Predicting chronic symptoms after an acute "stressor"--lessons learned from 3 medical conditions.
Stressful events occur in the lives of millions of individuals each year. Such events, or "stressors", are experiences that threaten personal well-being, and include traumatic events such as motor vehicle collision, infectious illness, and situations such as military deployment. While most individuals recover from such events, others develop persistent somatic symptoms, such as chronic pain and fatigue, and/or psychological disturbances, such as posttraumatic stress disorder. Recent findings from the study of risk factors for the development of chronic somatic symptoms after a traumatic, infectious, or situational stressor suggest that similar pre-event, event-related, and post-event risk factors influence the development of chronic symptoms in each condition. Females, and those with pre-event distress or psychological factors, may be at higher risk of developing chronic symptoms after such events. Regarding the event, or "stressor", it appears as though the intensity or specific characteristics of exposure may be a relatively unimportant predictor of patient outcome. Instead, other factors such as the worry, or expectation, of chronicity may increase the risk of chronic symptom development. After the event, inactivity and time off work appear to increase the risk of chronic symptoms. Health care providers have an important role in emphasizing the benefits of resuming usual activities, and downplaying potential benefits of continuing in the sick role (e.g., time off work, increased family attention). While many aspects of the complex interaction of biological, psychological, and social factors that influence patient outcome after a stressful event remain to be elucidated, it appears that for the present, one of the most important interventions is to continue to emphasize to patients the old saying, "rest makes rust".
McLean
Samuel A
SA
Department of Emergency Medicine, University of Michigan Medical Center, 24 Frank Lloyd Wright Drive, P.O. Box 385, Ann Arbor, MI 48106, USA. samclean@umich.edu
Clauw
Daniel J
DJ
D015984:Causality; D002986:Clinical Trials as Topic; D003141:Communicable Diseases / Q000453:epidemiology*; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005544:Forecasting / Q000379:methods; D006801:Humans; D018923:Persian Gulf Syndrome / Q000453:epidemiology*; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology*; D013312:Stress, Physiological / Q000175:diagnosis / Q000453:epidemiology; D014911:Whiplash Injuries / Q000453:epidemiology*