Risk factors for psychological distress following injury.
OBJECTIVE
To identify predictors of psychological morbidity among injured patients admitted to an Emergency Department (ED).


METHODS
A prospective cohort study.


METHODS
Participants were consecutive male ED attenders. 210 (97.7%) patients consented to participate. At one month, 128 (61.0%) responded, at six months, 114 (54.3%), at eighteen months 96 (45.7%).


METHODS
Measures immediately following injury were the Hospital Anxiety and Depression Scale, the Eysenck Personality Questionnaire and the McGill pain questionnaire. Recovery at one month was recorded using the SF-36 Health Survey, COPE scale, Perceived Stress Scale and Revised Impact of Events Scale. At six and eighteen months outcome was measured using the General Health Questionnaire (28 items) and Revised Impact of Events Scale. Multivariate analysis identified pre-morbid, accident-related and recovery factors influencing outcome at six and eighteen months.


RESULTS
The strongest predictors of outcome were initial levels of anxiety and depression, prior history of mental health problems, early PTSD symptoms and involvement in litigation. These factors predicted between 40-60% of the variance at six months (p<0.001), and 50-60% of the variance in psychological distress at eighteen months (p<0.001).


CONCLUSIONS
Factors identifying individuals at-risk from psychological distress following injury include those related to the immediate response and the recovery phases of injury. Further development is needed to convert identified predictors into a comprehensive screening tool for clinical use.
Mason
S
S
Department of Emergency Medicine, Northern General Hospital, Sheffield, UK. s.mason@sheffield.ac.uk
Turpin
G
G
Woods
D
D
Wardrope
J
J
Rowlands
A
A
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D005163:Factor Analysis, Statistical; D006801:Humans; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000523:psychology*