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Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries

Bell, Teresa M., PhD; Vetor, Ashley N., MPH; Zarzaur, Ben L., MD, MPH

Journal of Trauma and Acute Care Surgery: November 2018 - Volume 85 - Issue 5 - p 999–1006
doi: 10.1097/TA.0000000000001992
EAST Journal Club

BACKGROUND Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and posttraumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment.

METHODS Adults (18 and older) admitted to a Level I trauma center with an injury severity score greater than 10 but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological Studies—Depression and PTSD CheckList—Civilian Versions surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis.

RESULTS Five hundred injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3%, 1 month; 49.9%, 2 months; 49.0%, 4 months; and 50.2%, 12 months). Only 22.2% of depressed patients reported receiving treatment for depression; 44.4% of patients screened positive for PTSD (26.6%, 1 month; 27.8%, 2 months; 29.8%, 4 months; and 30.0%, 12 months), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (odds ratio, 0.44; 95% confidence interval, 0.21–0.95).

CONCLUSION Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury.

LEVEL OF EVIDENCE Therapeutic/Care management, level IV.

From the Department of Surgery (T.M., A.N., B.L.Z.), School of Medicine, Indiana University, Indianapolis, Indiana.

Submitted: February 15, 2018, Revised: April 26, 2018, Accepted: May 8, 2018, Published online: May 30, 2018.

Presented at the 48th Annual Meeting of the Western Trauma Association, February 2018, in Whistler, British Columbia, Canada.

Research reported in this publication was supported by the National Institute of General Medical Science of the National Institutes of Health under award number K23GM084427 as well as KL2TR001106, and UL1TR001108 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award; the IUPUI Research Support Funds Grant; and the IU Grand Challenge Initiative. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Address for reprints: Ben L. Zarzaur, MD, MPH, 720 Eskenazi Ave, H-2 Room 431, Indianapolis, IN 46202; email:

© 2018 Lippincott Williams & Wilkins, Inc.