The psychiatric sequelae of traumatic injury.
OBJECTIVE
Traumatic injury affects millions of people each year. There is little understanding of the extent of psychiatric illness that develops after traumatic injury or of the impact of mild traumatic brain injury (TBI) on psychiatric illness. The authors sought to determine the range of new psychiatric disorders occurring after traumatic injury and the influence of mild TBI on psychiatric status.


METHODS
In this prospective cohort study, patients were drawn from recent admissions to four major trauma hospitals across Australia. A total of 1,084 traumatically injured patients were initially assessed during hospital admission and followed up 3 months (N=932, 86%) and 12 months (N=817, 75%) after injury. Lifetime psychiatric diagnoses were assessed in hospital. The prevalence of psychiatric disorders, levels of quality of life, and mental health service use were assessed at the follow-ups. The main outcome measures were 3- and 12-month prevalence of axis I psychiatric disorders, levels of quality of life, and mental health service use and lifetime axis I psychiatric disorders.


RESULTS
Twelve months after injury, 31% of patients reported a psychiatric disorder, and 22% developed a psychiatric disorder that they had never experienced before. The most common new psychiatric disorders were depression (9%), generalized anxiety disorder (9%), posttraumatic stress disorder (6%), and agoraphobia (6%). Patients were more likely to develop posttraumatic stress disorder (odds ratio=1.92, 95% CI=1.08-3.40), panic disorder (odds ratio=2.01, 95% CI=1.03-4.14), social phobia (odds ratio=2.07, 95% CI=1.03-4.16), and agoraphobia (odds ratio=1.94, 95% CI=1.11-3.39) if they had sustained a mild TBI. Functional impairment, rather than mild TBI, was associated with psychiatric illness.


CONCLUSIONS
A significant range of psychiatric disorders occur after traumatic injury. The identification and treatment of a range of psychiatric disorders are important for optimal adaptation after traumatic injury.
Bryant
Richard A
RA
School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia. r.bryant@unsw.edu.au
O'Donnell
Meaghan L
ML
Creamer
Mark
M
McFarlane
Alexander C
AC
Clark
C Richard
CR
Silove
Derrick
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000379:Agoraphobia / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001315:Australia; D001930:Brain Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D016584:Panic Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010698:Phobic Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D018570:Risk Assessment / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D014600:Utilization Review / Q000706:statistics & numerical data; D055815:Young Adult