Psychological morbidity and health-related quality of life after injury: multicentre cohort study

Abstract

Purpose To demonstrate the impact of psychological morbidity 1 month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services.Methods Multicentre cohort study of 16–70-year-olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and 1, 2, 4 and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity 1 month post-injury and MID in HRQoL over the 12 months after injury.ResultsA total of 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% reported a MID at 1 month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores 1 month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study.ConclusionsHospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury.Electronic supplementary materialThe online version of this article (doi:10.1007/s11136-016-1439-7) contains supplementary material, which is available to authorized users.

Survey of Psychiatric Disorders and Quality of Life among Kaohsiung Gas Explosion Victims 12 Months after the Event

“…Psychological problems after a traumatic event can cause more damage than the impact of changes in material QoL [8]. Many disaster studies have found that physical injuries, work ability, financial problems, postdisaster mental illness and QoL are closely related [8,11,13]. A year after the disaster, we can not only still observe the effects of psychological problems but also see the increasing impact and inconvenience of serious physical injuries on financial problems.…”

“…Additionally, only occupation was not associated with VT. Psychological problems after a traumatic event can cause more damage than the impact of changes in material QoL [8]. Many disaster studies have found that physical injuries, work ability, financial problems, postdisaster mental illness and QoL are closely related [8,11,13].…”

“…The DRPST was initially designed to enable effective and rapid screening of MDE and PTSD in disaster survivors [1][2][3] and policemen/firefighters [8,14,16] (including 17 items for PTSD and 9 items for MDEs) according to the DSM-IV criteria. A seven-symptom scale and a three-symptom analog scale were selected for PTSD and MDE screening, respectively.…”

“…A seven-symptom scale and a three-symptom analog scale were selected for PTSD and MDE screening, respectively. Scores of 4 or higher on the PTSD scale were used to define the group of survivors with PTSD; this method has been validated in previous studies [1][2][3]8,15,16]. The positive predictive value of this cutoff score was 97.2%, and the negative predictive value was 97.4%.…”

“…Following a disaster, psychological problems have a greater impact on quality of life than injuries [8]. Health-related quality of life (HRQoL) includes physical, mental, and social dimensions.…”