health, P.O. Box 384, Ouidah, Benin, Tel +229 97167245, Email
| | - Yolaine Glèlè Ahanhanzo
- Epidemiology and Biostatistics Department, Regional Institute of Public Health, Ouidah, Benin
| | - Alphonse Kpozehouen
- Epidemiology and Biostatistics Department, Regional Institute of Public Health, Ouidah, Benin
| | - Bella Hounkpe Dos Santos
- Epidemiology and Biostatistics Department, Regional Institute of Public Health, Ouidah, Benin
- Center for Research in Epidemiology, Biostatistics and Clinical Research, Public Health School, (Université Libre de Bruxelles), Brussels, Belgium
| | - Edgard-Marius Ouendo
- Health Policies and Systems Department, Regional Institute of Public Health, Ouidah, Benin
| | - Alain Levêque
- Center for Research in Epidemiology, Biostatistics and Clinical Research, Public Health School, (Université Libre de Bruxelles), Brussels, Belgium
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Pozzato I, Tran Y, Gopinath B, Cameron ID, Craig A. The contribution of pre-injury vulnerability to risk of psychiatric morbidity in adults injured in a road traffic crash: Comparisons with non-injury controls. J Psychiatr Res 2021; 140:77-86. [PMID: 34098389 DOI: 10.1016/j.jpsychires.2021.05.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/26/2022]
Abstract
People who sustain injury in a road traffic crash (RTC) have significant risk of psychiatric morbidity, but effective screening for identifying at-risk individuals soon after the RTC is lacking. We investigated whether pre-injury vulnerability can assist as an early screen to manage this risk. We recruited 120 adults who sustained physical injury in a RTC and admitted to an emergency department (ED). They were comprehensively assessed for acute and long-term presence of psychiatric disorder/morbidity and disability over 12-months after the injury, with comparisons to a non-injury control. Propensity matching based on six pre-injury vulnerability factors (age, sex, education, socioeconomic status, prior mental health, prior physical health) with the control group was used to determine membership of high vulnerability (HV) and low vulnerability (LV) injury sub-groups. Compared to the LV sub-group and controls that had similar pre-injury vulnerability, the HV sub-group had a worrying post-RTC recovery profile, with significantly higher rates of long-term psychiatric morbidity (42.2% vs. 23.1% and 15.9% respectively, p = .002) including post-traumatic stress disorder and/or depression, and poorer psychological adjustment over the 12-months. In contrast, the HV and LV sub-groups were similar in injury-related characteristics and post-injury physical (pain, fatigue, physical functioning) and participation outcomes. Findings provide preliminary evidence that pre-injury vulnerability, primarily prior mental health status, is a promising screen for early identification of people at risk of psychiatric morbidity post-RTC. It is suggested this screen could be implemented in ED to prevent chronicity and improve recovery following a traumatic injury. Further research is warranted to enhance the screen's effectiveness.
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Affiliation(s)
- Ilaria Pozzato
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia.
| | - Yvonne Tran
- Centre of Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Australia
| | - Bamini Gopinath
- Department of Linguistics, Macquarie University, Sydney, NSW, Australia
| | - Ian Douglas Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
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