title: Coping with serious accidental injury: a one-year follow-up study.
abstract: BACKGROUND
  The aim of this study was to analyze changes of coping strategies in severely injured accident victims over time and to compare patients with high and low posttraumatic stress disorder (PTSD) symptom levels with regard to their coping patterns and accident-related cognitions.
  
  
  METHODS
  106 consecutive patients with severe accidental injuries admitted to a trauma surgery intensive care unit (ICU) were assessed within 1 month after the trauma and 6 and 12 months later. Assessments included a clinical interview, the Freiburg Questionnaire of Coping with Illness, the patients' accident-related cognitions, the Clinician-Administered PTSD Scale, the 90-item revised Symptom Checklist (SCL-90-R), and the Sense of Coherence Questionnaire (SOC). Patients who met the criteria for either full or subsyndromal PTSD at least once over the observation period (36 subjects; 34.0%) were assigned to a highly symptomatic group (HSG), the remainder (70 subjects; 66.0%) to a less symptomatic group.
  
  
  RESULTS
  Overall, active problem-focused coping was predominant immediately after the accident and declined over time, with a stronger decrease in the HSG. Patients in the HSG scored higher on the SCL Global Severity Index and lower on the SOC. The patients' subjective appraisal of accident severity was higher in the HSG, whereas there was no group difference with regard to accident-related variables such as type of accident, injury severity and mild to moderate traumatic brain injury.
  
  
  CONCLUSIONS
  Active problem-focused coping, although utilized most frequently and often regarded as protective, might be an inadequate strategy in face of acute stress following a severe accident. Clinicians should not expect their patients to cope very actively in the acute ICU phase. In the subsequent rehabilitation, active coping seems to be more adaptive.
authors.affiliation: Department of Psychiatry, University Hospital, Zurich, Switzerland. Urs.Hepp@usz.ch
authors.forename: Urs
authors.initials: U
authors.lastname: Hepp
authors.forename: Hanspeter
authors.initials: H
authors.lastname: Moergeli
authors.forename: Stefan
authors.initials: S
authors.lastname: Büchi
authors.forename: Lutz
authors.initials: L
authors.lastname: Wittmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Schnyder
mesh_terms: D000059:Accidents / Q000523:psychology*; D000223:Adaptation, Psychological; D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011340:Problem Solving; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology; D014947:Wounds and Injuries / Q000523:psychology* / Q000601:surgery