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

Douglas F. Zatzick, Frederick P. Rivara, Avery B. Nathens, Gregory Jurkovich, Jin Wang, Ming Yu Fan, Joan Russo, David S. Salkever, Ellen J. Mackenzie

Research output: Contribution to journalArticle

153 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1469-1480
Number of pages12
JournalPsychological Medicine
Volume37
Issue number10
DOIs
StatePublished - Oct 1 2007
Externally publishedYes

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Post-Traumatic Stress Disorders
Hospitalization
Wounds and Injuries
Survivors
Confidence Intervals
Insurance
Checklist
Benzodiazepines
Hispanic Americans
Diagnostic and Statistical Manual of Mental Disorders
Medical Records
Prescriptions
Intensive Care Units
Patient Care
Depression
Pain

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

Cite this

Zatzick, D. F., Rivara, F. P., Nathens, A. B., Jurkovich, G., Wang, J., Fan, M. Y., ... Mackenzie, E. J. (2007). A nationwide US study of post-traumatic stress after hospitalization for physical injury. Psychological Medicine, 37(10), 1469-1480. https://doi.org/10.1017/S0033291707000943

A nationwide US study of post-traumatic stress after hospitalization for physical injury. / Zatzick, Douglas F.; Rivara, Frederick P.; Nathens, Avery B.; Jurkovich, Gregory; Wang, Jin; Fan, Ming Yu; Russo, Joan; Salkever, David S.; Mackenzie, Ellen J.

In: Psychological Medicine, Vol. 37, No. 10, 01.10.2007, p. 1469-1480.

Research output: Contribution to journalArticle

Zatzick, DF, Rivara, FP, Nathens, AB, Jurkovich, G, Wang, J, Fan, MY, Russo, J, Salkever, DS & Mackenzie, EJ 2007, 'A nationwide US study of post-traumatic stress after hospitalization for physical injury', Psychological Medicine, vol. 37, no. 10, pp. 1469-1480. https://doi.org/10.1017/S0033291707000943
Zatzick, Douglas F. ; Rivara, Frederick P. ; Nathens, Avery B. ; Jurkovich, Gregory ; Wang, Jin ; Fan, Ming Yu ; Russo, Joan ; Salkever, David S. ; Mackenzie, Ellen J. / A nationwide US study of post-traumatic stress after hospitalization for physical injury. In: Psychological Medicine. 2007 ; Vol. 37, No. 10. pp. 1469-1480.
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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.",
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AU - Zatzick, Douglas F.

AU - Rivara, Frederick P.

AU - Nathens, Avery B.

AU - Jurkovich, Gregory

AU - Wang, Jin

AU - Fan, Ming Yu

AU - Russo, Joan

AU - Salkever, David S.

AU - Mackenzie, Ellen J.

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N2 - 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.

AB - 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.

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