title: A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury.
abstract: OBJECTIVE
  To examine factors other than injury severity that are likely to influence functional outcomes after hospitalization for injury.
  
  
  BACKGROUND
  This study used data from the National Study on the Costs and Outcomes of Trauma investigation to examine the association between posttraumatic stress disorder (PTSD), depression, and return to work and the development of functional impairments after injury.
  
  
  METHODS
  A total of 2707 surgical inpatients who were representative of 9374 injured patients were recruited from 69 hospitals across the US. PTSD and depression were assessed at 12 months postinjury, as were the following functional outcomes: activities of daily living, health status, and return to usual major activities and work. Regression analyses assessed the associations between PTSD and depression and functional outcomes while adjusting for clinical and demographic characteristics.
  
  
  RESULTS
  At 12 months after injury, 20.7% of patients had PTSD and 6.6% had depression. Both disorders were independently associated with significant impairments across all functional outcomes. A dose-response relationship was observed, such that previously working patients with 1 disorder had a 3-fold increased odds of not returning to work 12 months after injury odds ratio = 3.20 95% (95% confidence interval = 2.46, 4.16), and patients with both disorders had a 5-6 fold increased odds of not returning to work after injury odds ratio = 5.57 (95% confidence interval = 2.51, 12.37) when compared with previously working patients without PTSD or depression.
  
  
  CONCLUSIONS
  PTSD and depression occur frequently and are independently associated with enduring impairments after injury hospitalization. Early acute care interventions targeting these disorders have the potential to improve functional recovery after injury.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA. dzatzick@u.washington.edu
authors.forename: Douglas
authors.initials: D
authors.lastname: Zatzick
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Jin
authors.initials: J
authors.lastname: Wang
authors.forename: Ming-Yu
authors.initials: MY
authors.lastname: Fan
authors.forename: Jutta
authors.initials: J
authors.lastname: Joesch
authors.forename: Ellen
authors.initials: E
authors.lastname: Mackenzie
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D020127:Recovery of Function; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology* / Q000628:therapy