The role of social support in the relationship between mental health and posttraumatic stress disorder amongst orthopaedic patients

Post-Traumatic Stress Disorder and Coping Strategies Among People with HIV in Lira District, Uganda: A Cross-Sectional Study

Background

Post-traumatic stress disorder (PTSD) is the most commonly reported mental health consequence following traumatic events. However, little is known about how people with HIV cope with the PTSD burden in Lira city, northern Uganda.

Materials and Methods

This study was carried out in Lira District Health Centre IVs from February 10, 2022, to March 10, 2022. A facility-based cross-sectional study was employed among 390 people with HIV attending Lira Health Centre IVs. A consecutive sampling technique was used to select the sample size. Questionnaires were used to collect data. A binary logistic regression model was fitted to identify factors associated with independent variables, and AOR was employed to estimate the strength of association between independent and dependent variables.

Results

Results show that the estimated prevalence of PTSD was 254 (65.1%) and was higher among the females 191 (75.2%), those with no formal education 143 (56.3%), aged 40 years and above 121 (47.6%), and married 127 (50.0%). Results indicate that male respondents had a 51% reduced odds of developing PTSD burden compared to female respondents (AOR: 0.49; 95% CI: 0.30–0.81; P = 0.005). Individuals who did not use planning activities as a coping strategy had more than 2-fold increased odds of experiencing PTSD compared to those who planned activities (AOR: 2.43; 1.26–4.70; P = 0.008). Participants who did not have emotional support had close to 3-fold increased chances of developing PTSD compared to those who had emotional support (AOR: 2.94; 1.74–4.98; P ≤ 0.001). Participants who indicated they were not taking recourse to spirituality had more than 4-fold increased odds of experiencing PTSD compared to those who had spirituality (AOR: 4.40; 1.83–10.46; P = 0.001).

Conclusion

A considerable burden of PTSD among HIV clients attending health centre IVs in Lira District was notably higher and was associated with gender, planning activities, emotional support and spirituality. Early screening of PTSD among HIV clients is needed to alleviate the burden. There is also a need to include PTSD treatment services in the treatment programme of HIV care services in health centre IVs in Lira District.

Symptom cluster profiles following traumatic orthopedic injuries: A protocol

Traumatic injuries affect millions of Americans annually, resulting in $671 billion in healthcare costs and lost productivity. Postinjury symptoms, like pain, sleep disturbance, anxiety, depression, and stressor-related disorders are highly prevalent following traumatic orthopedic injuries (TOI) and may contribute to negative long-term outcomes. Symptoms rarely present in isolation, but in clusters of two or more symptoms that co-occur to affect health in aggregate. Identifying symptom cluster profiles following TOI may identify those at highest risk for negative outcomes. Dysregulation of brain-derived neurotrophic factor (BDNF) is a potential biological mechanism responsible for symptom cluster profile membership after TOI and may be targeted in future precision-health applications. The purpose of this paper is to present the protocol of a cross-sectional study designed to identify symptom cluster profiles and measure the extent to which the BDNF val66met mutation and serum concentration of BDNF are associated with membership in symptom cluster profiles. We plan to recruit 150 TOI survivors within the first 72 h of injury. The study aims are to (1) describe TOI survivors' membership in symptom cluster profiles, indicated by pain, sleep disturbance, and symptoms of anxiety, depression, and stressor-related disorders, immediately following a TOI; (2) examine associations between demographic and clinical factors and symptom cluster profile membership among TOI survivors; (3) test the hypothesis that low serum concentrations of BDNF are associated with membership among symptom cluster profiles following TOI; and (4) test the hypothesis that the presence of the val66met mutation on one or both alleles of the BDNF gene is associated with membership among symptom cluster profiles following TOI.

Prevalence and association of anxiety and depression among orthopaedic trauma inpatients: a retrospective analysis of 1994 cases

Background

Patients with traumatic injuries are often accompanied by emotional disorders, which seriously impede functional gains. The objective of this study was to identify the prevalence and risk factors associated with underlying anxiety and depression in orthopaedic trauma patients.

Methods

From July 2015 to December 2017, all orthopaedic trauma patients were included in the retrospective study. Patients with conditions that might affect cognitive impairment were excluded from the study. Basic demographic data were collected. All patients were screened for emotional disorders on admission using a simple questionnaire called “Huaxi Emotional-Distress Index” (HEI). Bivariate analyses and logistic regression were used to identify the factors associated with a HEI score of > 8.

Results

One hundred and sixty-two patients (8.1%) had a HEI score of > 8. About 1.0% of enrolled patients had severe emotional disorders (HEI score ≥ 17). The reasons caused by emotional disorders in patients with orthopaedic trauma were a higher Injury Severity Score (ISS), a higher visual analogue score (VAS) and type of surgery. On logistic regression, marital status was a protective factor for emotional disorders, while VAS and ISS were the risk factors for emotional disorders.

Conclusions

Although a significantly low percentage of orthopaedic trauma patients in our setting have emotional disorders, traumatic orthopaedic surgeons still need to pay attention to the risk of emotional disorders and integrate effective screening tools into clinical practice to screen for these factors and stratify emotional disorders. Appropriate targeted psychological intervention and treatment should be adopted according to the stratification of emotional disorders.

Prevalence and determinants of post-traumatic stress disorder among road traffic accident survivors: a prospective survey at selected hospitals in southern Ethiopia

BACKGROUND

Post-traumatic stress disorder (PTSD) is prevalent among road traffic accident survivors (RTA), yet the psychological welfare of the persons has largely been ignored as health care professionals focus more on managing physical injuries. Many literatures from other parts of the world have addressed the issue of post-traumatic stress disorder among road traffic accident survivors, but such studies are mostly unavailable in sub-Saharan Africa, especially in Ethiopia. Therefore, this study examined the prevalence and determinants of PTSD among RTA survivors attending selected hospitals in southern Ethiopia.

METHODS

Institution based cross-sectional study design was employed from April 1/2018-Sep 30/2019. Data were collected from a sample of consecutively selected 423 RTA survivors through an interviewer-administered technique. A pre-tested post-traumatic stress disorder Checklist-Specific version (PCL-S) tool was used to screen PTSD. Data were entered and analysed using SPSS 22 software. A logistic regression model was fitted to identify determinants of PTSD. An adjusted odds ratio (AOR) with a 95% confidence interval was computed to determine the level of significance with a p-value of less than 0.05.

RESULT

A total of 416 participants were included in the study and the response rate was 98.6%. The prevalence of probable PTSD among RTA survivors was 15.4% (64). After adjusting for the effects of potential confounding variables; time since accident (30-90 days) (AOR = 0.33; 95%CI (0.15, 0.73), history of previous road traffic accident (AOR = 2.67; 95%CI (1.23, 5.77), depressive symptoms (AOR = 2.5, 95% CI (1.10, 6.10)) and common mental disorder (AOR = 12.78, 95% CI (5.56, 29.36)) were significant determinants of PTSD.

CONCLUSION

The prevalence of probable PTSD in the current study was high (15.4%). Time since accident, history of a previous road traffic accident, having depressive symptoms and common mental disorder were significant determinants of PTSD. RTA survivors attending adult Emergency and orthopedic clinics need to be screened for PTSD and get appropriate management.

Psychosocial health of patients receiving orthopaedic treatment in northern Tanzania: A cross-sectional study

Background

Patients with musculoskeletal injuries in Sub-Saharan Africa often receive prolonged inpatient treatment due to limited access to surgical care. Little is known regarding the psychosocial impact of prolonged conservative treatment for orthopaedic injuries, which may add to disability and preclude rehabilitation.

Methods

A cross-sectional, questionnaire study was conducted to characterize the psychosocial health of orthopaedic inpatients at a tertiary hospital in Moshi, Tanzania. Three validated surveys assessing coping strategies, functional social support, and symptoms of depression were orally administered to all orthopaedic patients with a length of stay (LOS) ≥ 6 days by a Tanzanian orthopaedic specialist.

Results

Fifty-nine patient surveys were completed, and revealed 92% (54) of patients were more likely to utilize more adaptive than maladaptive coping strategies. Patients with chest or spinal column injuries were more likely to use maladaptive coping strategies (p = 0·027). Patients with head injuries had more social support compared to others (p = 0·009). Lack of insurance, limited education, and rural origins were associated with less functional social support, although this finding did not reach statistical significance. 23·7% (14) of patients had symptoms consistent with mild depression, 33·9% (20) with moderate depression, and 3·4% (2) with moderately-severe depression. LOS was the only significant predictor for depression severity.

Conclusions

61% (36) of orthopaedic inpatients exhibited depressive symptoms, indicating that the psychosocial health in this population is sub-optimal. Mental health is a crucial element of successful orthopaedic care. Access to timely surgical care would greatly decrease LOS, the most prominent predictor of depressive symptom severity.

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The majority of orthopaedic patients were found to have symptoms of depression.

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Length of stay was the only significant predictor of depression symptom severity.

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Patients with torso injuries tended to use more maladaptive coping strategies.

Received and perceived support subscales of the Berlin Social Support Scales in women diagnosed with breast cancer attending the breast clinic at Tygerberg hospital: structure and correlates

Research in the field of psycho-oncology in South Africa is increasing, and there is a need for validated measures that assess factors associated with cancer, such as social support. The Berlin Social Support Scales are a battery of instruments that measure various types and functions of social support. The measure was originally developed for use among adult cancer patients, and their partners but has also been used among other clinical populations and healthy adults. We investigated the psychometric properties of the English version of the perceived and received sub-scales, Berlin Social Support Scales. Our sample included South African women ( N = 201) who were diagnosed with breast cancer and receiving treatment at a public health care facility. We administered several measures, including a demographic questionnaire, the Berlin Social Support subscales, the Duke-UNC Functional Social Support Questionnaire, and The Functional Assessment of Cancer Therapy to participants. Validity and reliability analyses were conducted. Factor analysis resulted in the retention of 17 items that clustered on two factors, namely received support and perceived support. The 17-item version of the Berlin Social Support Scale demonstrated strong reliability and validity in the sample. The two subscales are quick to administer, easy to interpret, and are a reliable measure of social support among breast cancer patients in South Africa.

Prevalence and correlates of post-traumatic stress disorder among survivors of road traffic accidents in Ethiopia

Background

Post-traumatic stress disorder is the most common mental disorders occurring among survivors of road traffic accident. However, research into post-traumatic stress disorder and correlates in low and middle-income countries is limited. To the best of our knowledge, there is no published study of the post-traumatic stress disorder and associated factors conducted in Ethiopia. Therefore, this study aimed to determine the prevalence of post-traumatic stress disorder and associated factors among survivors of road traffic accident.

Methods

Institution based cross-sectional study was conducted in May 2016. Data were collected using a pretested, structured, standardized post-traumatic stress disorder Checklist-Specific version (PCL-S) questionnaire. Systematic sampling technique was used to select the study participants. Binary logistic regression analysis was used to identify associated factors. Odds ratio with 95% CI was computed to assess the strength of associations.

Results

The prevalence of post-traumatic stress disorder was found to be 22.8% (CI 19.2, 26.6) among survivors of road traffic accident. In the multivariable analysis, Being female [AOR = 2.23, 95% CI 1.40, 3.56], having poor social support [AOR = 2.1, 95% CI 1.34, 3.46], duration since accident (1–3 months) [AOR = 1.72, 95% CI 1.07, 2.76] and having depression [AOR = 3.46, 95% CI 1.99, 5.99] were significantly associated with PTSD among survivors of road traffic accident.

Conclusion

In the current study the magnitude of post-traumatic stress disorder was high. Being female, poor social support, duration since the accident (1–3 months) and depression were found to be significant predictors of post-traumatic stress disorders. The finding suggests a need for early screening for post-traumatic disorder among survivors of road traffic accidents.

An integrated-delivery-of-care approach to improve patient reported physical function and mental wellbeing after orthopedic trauma: study protocol for a randomized controlled trial

BACKGROUND

Orthopedic trauma injury impacts nearly 2.8 million people each year. Despite surgical improvements and excellent survivorship rates, many patients experience poor quality of life (QOL) outcomes years later. Psychological distress commonly occurs after injury. Distressed patients more frequently experience rehospitalizations, pain medication dependence, and low QOL. This study was developed to test whether an integrative care approach (IntCare; ten-step program of emotional support, education, customized resources, and medical care) was superior to usual care (UsCare). The primary aim was to assess patient functional QOL (objective and patient-reported outcomes) with secondary objectives encompassing emotional wellbeing and hospital outcomes. The primary outcome was the Lower Extremity Gain Scale score.

METHODS/DESIGN

A single-blinded, single-center, repeated measures, randomized controlled study is being conducted with 112 orthopedic trauma patients aged 18-85 years. Patients randomized to the IntCare group have completed or are receiving a guided ten-step support program during acute care and at follow-up outpatient visits. The UsCare group is being provided the standard of care. Patient-reported outcomes and objective functional measures are collected at the hospital and at weeks 2, 6, and 12 and months 6 and 12 post surgery. The main study outcomes are changes in Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires of Physical Function quality of life, Satisfaction with Social Roles, and Positive-Illness Impact, Post-Traumatic Stress Disorder Check List, and the Tampa Scale of Kinesiophobia-11 from baseline to month 12. Secondary outcomes are changes in objective functional measures of the Lower Extremity Gain Scale, handgrip strength, and range of motion of major joints from week 2 to month 12 post surgery. Clinical outcomes include hospital length of stay, medical complications, rehospitalizations, psychological measures, and use of pain medications. A mixed model repeated measures approach assesses the main effects of treatment and time on outcomes, as well as their interaction (treatment × time).

DISCUSSION

The results from this study will help determine whether an integrative care approach during recovery from traumatic orthopedic injury can improve the patient perceptions of physical function and emotional wellbeing compared to usual trauma care. Additionally, this study will assess the ability to reduce the incidence or severity of psychological distress and mitigate medical complications, readmissions, and reduction of QOL after injury.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02591472 . Registered on 28 October 2015.

Perceived social support among patients with burn injuries: A perspective from the developing world

BACKGROUND

Social support is among the most well-established predictors of post-burn psychopathology after burn. Despite a disproportionately large burden of burns in the developing world, the nature of social support among burn patients in this context remains elusive. We, therefore, seek to investigate social support and its biopsychosocial determinants among patients with burn injuries in Pakistan.

METHODS

A cross-sectional study of 343 patients presenting with burn injuries at four teaching hospitals in the Punjab province of Pakistan was conducted. Patient evaluation consisted of a multi-part survey of demographic status, clinical features, and social support as measured by the validated Urdu translation of the Multidimensional Scale of Perceived Social Support (MSPSS). Multiple regression analysis was performed to evaluate associations between patient characteristics and MSPSS score.

RESULTS

Mean overall MSPSS score was 57.64 (std dev 13.57). Notable positive predictors of social support include male gender, Punjabi ethnicity, burn surface area, and ego resiliency.

CONCLUSION

Our study reveals a troubling pattern of inadequate social support among certain subgroups of Pakistani burn patients. Addressing these inequities in the provision of social support must be prioritized as part of the global burn care agenda.

"Life is at a standstill" Quality of life after lower extremity trauma in Malawi

PURPOSE

Low- and middle-income countries face a disproportionate burden of death and disability from injuries, many of which are due to road traffic accidents or falls. Lower extremity injuries in particular have implications not only for physical disabilities affecting work and school performance, but also for quality of life (QOL) of the individual. This qualitative study explores the psychosocial impact and QOL changes due to lower extremity injuries among trauma patients in central Malawi.

METHODS

We transcribed and translated interviews with 20 patients who received care for a trauma to the lower extremity at a tertiary hospital in Lilongwe. We used NVivo to organize and thematically analyze the data.

RESULTS

Participants reported limitations in physical functioning, activities of daily living, social roles, and vocational and social activities. Limited mobility led to unplanned long-term disruptions in work, personal financial loss, and household economic hardship. As a result, psychological distress, fears and worries about recovery, and poor perceptions of health and QOL were common. Several contextual factors influenced patient outcomes including socioeconomic status, religious beliefs, social networks, local landscape, housing structures, and transportation accessibility.

CONCLUSION

Lower extremity trauma led to physical suffering and ongoing social and economic costs among Malawians. Injuries affecting mobility have broad QOL and economic consequences for patients and affected family members. Interventions are needed to improve post-injury recovery and QOL. Better access to trauma surgery and social and welfare support services for people living with disabling conditions are needed to alleviate the consequences of injuries.

Posttraumatic stress disorder associated with orthopaedic trauma: a study in patients with extremity fractures

OBJECTIVE

The aims of this prospective study were to determine the prevalence of posttraumatic stress disorder (PTSD) in a population of young male military conscripts who experienced an extremity long-bone fracture, and to evaluate whether injury-related variables are associated with the development of PTSD.

DESIGN

Prospective, nonrandomized comparative study.

SETTING

Level 1 trauma center.

PATIENTS AND METHODS

A total of 148 men (age older than 18 years) who had 1 or more acute long-bone extremity fractures within 12 months and were seen at the Seoul Regional Military Manpower Center for examination of military conscripts from March 2013 to March 2014, were enrolled. The Korean version of the posttraumatic disorder scale was used to identify aspects of PTSD. The injury-related variables assessed included injury mechanism, fracture location and multiplicity, fracture severity, and the occurrence of joint ankylosis and secondary osteoarthritis.

RESULTS

Of the 148 participants, 40 (27.0%) met the criteria for the diagnosis of PTSD. Multivariate logistic linear analysis confirmed that lower extremity fracture, multiple fractures, and a higher pain visual analog scale score were significantly (P = 0.042, P = 0.043 and P < 0.001, respectively) related to the occurrence of PTSD.

CONCLUSIONS

Lower extremity fracture, multiple extremity fractures, and higher pain visual analog scale scores were significantly related to the occurrence of PTSD. To achieve an optimal recovery after orthopaedic injury, clinicians must address both physical and psychologic needs of their patients.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.