title: Psychological distress after physical injury: a one-year follow-up study of conscious hospitalised patients.
abstract: BACKGROUND
  Acute physical injury may lead to psychological distress. The relationship between peritraumatic responses, injury severity, the personality trait of optimism/pessimism and psychological distress is not fully understood. In addition, the development of post-traumatic stress symptoms may differ in subgroups.
  
  
  METHODS
  One hundred and eighty-one patients (18-65 years) completed questionnaires 1 (baseline), 3 and 12 months after first admission for acute physical injury. All patients were conscious on arrival. Scores on the Casualty Chain Inventory (CCI) for peritraumatic responses, the Impact of Event Scale (IES), the Hospital Anxiety and Depression Scale (HADS), the Life Orientation Test-Revised (LOT-R), trauma-related variables (ISS, Abbreviated Injury Scale [AIS], Glasgow Coma Scale [GCS]), and background variables were assessed.
  
  
  RESULTS
  Mean IES scores were 21.5 (95% CI: 19.0-24.0) at baseline and 15.8 (13.5-18.1) at 12 months (p<0.001). One subgroup (delayed onset, 12.2%) had an increase of at least 10 points in the IES score and another subgroup (chronic, 13.3%) had high and persistent post-traumatic stress symptoms during the follow-up period. At baseline, 45.3% had an IES score ≥ 20, indicating possible clinical case levels, compared with 33.1% at 12 months. Accordingly, 14% had anxiety symptoms and 10.8% had depression symptoms at a case level (HADS ≥ 8) at one-year follow-up. Mutually independent predictors of post-traumatic stress symptoms at 12 months were dissociation (OR 1.3, 95% CI: 1.1-1.6) and perception (OR 1.1, 95% CI: 1.0-1.3) measured by the CCI. Being in work before injury (OR 0.1, 95% CI: 0.02-0.4) and higher educational level (OR 0.3, 95% CI: 0.1-0.7) were associated with fewer IES symptoms. Dissociation and having a pessimistic trait predicted anxiety and depression at 12 months. Previous psychiatric problems predicted anxiety symptoms, and high educational level predicted less depression symptoms.
  
  
  CONCLUSIONS
  One-third of conscious physical injured patients had post-traumatic stress symptoms at a possible clinical case level one year after the traumatic event, and one-third of these had delayed onset. Symptoms of peritraumatic dissociation and perception were mutually independent predictors of psychological distress.
authors.affiliation: Department of Research and Development, Division of Critical Care, Oslo University Hospital, Ulleval, Oslo, Norway. Electronic address: Laila.Skogstad@ous-hf.no.
authors.forename: Laila
authors.initials: L
authors.lastname: Skogstad
authors.forename: Kirsti
authors.initials: K
authors.lastname: Tøien
authors.forename: Erlend
authors.initials: E
authors.lastname: Hem
authors.forename: Anette Hylen
authors.initials: AH
authors.lastname: Ranhoff
authors.forename: Leiv
authors.initials: L
authors.lastname: Sandvik
authors.forename: Øivind
authors.initials: Ø
authors.lastname: Ekeberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology*; D013315:Stress, Psychological; D014947:Wounds and Injuries / Q000523:psychology*; D055815:Young Adult
keywords: Casualty Chain Inventory; Delayed onset; Injury; Post-traumatic stress symptoms; Psychological distress; Resilience