title: Psychological distress associated with severe lower-limb injury.
abstract: BACKGROUND
  Little is known about the psychological morbidity associated with limb-threatening injuries. It was hypothesized that a substantial proportion of patients who sustain a severe lower-limb injury will report serious psychological distress.
  
  
  METHODS
  Adult patients who were admitted to one of eight level-I trauma centers for treatment of an injury threatening the lower limb were enrolled during their initial hospitalization. Patients were recontacted at three, six, twelve, and twenty-four months after the injury and asked to complete the Brief Symptom Inventory (BSI), a fifty-three-item, self-reported measure of psychological distress. Patients who screen positive on the BSI are considered likely to have a psychological disorder and should receive a mental health evaluation. Longitudinal regression techniques were used to model positive case status (i.e., likely to have a psychological disorder) as a function of patient, injury, and treatment characteristics.
  
  
  RESULTS
  Of the 569 patients enrolled, 545 (96%) completed at least one BSI and 385 (68%) completed all four. Forty-eight percent of the patients screened positive for a likely psychological disorder at three months after the injury, and this percentage remained high (42%) at twenty-four months. Two years after the injury, almost one-fifth of the patients reported severe phobic anxiety and/or depression. While these two subscales reflected the highest prevalence of severe psychological distress, none of the BSI subscales reflected the prevalence expected from a normal sample (i.e., 2% to 3%). Factors associated with a likely psychological disorder included poorer physical function, younger age, non-white race, poverty, a likely drinking problem, neuroticism, a poor sense of self-efficacy, and limited social support. Relatively few patients reported receiving any mental health services following the injury (12% at three months and 22% at twenty-four months).
  
  
  CONCLUSIONS
  Severe lower-limb injury is associated with considerable psychological distress. More attention to the psychological as well as the physical health of patients who sustain a limb-threatening injury may be needed to ensure an optimal recovery following these devastating injuries.
authors.affiliation: mmcarth@jhmi.edi
authors.forename: Melissa L
authors.initials: ML
authors.lastname: McCarthy
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: MacKenzie
authors.forename: David
authors.initials: D
authors.lastname: Edwin
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bosse
authors.forename: Renan C
authors.initials: RC
authors.lastname: Castillo
authors.forename: Adam
authors.initials: A
authors.lastname: Starr
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D015995:Prevalence; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology