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

Abstract

BackgroundAmong 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.MethodsWe 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.ResultsSymptoms 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.ConclusionsAmong 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.

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

“…In our study the EQ-5D summary scores showed that injury patients with had a mean utility loss of 0.23 -0.45 compared to injury patients without PTSD. This corresponds with the utility loss of 0.23-0.33 of patients with PTSD compared to those without found by Haagsma et al in a similar sample of injury patients [12].…”

“…The lowresponse rates may have led to selection bias and in its turn to under-or overestimation of the prevalence of PTSD [20]. In the case of our study there was the risk of overestimation, since women were overrepresented while female gender is thought to be a predictor of PTSD [1,12,29,30]. Also patients who demonstrated PTSD symptoms at a previous time point tended to respond to the questionnaire more often, who are likely to still have PTSD at later time points.…”

“…However, these studies were again restricted to victims at the higher end of the severity spectrum. In a study that included a comprehensive population of injury patients the impact of PTSD on HRQoL was measured at 24 months post-injury only [12]. A longitudinal study on PTSD and HRQoL with multiple assessments over time might elucidate the association between PTSD and reduced HRQoL further.…”

Cannabis use and symptom severity in individuals at ultra high risk for psychosis: a meta‐analysis

“…Authors were contacted if it was unclear whether samples overlapped. To avoid bias, studies using UHR individuals recruited solely from prisons, or young offender institutions were excluded 22 as substance use in these groups tends to be higher than in the general population 23.…”

Symptoms of posttraumatic stress disorder after exposure to biological material

“…21 During the interviews, at the time of data collection, some individuals reported a delay in the results of the exams of the source patient, with this situation generating an intense feeling of fear and anguish. Some authors have also shown this in their findings, reporting that waiting times for definitive blood test results cause anxiety and increase the duration of some psychiatric consequences following the exposure.…”