Secondary Prevention of Posttraumatic Stress Disorder in Patients with Traumatic Physical Injury

Abstract

Introduction: Traumatic physical injury can result in devastating physiological and psychological consequences. Yet, routine preventative psychological bedside intervention during hospitalization for these injuries is uncommon. This observational study evaluated the effectiveness of a novel secondary preventative intervention aimed at mitigating risk of posttraumatic psychological maladjustment. Risk factors for Posttraumatic Stress Disorder, Major Depression, and substance use problems were identified. Influence of maladjustment on subsequent health care utilization was also examined. Results: Lower than expected rates of both PTSD (16 vs. 20 to 30 percent) and substance use problems (15 vs. 20 to 55 percent), as well as a higher than expected rate of outpatient behavioral health treatment engagement for those with psychiatric problems (50 vs. 33 percent), at Follow-Up were demonstrated. Risk of PTSD at Follow-Up was shown to predict 30-day emergency department use and presence of Major Depression at Follow-Up significantly predicted hospital readmission. Survivors of traumatic injury who were uninsured, had a premorbid PTSD diagnosis, suffered an interpersonal injury, and were survivors of past injury-congruent trauma were most at risk of PTSD at Follow-Up. Acute symptoms of maladjustment during hospitalization and premorbid Depressive Disorders were predictive of Major Depression post-traumatic injury. No risk factors related to substance use problems at Follow-Up were identified. Conclusions: There is evidence to suggest the Intervention favorably impacted vulnerability to PTSD and substance use, as well as propensity to engage in specialty behavioral health treatment, post-traumatic physical injury. The current investigation also successfully identified unique risk factors for PTSD and Major Depression following injury, supporting the hypothesis that PTSD, Major Depression, and substance use problems are discrete reactions to traumatic injury.