The role of post-traumatic stress disorder and depression in predicting disability after injury

Objectives: To examine the relationship between psychological response to injury at 1 week and 3 months, and disability at 12 months. Design: Multisite, longitudinal study. Participants and setting: 802 adult patients admitted to trauma services at four Australian hospitals from 13 March 2004 to 21 February 2006 were assessed before discharge and followed up at 3 and 12 months. Main outcome measure: Disability, measured with the 12-item version of the World Health Organization Disability Assessment Schedule II. Results: Logistic regression identified the degree to which high levels of depression and post-traumatic stress disorder (PTSD) at 1 week and at 3 months predicted disability at 12 months. After controlling for demographic variables and characteristics of the injury, patients with PTSD or subsyndromal PTSD at 1 week were 2.4 times more likely, and those with depression at 1 week were 1.9 times more likely to have high disability levels at 12 months. PTSD at 3 months was associated with 3.7 times, and depression at 3 months with 3.4 times the risk of high disability at 12 months. Conclusions: PTSD and depression at 1 week and at 3 months after injury significantly increased the risk of disability at 12 months. Routine assessment of symptoms of depression and PTSD in patients who have been physically injured may facilitate triage to evidence-based treatments, leading to improvement in both physical and psychological outcomes. MJA 2009; 190: S71-S74