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Posttraumatic Stress Disorder after Injury: Impact on General Health Outcome and Early Risk Assessment

Michaels, Andrew J. MD, MPH; Michaels, Claire E. MD, MA; Moon, Christina H. BA; Smith, Joshua S. BA; Zimmerman, Marc A. PhD; Taheri, Paul A. MD, MBA; Peterson, Christopher PhD

The Journal of Trauma: Injury, Infection, and Critical Care: September 1999 - Volume 47 - Issue 3 - p 460-467

Objective: To evaluate prospectively components of general health outcome after trauma and to report on the further validation of the Michigan Critical Events Perception Scale (MCEPS), an instrument that predicts increased risk for post-traumatic stress disorder (PTSD).

Methods: Adults without neurologic injury admitted to a Level I trauma center in 1997 were interviewed during hospitalization. Baseline data included demographics, injury mechanism, Injury Severity Score, the Short Form 36 (SF36), and the MCEPS, which measures peri-traumatic dissociation (the sense of depersonalization or derealization during an injury event). Surveys sent by mail and completed 6 months later included the SF36 and civilian Mississippi Scale for PTSD.

Results: A total of 140 patients were interviewed; the 70% (n = 100 patients) who completed the 6-month assessment form the study group. Injuries were categorized as 71% blunt, 13% penetrating, and 16% burn. Mean Injury Severity Score was 13.7 ±0.52. PTSD at 6 months occurred in 42% of the patients and was directly related to MCEPS dissociation (p = 0.001; odds ratio = 3.1; 95% confidence interval, 1.6, 5.9). A stepwise linear regression explains 40% of the variance in 6-month SF36 general health outcome (adjusted R 2 = 0.402). The model controls for individual factors related to dissociation, PTSD, and general health outcome. Development of PTSD was independently and inversely related to general health outcome as measured by the SF36 at 6 months (p < 0.001, β = −0.404). The R 2 change of 0.132 for PTSD (vs. 0.082 for 6-month physical function) illustrates that PTSD contributes more to the patient's perceived general health at 6 months than the degree of physical function or injury severity.

Conclusions: Within hours of injury, the MCEPS identifies patients who are three times more likely to develop PTSD. PTSD compromises self-reported general health outcome in injured adults independent of baseline status, Injury Severity Score, or degree of physical recovery. These data suggest that psychological morbidity is an important part of the patient's perceived general health.

From Trauma Services, Legacy/Emanuel Hospital, Portland, Oregon, and Departments of Surgery and Psychology, and the School of Public Health, University of Michigan, Ann Arbor, Michigan.

This research was supported in part by the Robert Wood Johnson Foundation.

Presented at the 12th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 14, 1999, Orlando, Florida.

Address for reprints: Andy Michaels, MD, Trauma Services, Legacy Emanuel Hospital, 501 North Graham, Suite 130, Portland, OR 97227; email:

© 1999 Lippincott Williams & Wilkins, Inc.