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Psychiatric outcome at least 20 years after trauma

A survey on the status of subjective general health and psychiatric symptoms with a focus on posttraumatic stress disorder

Halvachizadeh, Sascha MD; Teuber, Henrik DO; Allemann, Florin MD; Luidl, Anna Theresa MD; von Känel, Roland MD; Zelle, Boris MD; Tiziani, Simon MD; Rauen, Katrin MD; Pape, Hans-Christoph MD; Pfeifer, Roman MD

Journal of Trauma and Acute Care Surgery: June 2019 - Volume 86 - Issue 6 - p 1027–1032
doi: 10.1097/TA.0000000000002232

BACKGROUND Information on long-term psychiatric sequelae after severe trauma is sparse. We therefore performed a survey addressing several symptoms related to posttraumatic stress disorder (PTSD) in patients who sustained multiple injuries more than 20 years after trauma.

METHODS Patients injured between January 1, 1973, and December 31, 1990, were contacted at least 20 years later. We included multiply injured patients aged between 3 and 60 years from a single level 1 trauma center. A questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD, including individual symptoms related to intrusion, avoidance, and hyperarousal was sent to all patients.

RESULTS A total of 359 patients (56.35%) received a questionnaire. Of these, 337 patients (93.87%) returned the questionnaire and were included in the study (223 males [66.17%] and 114 females [33.82%]). Mean ± SD follow-up was 29.5 ± 8.5 years. Nearly half the study population (47.18%) experienced lasting psychiatric sequelae, such as intrusive recollection (n = 65, 19.28%), avoidance (n = 92, 27.29%), or hyperarousal (n = 95, 28.18%) at least monthly. Ten patients (2.96%) fulfilled all Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnostic criteria for PTSD. A total of 131 patients (38.87%) reported fair or poor general health status. There was no difference in injury severity in patients with or without PTSD (injury severity score, 8.33 vs. 20.36, respectively; p = 0.52) or PTSD-related symptoms including intrusion (19.88 vs. 20.32, p = 0.74), avoidance (19.99 vs. 20.3, p = 0.79), and hyperarousal (19.36 vs. 20.68, p = 0.26).

CONCLUSION At least 20 years after injury, no correlation was found between the development of psychiatric complications and the severity of injury. While the rate of full-blown PTSD was low, nearly half the study population regularly suffered from at least one psychiatric symptom attributable to the initial trauma. Awareness for the development of psychiatric complications and early initiation of psychiatric counseling are advisable.

LEVEL OF EVIDENCE Prognostic and epidemiologic, level II.

From the Department of Trauma (S.H., H.T., F.A., S.T., H.-C.P., R.P.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; Medical University RWTH Aachen (A.T.L.), Aachen, Germany; Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine (R.v.K., K.R.), University Hospital Zurich, University of Zurich, Zurich, Switzerland; and Department of Orthopedic Surgery, University of Texas Health Science Center at San Antonio (B.Z.), San Antonio, Texas.

Submitted: August 8, 2018, Revised: January 8, 2019, Accepted: January 15, 2019, Published online: February 13, 2019.

This study was presented at the 77th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery and 4th World Trauma Congress, San Diego, CA, September, 26–29 2018; WTC Oral Presentation for AAST20180021.

Address for reprints: Sascha Halvachizadeh, MD, Department of Trauma, University Hospital Zurich, University of Zurich, Rämistrasse 100 8091, Zurich, Switzerland; email:

© 2019 Lippincott Williams & Wilkins, Inc.