Prevalence and predictors of post-traumatic stress symptoms in 2200 hospitalised and non-hospitalised injured New Zealanders

2021 ◽  
pp. 000486742110607
Author(s):  
Shanthi Ameratunga ◽  
Ari Samaranayaka ◽  
Emma H Wyeth ◽  
Gabrielle Davie ◽  
Rebbecca Lilley ◽  
...  
Keyword(s):  
Relative Risk ◽  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Perceived Threat ◽  
Post Traumatic Stress ◽  
Post Injury ◽  
Accident Compensation ◽  
Post Traumatic ◽  
Threat To Life

Objective: Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand’s Accident Compensation Corporation. This government-funded universal no-fault insurance scheme replaced tort-based compensation for injuries in 1974 since when civil litigation (which can bias post-traumatic stress disorder estimates) has been rare. Methods: A total of 2220 Accident Compensation Corporation claimants aged 18–64 years recruited to the Prospective Outcomes of Injury Study were interviewed at 12 months post-injury to identify symptoms suggestive of post-traumatic stress disorder using the Impact of Events Scale. Multivariable models examined the extent to which baseline sociodemographic, injury, health status and service interaction factors predicted the risk of post-traumatic stress disorder symptoms among hospitalised and non-hospitalised groups. Results: Symptoms suggestive of post-traumatic stress disorder were reported by 17% of hospitalised and 12% of non-hospitalised participants. Perceived threat to life at the time of the injury doubled this risk among hospitalised (adjusted relative risk: 2.0; 95% confidence interval: 1.2–3.2) and non-hospitalised (relative risk: 1.8; 95% confidence interval: 1.2–2.8) participants. Among hospitalised participants, other predictors included female gender, Pacific and ‘other’ minority ethnic groups, pre-injury depressive symptoms, financial insecurity and perceived inadequacies in healthcare interactions, specifically information and time to discuss problems. Among non-hospitalised survivors, predictors included smoking, hazardous drinking, assault and poor expectations of recovery. Conclusion: One in six hospitalised and one in eight non-hospitalised people reported post-traumatic stress disorder symptoms 12 months following injury. Perceived threat to life was a strong predictor of this risk in both groups. Identifying early predictors of post-traumatic stress disorder, regardless of whether the injury required hospitalisation, could help target tailored interventions that can reduce longer-term psychosocial morbidity.

Support for the mutual maintenance of pain and post-traumatic stress disorder symptoms

2009 ◽  
Vol 40 (7) ◽  
pp. 1215-1223 ◽  
Author(s):  
A. Liedl ◽  
M. O'Donnell ◽  
M. Creamer ◽  
D. Silove ◽  
A. McFarlane ◽  
...  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Structural Equation ◽  
Stress Disorder ◽  
Traumatic Event ◽  
Saturated Model ◽  
Post Traumatic Stress ◽  
Post Injury ◽  
Post Traumatic ◽  
The Relationship

BackgroundPain and post-traumatic stress disorder (PTSD) are frequently co-morbid in the aftermath of a traumatic event. Although several models attempt to explain the relationship between these two disorders, the mechanisms underlying the relationship remain unclear. The aim of this study was to investigate the relationship between each PTSD symptom cluster and pain over the course of post-traumatic adjustment.MethodIn a longitudinal study, injury patients (n=824) were assessed within 1 week post-injury, and then at 3 and 12 months. Pain was measured using a 100-mm Visual Analogue Scale (VAS). PTSD symptoms were assessed using the Clinician-Administered PTSD Scale (CAPS). Structural equation modelling (SEM) was used to identify causal relationships between pain and PTSD.ResultsIn a saturated model we found that the relationship between acute pain and 12-month pain was mediated by arousal symptoms at 3 months. We also found that the relationship between baseline arousal and re-experiencing symptoms, and later 12-month arousal and re-experiencing symptoms, was mediated by 3-month pain levels. The final model showed a good fit [χ2=16.97, df=12, p>0.05, Comparative Fit Index (CFI)=0.999, root mean square error of approximation (RMSEA)=0.022].ConclusionsThese findings provide evidence of mutual maintenance between pain and PTSD.

scholarly journals Thinking that one's life was in danger: perceived life threat in individuals directly or indirectly exposed to terror

2016 ◽  
Vol 209 (4) ◽  
pp. 306-310 ◽  
Author(s):  
Trond Heir ◽  
Ines Blix ◽  
Charlotte K. Knatten
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Perceived Threat ◽  
Post Traumatic Stress ◽  
Cross Sectional ◽  
Ptsd Checklist ◽  
Post Traumatic ◽  
Life Threat ◽  
Bomb Explosion

BackgroundPerceived life threat is associated with post-traumatic stress disorder (PTSD). Still, it is not known whether perceived threat may be important for PTSD in people indirectly exposed to trauma.AimsTo examine the prevalence of perceived life threat and the association with PTSD in individuals directly or indirectly exposed to terror.MethodData are cross-sectional from a survey 10 months after the 2011 Oslo bombing. Perceived life threat was measured by the question: ‘How great do you think the danger was that you would die?’ scored on a five-point scale. PTSD was measured with the PTSD Checklist (PCL).ResultsThe retrospective belief that one's life was in great or overwhelming danger was reported by 65% and 22% of employees who had been present or not present, respectively, at the site of the bomb explosion (n= 1923). A high perceived life threat was associated with PTSD among those present (odds ratio (OR) = 5.7, 95% CI 1.9–16.9) and not present (OR = 5.2. 95% CI 3.0–9.0), even after adjusting for objective exposure, demographics and neuroticism.ConclusionsPerceived life threat may play a central role in the development and maintenance of PTSD in people directly as well as indirectly exposed to terror. Moderating perceptions of having been in serious danger may be an appropriate approach to the prevention and treatment of PTSD.

Post-traumatic stress disorder: present and future

2010 ◽  
Vol 27 (3) ◽  
pp. i-vi ◽  
Author(s):  
Niall Crumlish
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Acute Stress ◽  
Adjustment Disorder ◽  
Perceived Threat ◽  
Post Traumatic Stress ◽  
Post Traumatic ◽  
Serious Injury ◽  
Prolonged Response

Post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) differ from almost every other psychiatric diagnosis in that they may only be diagnosed with reference to an aetiological event – an external traumatic stressor. ASD occurs immediately after the stressor and is comparatively short-lived, while PTSD is a prolonged abnormal response that may take months to develop. The types of stressor leading to ASD and PTSD are identical and were intended to be tightly defined, involving a perceived threat of death, serious injury or loss of physical integrity.It is useful initially to distinguish ASD and PTSD from adjustment disorders, which are also diagnosed only after an observable life event. An adjustment disorder may be thought of as a gradual and prolonged response to stressful changes in a person's life. The range of stressors precipitating an adjustment disorder is potentially much broader than that precipitating ASD or PTSD, as a threat of death or injury is not needed.Indeed, a ‘threat’ as such is not needed, as the event may be a loss. Events such as job loss or the breakup of a relationship may lead to an adjustment disorder, as well as threats such as accidents or assaults. The diagnostic criteria for adjustment disorder do not specify what the immediate response, if any, to the precipitating stressor must be.

scholarly journals Post-traumatic stress disorder: the neurobiological impact of psychological trauma

2011 ◽  
Vol 13 (3) ◽  
pp. 263-278 ◽  
Keyword(s):  
Post Traumatic Stress Disorder ◽  
Traumatic Stress ◽  
Stress Disorder ◽  
Signs And Symptoms ◽  
Psychological Trauma ◽  
Perceived Threat ◽  
Post Traumatic Stress ◽  
Clinical Syndromes ◽  
Post Traumatic ◽  
Fight Or Flight Response

The classic fight-or-flight response to perceived threat is a reflexive nervous phenomenon thai has obvious survival advantages in evolutionary terms. However, the systems that organize the constellation of reflexive survival behaviors following exposure to perceived threat can under some circumstances become dysregulated in the process. Chronic dysregulation of these systems can lead to functional impairment in certain individuals who become "psychologically traumatized" and suffer from post-traumatic stress disorder (PTSD), A body of data accumulated over several decades has demonstrated neurobiological abnormalities in PTSD patients. Some of these findings offer insight into the pathophysiology of PTSD as well as the biological vulnerability of certain populations to develop PTSD, Several pathological features found in PTSD patients overlap with features found in patients with traumatic brain injury paralleling the shared signs and symptoms of these clinical syndromes.

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