Prevalence and prognostic factors for psychological distress after trauma.

Abstract Objective To describe the prevalence and prognostic factors of symptoms of anxiety and depression and posttraumatic stress symptoms (PTSS) after injury in the clinical trauma population. Design Multicentre prospective observational cohort study. Setting Ten hospitals in Noord-Brabant, the Netherlands. Participants 4,239 adult trauma patients admitted between August 2015 and December 2016 Interventions Patients were asked to complete a questionnaire at one week, and one, three, six and twelve months after injury. Main Outcome Measures The Hospital Anxiety and Depression Scale was used to assess anxiety and depressive symptoms and the Impact of Event Scale was used to assess PTSS. Results The prevalence of symptoms of anxiety and depression decreased from 10% and 12% respectively at one week after injury to 7% and 7% at twelve months after injury. Acute traumatic stress symptoms were present in 13% at one week and PTSS was prevalent in 10% of the participants at twelve months after injury. Strong prognostic factors for poor psychological outcome in multivariable logistic mixed models were pre-injury frailty, psychological complaints and non-working status pre-injury, female gender, low educational level and accident category (i.e. traffic accident, work-related or accidents at home compared to sport injuries). Conclusion Psychological distress is a common health problem during the first year after injury. Important prognostic factors for psychological distress include psychological complaints before injury and frailty. Early recognition of psychological problems after injury could facilitate discussion between caregivers and patients and improve recovery.