Acute stress response patterns to accidental injuries.
We examined, by means of clinical interviews and several self-report measures (IES, STAI), 110 accident victims' primary appraisal of injury during five different timepoints before, during, and immediately after the accident. The appraisals were combined with the corresponding most dominant emotion in a matrix, revealing six different acute stress response patterns: ordinary (O: 64 subjects--58%); emotional (E: 19 subjects--17%); controlled (C: 9 subjects--8%); derealization (D: 15 subjects--14%); and denial-elation (DE: 3 subjects--3%). The E response pattern was associated with being female (RR 3.31). Psychopathology at the time of the injury or risk of death during the accident increased the risk for a D or E response (RR 1.61 and RR 1.92, respectively). The presence of psychophysiological symptoms or reduced appetite during the hospital stay was associated with E, C, or D response patterns compared with an O pattern (RR 1.76 and RR 2.18, respectively). A DE response was associated with severe brain injury partly undetected by the surgeons. We conclude that the identification of different clinical response patterns may be a meaningful approach to better tailor response-specific interventions for trauma victims.
Schnyder
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Psychiatrische Poliklinik, Universitätsspital, Zürich, Switzerland. uschnyd@psyp.unizh.ch
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D000059:Accidents / Q000523:psychology*; D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000209:etiology*; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology*