Coping with Serious Accidental Injury: A One-Year Follow-Up Study

Abstract

Background: The aim of this study was to analyze changes of coping strategies in severely injured accident victims over time and to compare patients with high and low posttraumatic stress disorder (PTSD) symptom levels with regard to their coping patterns and accident-related cognitions. Methods: 106 consecutive patients with severe accidental injuries admitted to a trauma surgery intensive care unit (ICU) were assessed within 1 month after the trauma and 6 and 12 months later. Assessments included a clinical interview, the Freiburg Questionnaire of Coping with Illness, the patients’ accident-related cognitions, the Clinician-Administered PTSD Scale, the 90-item revised Symptom Checklist (SCL-90-R), and the Sense of Coherence Questionnaire (SOC). Patients who met the criteria for either full or subsyndromal PTSD at least once over the observation period (36 subjects; 34.0%) were assigned to a highly symptomatic group (HSG), the remainder (70 subjects; 66.0%) to a less symptomatic group. Results: Overall, active problem-focused coping was predominant immediately after the accident and declined over time, with a stronger decrease in the HSG. Patients in the HSG scored higher on the SCL Global Severity Index and lower on the SOC. The patients’ subjective appraisal of accident severity was higher in the HSG, whereas there was no group difference with regard to accident-related variables such as type of accident, injury severity and mild to moderate traumatic brain injury. Conclusions: Active problem-focused coping, although utilized most frequently and often regarded as protective, might be an inadequate strategy in face of acute stress following a severe accident. Clinicians should not expect their patients to cope very actively in the acute ICU phase. In the subsequent rehabilitation, active coping seems to be more adaptive.

Treating Acute Stress Disorder and Posttraumatic Stress Disorder with Cognitive Behavioral Therapy or Structured Writing Therapy: A Randomized Controlled Trial

“…SWT encourages patients to reflect upon their coping strategies in response to the trauma, which intricately relate to the development and maintenance of PTSD [42]. In addition, SWT aims to promote social sharing and support, the lack of which is a major predictor of PTSD [43].…”

The Handbook of Salutogenesis

“…Posttraumatic stress symptoms did not correlate with injury severity but with pretraumatic stressors, the patients' subjective appraisal of the accident, their current coping pattern, and with their sense of coherence. The authors also found that traumatic events such as life-threatening accidents may change a person's sense of coherence, even if psychiatric symptoms abate Schnyder, Moergeli, Trentz, Klaghofer, & Buddeberg, 2001;Schnyder, Moergeli, Klaghofer, Sensky, & Buchi, 2003), but that sense of coherence has no predicting value for the development of posttraumatic stress disorders after severe injuries (Hepp, Moergeli, Buchi, Wittmann, & Schnyder, 2005;Wittmann, Moergeli, MartinSoelch, Znoj, & Schnyder, 2008). The relationship of sense of coherence to the psychosocial effects of health problems was confirmed by the same group of authors in patients with rheumatic rheumatoid arthritis (Schnyder, Büchi, Mörgeli, Sensky, & Klaghofer, 1999).…”

Posttraumatic Stress Disorder Following Injury: Trajectories and Impact on Health-Related Quality of Life

“…Additionally, this study was not restricted to particular injury subgroups, whereas most studies regarding the prevalence of PTSD among injury patients concern specific groups of injury patients such as victims of motor vehicle accidents or victims with severe injuries [9,[31][32][33][34]. The high variety of type of injury and injury severity included in this study and the relatively large sample size allowed examination of the association of a number of patient and injury characteristics and PTSD.…”