title: The temporal relationship between mental health and disability after injury.
abstract: OBJECTIVE
  This longitudinal study investigated the temporal relationship patterns between disability and mental health after injury, with a focus on posttraumatic stress disorder (PTSD), depression, and anxiety.
  
  
  METHODS
  We conducted a multi-sited longitudinal cohort study with a large sample of hospital patients admitted after injury (N = 1,149, mean age = 37.9, 73.6% male). Data were collected prior to discharge from hospital, and follow-up assessments took place 3 and 12 months postinjury. A cross-lagged structural equation model (SEM) was used to assess the prospective relationship between posttraumatic stress, anxiety, and depression symptoms and disability while controlling for demographic characteristics and objective measures of injury severity.
  
  
  RESULTS
  Acute depression significantly predicted 3-month disability, and 3-month PTSD severity significantly predicted 12-month disability. Premorbid disability had a significant effect on acute anxiety, depression, and posttraumatic stress symptoms, and 3-month depression but disability after the injury did not predict 12-month psychopathology.
  
  
  CONCLUSIONS
  We did not find a reciprocal relationship between disability and psychopathology. Rather we found that depression played a role in early disability while PTSD played a role in contributing to long-term delays in the recovery process. The results of this study highlight the need for mental health screening for symptoms of PTSD and depression in the acute aftermath of trauma, combined with early intervention programs in injury populations.
authors.affiliation: Australian Centre for Posttraumatic Mental Health, Carlton, Victoria, Australia; Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schweininger
authors.forename: David
authors.initials: D
authors.lastname: Forbes
authors.forename: Mark
authors.initials: M
authors.lastname: Creamer
authors.forename: Alexander C
authors.initials: AC
authors.lastname: McFarlane
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
authors.forename: Meaghan L
authors.initials: ML
authors.lastname: O'Donnell
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008603:Mental Health; D011446:Prospective Studies; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D013997:Time Factors; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000523:psychology*
keywords: SEM; anxiety; depression; disability; injury; posttraumatic stress disorder