Psychological Medicine

Original Article

A nationwide US study of post-traumatic stress after hospitalization for physical injury

DOUGLAS F. ZATZICKa1a3 c1, FREDERICK P. RIVARAa1, AVERY B. NATHENSa2, GREGORY J. JURKOVICHa1, JIN WANGa1, MING-YU FANa3, JOAN RUSSOa3, DAVID S. SALKEVERa4 and ELLEN J. MACKENZIEa4

a1 Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA

a2 St Michael's Hospital, University of Toronto, Canada

a3 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

a4 Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, Baltimore, MD, USA

ABSTRACT

Background Injured survivors of individual and mass trauma are at risk for developing post-traumatic stress disorder (PTSD). Few investigations have assessed PTSD after injury in large samples across diverse acute care hospital settings.

Method A total of 2931 injured trauma survivors aged 18–84 who were representative of 9983 in-patients were recruited from 69 hospitals across the USA. In-patient medical records were abstracted, and hospitalized patients were interviewed at 3 and 12 months after injury. Symptoms consistent with a DSM-IV diagnosis of PTSD were assessed with the PTSD Checklist (PCL) 12 months after injury.

Results Approximately 23% of injury survivors had symptoms consistent with a diagnosis of PTSD 12 months after their hospitalization. Greater levels of early post-injury emotional distress and physical pain were associated with an increased risk of symptoms consistent with a PTSD diagnosis. Pre-injury, intensive care unit (ICU) admission [relative risk (RR) 1·17, 95% confidence interval (CI) 1·02–1·34], pre-injury depression (RR 1·33, 95% CI 1·15–1·54), benzodiazepine prescription (RR 1·46, 95% CI 1·17–1·84) and intentional injury (RR 1·32, 95% CI 1·04–1·67) were independently associated with an increased risk of symptoms consistent with a PTSD diagnosis. White injury survivors without insurance demonstrated approximately twice the rate of symptoms consistent with a diagnosis of PTSD when compared to white individuals with private insurance. By contrast, for Hispanic injury survivors PTSD rates were approximately equal between uninsured and privately insured individuals.

Conclusions Nationwide in the USA, more than 20% of injured trauma survivors have symptoms consistent with a diagnosis of PTSD 12 months after acute care in-patient hospitalization. Coordinated investigative and policy efforts could target mandates for high-quality PTSD screening and intervention in acute care medical settings.

(Online publication June 11 2007)

Correspondence

c1 Address for correspondence: Douglas Zatzick, M.D., Associate Professor, Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington, School of Medicine, Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA. (Email: dzatzick@u.washington.edu)

Footnotes

A preliminary version of this manuscript was presented at the National Institute of Drug Abuse Meeting on Disasters and Substance Abuse, Bethesda, MD, USA, on 7 December 2006.

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