Skip to main content
Emergency Medicine Journal : EMJ logoLink to Emergency Medicine Journal : EMJ
. 2002 Sep;19(5):400–404. doi: 10.1136/emj.19.5.400

The psychological burden of injury: an 18 month prospective cohort study

S Mason 1, J Wardrope 1, G Turpin 1, A Rowlands 1
PMCID: PMC1725976  PMID: 12204984

Abstract

Objectives: To determine the prevalence of post-trauma psychological problems among a cohort of male accident and emergency department patients admitted to hospital. To identify the changes in their psychological symptoms over an 18 month follow up period.

Methods: A prospective cohort study of male accident and emergency department patients who were admitted for treatment of an injury. Baseline interview recorded demographic details and accident details. Standardised questionnaires measured baseline psychological state and personality type. Follow up at six weeks, six months, and 18 months after injury was by face to face interview or postal questionnaire and recorded progress since injury, and documented psychological status through the use of standardised questionnaires to detect psychiatric disorder and symptoms of post-traumatic stress disorder (PTSD).

Results: 210 male patients were recruited into the study. Psychiatric disorder was identified in 47.6% of responders at six weeks, and 43.4% at six months after injury. This improved significantly at 18 months. PTSD symptoms were moderate in 25%–30% and severe in 5%–14% and did not change significantly over the study period. A significant relation was found between previous psychiatric history and psychological symptoms at 18 months after injury. No relation was identified between injury severity and psychological status after injury.

Conclusion: This study finds a high prevalence of psychological distress in male accident and emergency department patients after injury. Although some symptoms resolve over the follow up period, a proportion remain and may be related to previous psychiatric history. There was no relation identified between severity of injury and psychological morbidity.

Full Text

The Full Text of this article is available as a PDF (129.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Banks M. H. Validation of the General Health Questionnaire in a young community sample. Psychol Med. 1983 May;13(2):349–353. doi: 10.1017/s0033291700050972. [DOI] [PubMed] [Google Scholar]
  2. Bisson J. I., Jenkins P. L., Alexander J., Bannister C. Randomised controlled trial of psychological debriefing for victims of acute burn trauma. Br J Psychiatry. 1997 Jul;171:78–81. doi: 10.1192/bjp.171.1.78. [DOI] [PubMed] [Google Scholar]
  3. Blanchard E. B., Hickling E. J., Mitnick N., Taylor A. E., Loos W. R., Buckley T. C. The impact of severity of physical injury and perception of life threat in the development of post-traumatic stress disorder in motor vehicle accident victims. Behav Res Ther. 1995 Jun;33(5):529–534. doi: 10.1016/0005-7967(94)00079-y. [DOI] [PubMed] [Google Scholar]
  4. Breslau N., Davis G. C., Andreski P., Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry. 1991 Mar;48(3):216–222. doi: 10.1001/archpsyc.1991.01810270028003. [DOI] [PubMed] [Google Scholar]
  5. Breslau N., Davis G. C. Posttraumatic stress disorder in an urban population of young adults: risk factors for chronicity. Am J Psychiatry. 1992 May;149(5):671–675. doi: 10.1176/ajp.149.5.671. [DOI] [PubMed] [Google Scholar]
  6. Bryant R. A., Harvey A. G. Avoidant coping style and post-traumatic stress following motor vehicle accidents. Behav Res Ther. 1995 Jul;33(6):631–635. doi: 10.1016/0005-7967(94)00093-y. [DOI] [PubMed] [Google Scholar]
  7. Ehlers A., Mayou R. A., Bryant B. Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnorm Psychol. 1998 Aug;107(3):508–519. doi: 10.1037//0021-843x.107.3.508. [DOI] [PubMed] [Google Scholar]
  8. Feinstein A., Dolan R. Predictors of post-traumatic stress disorder following physical trauma: an examination of the stressor criterion. Psychol Med. 1991 Feb;21(1):85–91. doi: 10.1017/s0033291700014689. [DOI] [PubMed] [Google Scholar]
  9. Frommberger U. H., Stieglitz R. D., Nyberg E., Schlickewei W., Kuner E., Berger M. Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims. Eur Arch Psychiatry Clin Neurosci. 1998;248(6):316–321. doi: 10.1007/s004060050057. [DOI] [PubMed] [Google Scholar]
  10. Goldberg D. P., Hillier V. F. A scaled version of the General Health Questionnaire. Psychol Med. 1979 Feb;9(1):139–145. doi: 10.1017/s0033291700021644. [DOI] [PubMed] [Google Scholar]
  11. Green M. M., McFarlane A. C., Hunter C. E., Griggs W. M. Undiagnosed post-traumatic stress disorder following motor vehicle accidents. Med J Aust. 1993 Oct 18;159(8):529–534. doi: 10.5694/j.1326-5377.1993.tb138006.x. [DOI] [PubMed] [Google Scholar]
  12. Hobbs M., Mayou R., Harrison B., Worlock P. A randomised controlled trial of psychological debriefing for victims of road traffic accidents. BMJ. 1996 Dec 7;313(7070):1438–1439. doi: 10.1136/bmj.313.7070.1438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Horowitz M., Wilner N., Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med. 1979 May;41(3):209–218. doi: 10.1097/00006842-197905000-00004. [DOI] [PubMed] [Google Scholar]
  14. Joy D., Probert R., Bisson J. I., Shepherd J. P. Posttraumatic stress reactions after injury. J Trauma. 2000 Mar;48(3):490–494. doi: 10.1097/00005373-200003000-00020. [DOI] [PubMed] [Google Scholar]
  15. Kessler R. C., Sonnega A., Bromet E., Hughes M., Nelson C. B. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995 Dec;52(12):1048–1060. doi: 10.1001/archpsyc.1995.03950240066012. [DOI] [PubMed] [Google Scholar]
  16. Koren D., Arnon I., Klein E. Acute stress response and posttraumatic stress disorder in traffic accident victims: a one-year prospective, follow-up study. Am J Psychiatry. 1999 Mar;156(3):367–373. doi: 10.1176/ajp.156.3.367. [DOI] [PubMed] [Google Scholar]
  17. Mayou R., Bryant B., Duthie R. Psychiatric consequences of road traffic accidents. BMJ. 1993 Sep 11;307(6905):647–651. doi: 10.1136/bmj.307.6905.647. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Norris F. H. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol. 1992 Jun;60(3):409–418. doi: 10.1037//0022-006x.60.3.409. [DOI] [PubMed] [Google Scholar]
  19. Perry S., Difede J., Musngi G., Frances A. J., Jacobsberg L. Predictors of posttraumatic stress disorder after burn injury. Am J Psychiatry. 1992 Jul;149(7):931–935. doi: 10.1176/ajp.149.7.931. [DOI] [PubMed] [Google Scholar]
  20. Shalev A. Y., Freedman S., Peri T., Brandes D., Sahar T., Orr S. P., Pitman R. K. Prospective study of posttraumatic stress disorder and depression following trauma. Am J Psychiatry. 1998 May;155(5):630–637. doi: 10.1176/ajp.155.5.630. [DOI] [PubMed] [Google Scholar]
  21. Shepherd J. P., Qureshi R., Preston M. S., Levers B. G. Psychological distress after assaults and accidents. BMJ. 1990 Oct 13;301(6756):849–850. doi: 10.1136/bmj.301.6756.849. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Singh B., Lewin T., Raphael B., Johnston P., Walton J. Minor psychiatric morbidity in a casualty population: identification, attempted intervention and six-month follow-up. Aust N Z J Psychiatry. 1987 Jun;21(2):231–240. doi: 10.3109/00048678709160916. [DOI] [PubMed] [Google Scholar]
  23. White A. C. Psychiatric study of patients with severe burn injuries. Br Med J (Clin Res Ed) 1982 Feb 13;284(6314):465–467. doi: 10.1136/bmj.284.6314.465. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Zigmond A. S., Snaith R. P. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Web-only Table]

Articles from Emergency Medicine Journal : EMJ are provided here courtesy of BMJ Publishing Group

RESOURCES