Early short-term inpatient psychotherapeutic treatment versus continued outpatient psychotherapy on psychosocial outcome: a randomized controlled trial in trauma patients.
BACKGROUND
Inpatient psychotherapeutic support has been shown to reduce mental health problems in severely injured patients. However, this effect mostly disappears after discharge. The aim of this study was to compare short-term inpatient versus continued long-term outpatient psychotherapeutic support.


METHODS
Patients with at least two injuries of a combined Abbreviated Injury Scale Severity Score Index≥5 were included in the study. Of 862 screened patients, 113 met all inclusion criteria. They were randomly assigned to a short-term group (n=59), where only inpatient support was given, and a long-term group (n=54), with additional outpatient sessions. The cognitive behavioral treatment was standardized by a manual. Psychological assessment for depression, anxiety, and posttraumatic stress disorder (PTSD) was performed in written form at the time of inclusion, discharge, and 6 months, 12 months, and 18 months after trauma.


RESULTS
Forty-one percent (n=46) of all patients completed follow-up visits. The results show that symptoms of depression, anxiety, and PTSD disappeared more often in the long-term group than in the short-term group 1 year after trauma. Differences nearly reach significance for anxiety (p=0.051) and PTSD (p=0.059). Twenty-one percent of the short-term group patients showed at least one mental health disorder compared with no patients in the long-term group 1 year after trauma (p=0.035).


CONCLUSIONS
Psychotherapeutic support of severely injured patients seems to be more effective in reducing depression, anxiety, and PTSD if extended further into outpatient care. This conclusion should be considered preliminary because of the small number of study patients.
Faculty of Medicine, Institute for Research in Operative Medicine, Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, University of Witten/Herdecke, Witten, Germany.
Tanja
T
Tecic
Alexandra
A
Schneider
Astrid
A
Althaus
Yvette
Y
Schmidt
Christine
C
Bierbaum
Rolf
R
Lefering
Dirk
D
Mueller
Bertil
B
Bouillon
Christian
C
Janssen
Holger
H
Pfaff
Hans J
HJ
Erli
Christoph
C
Rangger
Edmund A M
EA
Neugebauer
D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology / Q000517:prevention & control; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003863:Depression / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D010352:Patient Dropouts; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D011614:Psychotherapy, Brief / Q000379:methods; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology*; D055815:Young Adult