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BMC Psychiatry
Published in: BMC Psychiatry 1/2012

Open Access 01-12-2012 | Research article

Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department

Authors: Juanita A Haagsma, Suzanne Polinder, Miranda Olff, Hidde Toet, Gouke J Bonsel, Ed F van Beeck

Published in: BMC Psychiatry | Issue 1/2012

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Abstract

Background

Among injury victims relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. PTSD is associated with functional impairments and decreased health-related quality of life (HRQoL). Previous studies that addressed the latter were restricted to injuries at the higher end of the severity spectrum. This study examined the association between PTSD symptoms and health-related quality of life (HRQoL) in a comprehensive population of injury patients of all severity levels and external causes.

Methods

We conducted a self-assessment survey which included items regarding demographics of the patient, accident type, sustained injuries, EuroQol health classification system (EQ-5D) and Health Utilities Index (HUI) to measure functional outcome and HRQoL, and the Impact of Event Scale (IES) to measure PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of PTSD. The survey was completed by 1,781 injury patients two years after they were treated at the Emergency Department (ED), followed by either hospital admission or direct discharge to the home environment.

Results

Symptoms indicative of PTSD were associated with more problems on all EQ-5D and HUI3 domains of functional outcome and a considerable utility loss in both hospitalized (0.23-0.24) and non-hospitalized (0.32-0.33) patients. Differences in reported problems between patients with IES scores higher or lower than 35 were largest for EQ-5D health domains pain/discomfort (82% versus 28%) and anxiety/depression (53% versus 11%) and HUI domains emotion (92% versus 33%) and pain (84% versus 38%). After adjusting for potential confounders, PTSD remained strongly associated with adverse HRQoL.

Conclusions

Among patients treated at an ED posttraumatic stress symptoms indicative of PTSD were associated with a considerable decrease in HRQoL in both hospitalized and non-hospitalized patients. PTSD symptoms may therefore raise a major barrier for full recovery of injury patients of even minor levels of severity.
Appendix
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Literature
1.
Mason S, Farrow TF, Fawbert D, Smith R, Bath PA, Hunter M, Woodruff PW, Turpin G: The development of a clinically useful tool for predicting the development of psychological disorder following injury. Br J Clin Psychol. 2009, 48 (Pt 1): 31-45.CrossRefPubMed
2.
Mayou R, Tyndel S, Bryant B: Long-term outcome of motor vehicle accident injury. Psychosom Med. 1997, 59 (6): 578-584.CrossRefPubMed
3.
Holbrook TL, Hoyt DB, Stein MB, Sieber WJ: Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men. J Trauma. 2002, 53 (5): 882-888. 10.1097/00005373-200211000-00012.CrossRefPubMed
4.
Ehlers A, Mayou RA, Bryant B: Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol. 1998, 107 (3): 508-519.CrossRefPubMed
5.
Mayou RA, Ehlers A, Bryant B: Posttraumatic stress disorder after motor vehicle accidents: 3-year follow-up of a prospective longitudinal study. Behav Res Ther. 2002, 40 (6): 665-675. 10.1016/S0005-7967(01)00069-9.CrossRefPubMed
6.
Meiser-Stedman R, Dalgleish T, Glucksman E, Yule W, Smith P: Maladaptive cognitive appraisals mediate the evolution of posttraumatic stress reactions: A 6-month follow-up of child and adolescent assault and motor vehicle accident survivors. J Abnorm Psychol. 2009, 118 (4): 778-787.CrossRefPubMed
7.
Yasan A, Guzel A, Tamam Y, Ozkan M: Predictive factors for acute stress disorder and posttraumatic stress disorder after motor vehicle accidents. Psychopathology. 2009, 42 (4): 236-241. 10.1159/000218521.CrossRefPubMed
8.
McKibben JB, Bresnick MG, Wiechman Askay SA, Fauerbach JA: Acute Stress Disorder and Posttraumatic Stress Disorder: A Prospective Study of Prevalence, Course, and Predictors in a Sample With Major Burn Injuries. J Burn Care Res. 2008, 29 (1): 22-35.CrossRefPubMed
9.
Corry NH, Klick B, Fauerbach JA: Posttraumatic stress disorder and pain impact functioning and disability after major burn injury. J Burn Care Res. 31 (1): 13-25.
10.
Dyster-Aas J, Willebrand M, Wikehult B, Gerdin B, Ekselius L: Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity. J Trauma. 2008, 64 (5): 1349-1356. 10.1097/TA.0b013e318047e005.CrossRefPubMed
11.
Hepp U, Moergeli H, Buchi S, Wittmann L, Schnyder U: Coping with serious accidental injury: a one-year follow-up study. Psychother Psychosom. 2005, 74 (6): 379-386. 10.1159/000087786.CrossRefPubMed
12.
Schnyder U, Moergeli H, Klaghofer R, Buddeberg C: Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims. Am J Psychiatry. 2001, 158 (4): 594-599. 10.1176/appi.ajp.158.4.594.CrossRefPubMed
13.
Quale AJ, Schanke AK, Froslie KF, Roise O: Severity of injury does not have any impact on posttraumatic stress symptoms in severely injured patients. Injury. 2009, 40 (5): 498-505. 10.1016/j.injury.2008.11.006.CrossRefPubMed
14.
Myhren H, Ekeberg O, Toien K, Karlsson S, Stokland O: Posttraumatic stress, anxiety and depression symptoms in patients during the first year post intensive care unit discharge. Crit Care. 14 (1): R14-
15.
O'Donnell ML, Creamer M, Holmes AC, Ellen S, McFarlane AC, Judson R, Silove D, Bryant RA: Posttraumatic Stress Disorder After Injury: Does Admission to Intensive Care Unit Increase Risk?. J Trauma.
16.
Kolassa IT, Kolassa S, Ertl V, Papassotiropoulos A, De Quervain DJ: The risk of posttraumatic stress disorder after trauma depends on traumatic load and the catechol-o-methyltransferase Val(158)Met polymorphism. Biol Psychiatry. 67 (4): 304-308.
17.
Kolassa IT, Ertl V, Eckart C, Glockner F, Kolassa S, Papassotiropoulos A, de Quervain DJ, Elbert T: Association study of trauma load and SLC6A4 promoter polymorphism in posttraumatic stress disorder: evidence from survivors of the Rwandan genocide. J Clin Psychiatry. 71 (5): 543-547.
18.
Zatzick D: Posttraumatic stress, functional impairment, and service utilization after injury: a public health approach. Semin Clin Neuropsychiatry. 2003, 8 (3): 149-157. 10.1016/S1084-3612(03)00017-0.CrossRefPubMed
19.
Zatzick DF, Marmar CR, Weiss DS, Browner WS, Metzler TJ, Golding JM, Stewart A, Schlenger WE, Wells KB: Posttraumatic stress disorder and functioning and quality of life outcomes in a nationally representative sample of male Vietnam veterans. Am J Psychiatry. 1997, 154 (12): 1690-1695.CrossRefPubMed
20.
Holbrook TL, Hoyt DB, Stein MB, Sieber WJ: Perceived threat to life predicts posttraumatic stress disorder after major trauma: risk factors and functional outcome. J Trauma. 2001, 51 (2): 287-292. 10.1097/00005373-200108000-00010. discussion 292-283CrossRefPubMed
21.
Landolt MA, Vollrath ME, Gnehm HE, Sennhauser FH: Post-traumatic stress impacts on quality of life in children after road traffic accidents: prospective study. Aust N Z J Psychiatry. 2009, 43 (8): 746-753. 10.1080/00048670903001919.CrossRefPubMed
22.
Zatzick DF, Jurkovich GJ, Fan MY, Grossman D, Russo J, Katon W, Rivara FP: Association between posttraumatic stress and depressive symptoms and functional outcomes in adolescents followed up longitudinally after injury hospitalization. Arch Pediatr Adolesc Med. 2008, 162 (7): 642-648. 10.1001/archpedi.162.7.642.CrossRefPubMed
23.
Polinder S, van Beeck EF, Essink-Bot ML, Toet H, Looman CW, Mulder S, Meerding WJ: Functional outcome at 2.5, 5, 9, and 24 months after injury in the Netherlands. J Trauma. 2007, 62 (1): 133-141. 10.1097/TA.0b013e31802b71c9.CrossRefPubMed
24.
Curtis LH, Hammill BG, Eisenstein EL, Kramer JM, Anstrom KJ: Using inverse probability-weighted estimators in comparative effectiveness analyses with observational databases. Med Care. 2007, 45 (10 Supl 2): S103-107.CrossRefPubMed
25.
Admoni O, Yagupsky P, Golan A, Kenes Y, Schifroni G, Horowitz I: Epidemiological, clinical and microbiological features of shigellosis among hospitalized children in northern Israel. Scand J Infect Dis. 1995, 27 (2): 139-144. 10.3109/00365549509018994.CrossRefPubMed
26.
Wohlfarth TD, van den Brink W, Winkel FW, ter Smitten M: Screening for Posttraumatic Stress Disorder: an evaluation of two self-report scales among crime victims. Psychol Assess. 2003, 15 (1): 101-109.CrossRefPubMed
27.
van der Ploeg E, Mooren TT, Kleber RJ, van der Velden PG, Brom D: Construct validation of the Dutch version of the impact of event scale. Psychol Assess. 2004, 16 (1): 16-26.CrossRefPubMed
28.
Drummond M, O'Brien B, Stoddart GL, Torrance GW: Methods for the Economic Evaluation of Health Care Programmes. 1997, Oxford, U.K.: Oxford Medical Publications
29.
Rabin R, de Charro F: EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001, 33 (5): 337-343. 10.3109/07853890109002087.CrossRefPubMed
30.
Coons SJ, Rao S, Keininger DL, Hays RD: A comparative review of generic quality-of-life instruments. Pharmacoeconomics. 2000, 17 (1): 13-35. 10.2165/00019053-200017010-00002.CrossRefPubMed
31.
Van Beeck EF, Larsen CF, Lyons RA, Meerding WJ, Mulder S, Essink-Bot ML: Guidelines for the conduction of follow-up studies measuring injury-related disability. J Trauma. 2007, 62 (2): 534-550. 10.1097/TA.0b013e31802e70c7.CrossRefPubMed
32.
EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol Group Health Policy . 1990, 16 (3): 199-208.
33.
Feeny D, Furlong W, Boyle M, Torrance GW: Multi-attribute health status classification systems. Health Utilities Index. Pharmacoeconomics. 1995, 7 (6): 490-502. 10.2165/00019053-199507060-00004.CrossRefPubMed
34.
Dolan P: Modeling valuations for EuroQol health states. Med Care. 1997, 35 (11): 1095-1108. 10.1097/00005650-199711000-00002.CrossRefPubMed
35.
CBS: Permanent onderzoek leefsituatie. 2003, Voorburg/Heerlen: Statistics Netherlands (CBS)
36.
Mosby: Mosby's Medical Dictionary. Elsevier Health Sciences. 2009, 8
37.
Rubin DB, Schenker N: Multiple imputation in health-care databases: an overview and some applications. Stat Med. 1991, 10 (4): 585-598. 10.1002/sim.4780100410.CrossRefPubMed
38.
Polinder S, Meerding WJ, Lyons RA, Haagsma JA, Toet H, Petridou ET, Mulder S, van Beeck EF: International variation in clinical injury incidence: exploring the performance of indicators based on health care, anatomical and outcome criteria. Accid Anal Prev. 2008, 40 (1): 182-191. 10.1016/j.aap.2007.05.001.CrossRefPubMed
39.
Gamper G, Willeit M, Sterz F, Herkner H, Zoufaly A, Hornik K, Havel C, Laggner AN: Life after death: posttraumatic stress disorder in survivors of cardiac arrest--prevalence, associated factors, and the influence of sedation and analgesia. Crit Care Med. 2004, 32 (2): 378-383. 10.1097/01.CCM.0000108880.97967.C0.CrossRefPubMed
40.
Grutters JP, Joore MA, van der Horst F, Verschuure H, Dreschler WA, Anteunis LJ: Choosing between measures: comparison of EQ-5D, HUI2 and HUI3 in persons with hearing complaints. Qual Life Res. 2007, 16 (8): 1439-1449. 10.1007/s11136-007-9237-x.CrossRefPubMedPubMedCentral
41.
Marra CA, Esdaile JM, Anis AH: Practical pharmacogenetics: the cost effectiveness of screening for thiopurine s-methyltransferase polymorphisms in patients with rheumatological conditions treated with azathioprine. J Rheumatol. 2002, 29 (12): 2507-2512.PubMed
42.
Oostenbrink R, HA AM, Essink-Bot ML: The EQ-5D and the Health Utilities Index for permanent sequelae after meningitis: a head-to-head comparison. J Clin Epidemiol. 2002, 55 (8): 791-799. 10.1016/S0895-4356(02)00448-1.CrossRefPubMed
43.
Saarni SI, Suvisaari J, Sintonen H, Pirkola S, Koskinen S, Aromaa A, Lonnqvist J: Impact of psychiatric disorders on health-related quality of life: general population survey. Br J Psychiatry. 2007, 190: 326-332. 10.1192/bjp.bp.106.025106.CrossRefPubMed
44.
Neal LA, Busuttil W, Rollins J, Herepath R, Strike P, Turnbull G: Convergent validity of measures of post-traumatic stress disorder in a mixed military and civilian population. J Trauma Stress. 1994, 7 (3): 447-455. 10.1002/jts.2490070310.CrossRefPubMed
45.
Shalev AY, Freedman S, Peri T, Brandes D, Sahar T: Predicting PTSD in trauma survivors: prospective evaluation of self-report and clinician-administered instruments. Br J Psychiatry. 1997, 170: 558-564. 10.1192/bjp.170.6.558.CrossRefPubMed
46.
Postulart D, Adang EM: Response shift and adaptation in chronically ill patients. Med Decis Making. 2000, 20 (2): 186-193. 10.1177/0272989X0002000204.CrossRefPubMed
47.
Jansen SJ, Stiggelbout AM, Nooij MA, Noordijk EM, Kievit J: Response shift in quality of life measurement in early-stage breast cancer patients undergoing radiotherapy. Qual Life Res. 2000, 9 (6): 603-615. 10.1023/A:1008928617014.CrossRefPubMed
48.
Lyons RA, Polinder S, Larsen CF, Mulder S, Meerding WJ, Toet H, Van Beeck E: Methodological issues in comparing injury incidence across countries. Int J Inj Contr Saf Promot. 2006, 13 (2): 63-70. 10.1080/17457300500258682.CrossRefPubMed
49.
Hebert R, Bravo G, Korner-Bitensky N, Voyer L: Refusal and information bias associated with postal questionnaires and face-to-face interviews in very elderly subjects. J Clin Epidemiol. 1996, 49 (3): 373-381. 10.1016/0895-4356(95)00527-7.CrossRefPubMed
Metadata
Title
Posttraumatic stress symptoms and health-related quality of life: a two year follow up study of injury treated at the emergency department
Authors
Juanita A Haagsma
Suzanne Polinder
Miranda Olff
Hidde Toet
Gouke J Bonsel
Ed F van Beeck
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-12-1

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