Citation

Bell TM, Vetor AN, Zarzaur BL. J. Trauma Acute Care Surg. 2018; 85(5): 999-1006.

Affiliation

Indiana University, School of Medicine, Department of Surgery, Indianapolis, IN.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001992

PMID

29851909

Abstract

BACKGROUND: Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and post-traumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment.

METHODS: Adults (18 and over) admitted to a Level I trauma center with an injury severity score (ISS) greater than 10, but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological Studies-Depression (CES-D) and PTSD CheckList - Civilian Versions (PCL-C) surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis.

RESULTS: 500 injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3% 1 month, 49.9% 2 month, 49.0% 4 month, and 50.2% 12 month). Only 22.2% of depressed patients reported receiving treatment for depression. 44.4% of patients screened positive for PTSD (26.6% 1 month, 27.8% 2 month, 29.8% 4 month, and 30.0% 12 month), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (OR 0.44, 95% CI 0.21-0.95).

CONCLUSION: Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury. LEVEL OF EVIDENCE: Level III Prognostic.

Language: en