Injury and Post-Traumatic Stress

Past research has shown that a sizable minority of those who experience physical trauma will develop psychological symptoms including anxiety, depression and post-traumatic stress disorder (PTSD). Researchers have not been able to fully understand the relationship between injury severity and psychological outcome. The authors of this work assessed 152 patients that presented in an emergency room with physical injuries with the goal of examining the relationship between their pre-trauma psychological state, severity of trauma, and PTSD symptom development.

Inclusion criteria for patients required that: the patient was between 16 and 70 years of age when the injury occurred, they were able to complete questionnaires within the study time period, they had geographical proximity to the study location, and that they showed evidence of acute psychological distress. Patients were excluded from the study if they had pre-existing major physical or psychiatric illness, or if they admitted they were deliberately responsible for their injury.

Participant's self-reports showed high levels of social, occupational and familial functioning; and high levels of life contentment before the trauma. The patient's injuries ranged from "mild" to "serious," and the study found that most injuries were not life threatening, and were relatively minor. But the study found that 93% (141 participants) met the diagnostic symptom criteria for PTSD outlined by the 4th edition of the Diagnostic and Statistical Manual by the end of the study period. Findings indicated that the patients experienced significant levels of trauma-related distress, as well as anxiety and depression. The authors note that anxiety appeared to be more prominent than depression.

The researchers state:

"This research supports two main conclusions: first that physical trauma need not be great to precipitate adverse psychological sequelae and, second, that even individuals who have stable backgrounds and who have high levels of life contentment before their trauma can develop acute psychological distress. Therefore, it is essential always to consider psychological well-being as part of routine assessment when individuals present after physical trauma."

"Other research also shows that, if PTSD goes untreated, it can become a chronic disorder with a concomitant burden on health services. There are established and effective treatment methods for this condition. However, the effectiveness of brief, early interventions aimed at preventing the development of full-blown chronic PTSD has not yet been demonstrated. Above all, this study shows the importance of integrated trauma services that take into account psychological and physical health needs."

Joy D, Probert R, Bisson J, Shepherd J. Posttraumatic Stress Reactions after Injury. The Journal of Trauma: Injury, Infection, and Critical Care 2000;48(3):490-494.