title: Psychosocial factors limit outcomes after trauma.
abstract: BACKGROUND
  Psychological morbidity compromises return to work after trauma. We demonstrate this relationship and present methods to identify risks for significant psychological morbidity.
  
  
  METHODS
  Thirty-five adults were evaluated prospectively for return to functional employment after injury using demographic data, validated psychological and health measures, and the Michigan Critical Events Perception Scale. Evaluation was conducted at admission and at 1 and 5 months after injury.
  
  
  RESULTS
  Poor return to work at 5 months was attributable to physical disability (p < 0.05) and psychological disturbance (p < 0.05) in a regression model that controlled for preinjury employment and psychopathologic factors as well as injury severity. A high score on the Impact of Events Scale administered during acute admission predicted development of acute stress disorder at 1 month (p < 0.01, odds ratio (OR) = 9.4) and posttraumatic stress disorder at 5 months (p < 0.05, OR = 6.7). Peritraumatic dissociation on the Michigan Critical Events Perception Scale was predictive for development of acute stress disorder (p < 0.05, OR = 5.8) at 1 month and posttraumatic stress disorder (p < 0.05, OR = 7.5) at 5 months.
  
  
  CONCLUSIONS
  Psychological morbidity after injury compromises return to work independent of preinjury employment and psychopathologic condition, Injury Severity Score, or ambulation. A high Impact of Events Scale score or peritraumatic dissociation at admission predicts this morbidity.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Michaels
authors.forename: C E
authors.initials: CE
authors.lastname: Michaels
authors.forename: C H
authors.initials: CH
authors.lastname: Moon
authors.forename: M A
authors.initials: MA
authors.lastname: Zimmerman
authors.forename: C
authors.initials: C
authors.lastname: Peterson
authors.forename: J L
authors.initials: JL
authors.lastname: Rodriguez
mesh_terms: D000203:Activities of Daily Living; D000208:Acute Disease; D000328:Adult; D004651:Employment / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000523:psychology*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D018434:Sickness Impact Profile; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*