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

Sascha Halvachizadeh, Henrik Teuber, Florin Allemann, Anna Theresa Luidl, Roland Von Känel, Boris A Zelle, Simon Tiziani, Katrin Rauen, Hans Christoph Pape, Roman Pfeifer

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1027-1032
Number of pages6
JournalJournal of Trauma and Acute Care Surgery
Volume86
Issue number6
DOIs
StatePublished - Jun 1 2019

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Diagnostic Self Evaluation
Post-Traumatic Stress Disorders
Psychiatry
Wounds and Injuries
Diagnostic and Statistical Manual of Mental Disorders
Surveys and Questionnaires
Injury Severity Score
Multiple Trauma
Trauma Centers
Population
Health Status
Counseling

Keywords

  • arousal
  • avoidance
  • intrusion
  • long-term follow-up
  • multiple trauma
  • psychiatric complication
  • PTSD
  • severe injury

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

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; Teuber, Henrik; Allemann, Florin; Luidl, Anna Theresa; Von Känel, Roland; Zelle, Boris A; Tiziani, Simon; Rauen, Katrin; Pape, Hans Christoph; Pfeifer, Roman.

In: Journal of Trauma and Acute Care Surgery, Vol. 86, No. 6, 01.06.2019, p. 1027-1032.

Research output: Contribution to journalArticle

Halvachizadeh, Sascha ; Teuber, Henrik ; Allemann, Florin ; Luidl, Anna Theresa ; Von Känel, Roland ; Zelle, Boris A ; Tiziani, Simon ; Rauen, Katrin ; Pape, Hans Christoph ; Pfeifer, Roman. / 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. In: Journal of Trauma and Acute Care Surgery. 2019 ; Vol. 86, No. 6. pp. 1027-1032.
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abstract = "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.",
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AU - Allemann, Florin

AU - Luidl, Anna Theresa

AU - Von Känel, Roland

AU - Zelle, Boris A

AU - Tiziani, Simon

AU - Rauen, Katrin

AU - Pape, Hans Christoph

AU - Pfeifer, Roman

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N2 - 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.

AB - 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.

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KW - avoidance

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KW - multiple trauma

KW - psychiatric complication

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