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Open Access Research article

Prevalence rate, predictors and long-term course of probable posttraumatic stress disorder after major trauma: a prospective cohort study

Juanita A Haagsma1*, Akkie N Ringburg24, Esther MM van Lieshout2, Ed F van Beeck1, Peter Patka2, Inger B Schipper3 and Suzanne Polinder1

Author Affiliations

1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, 3000, CA, The Netherlands

2 Department of Surgery–Traumatology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam, 3000, CA, the Netherlands

3 Department of Surgery-Traumatology, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300, RC, the Netherlands

4 Department of Surgery, Ikazia Hospital, Montessoriweg 1, Rotterdam, 3083, AN, The Netherlands

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BMC Psychiatry 2012, 12:236  doi:10.1186/1471-244X-12-236

Published: 27 December 2012

Abstract

Background

Among trauma patients relatively high prevalence rates of posttraumatic stress disorder (PTSD) have been found. To identify opportunities for prevention and early treatment, predictors and course of PTSD need to be investigated. Long-term follow-up studies of injury patients may help gain more insight into the course of PTSD and subgroups at risk for PTSD. The aim of our long-term prospective cohort study was to assess the prevalence rate and predictors, including pre-hospital trauma care (assistance of physician staffed Emergency Medical Services (EMS) at the scene of the accident), of probable PTSD in a sample of major trauma patients at one and two years after injury. The second aim was to assess the long-term course of probable PTSD following injury.

Methods

A prospective cohort study was conducted of 332 major trauma patients with an Injury Severity Score (ISS) of 16 or higher. We used data from the hospital trauma registry and self-assessment surveys that included the Impact of Event Scale (IES) to measure probable PTSD symptoms. An IES-score of 35 or higher was used as indication for the presence of probable PTSD.

Results

One year after injury measurements of 226 major trauma patients were obtained (response rate 68%). Of these patients 23% had an IES-score of 35 or higher, indicating probable PTSD. At two years after trauma the prevalence rate of probable PTSD was 20%. Female gender and co-morbid disease were strong predictors of probable PTSD one year following injury, whereas minor to moderate head injury and injury of the extremities (AIS less than 3) were strong predictors of this disorder at two year follow-up. Of the patients with probable PTSD at one year follow-up 79% had persistent PTSD symptoms a year later.

Conclusions

Up to two years after injury probable PTSD is highly prevalent in a population of patients with major trauma. The majority of patients suffered from prolonged effects of PTSD, underlining the importance of prevention, early detection, and treatment of injury-related PTSD.

Keywords:
Major trauma; Posttraumatic stress disorder; Follow-up study