Kenleigh Roden-Foreman

Perceived injustice after traumatic injury: Associations with pain, psychological distress, and quality of life outcomes 12 months after injury.

OBJECTIVE There is growing recognition that individuals who experience traumatic injuries perceive themselves as victims of injustice and that elevated levels of perceived injustice are associated with problematic physical and psychological outcomes. To date, research regarding injustice perception and injury outcomes has been restricted to a small number of musculoskeletal pain conditions. No research to date has examined the potential impact of perceived injustice among individuals admitted for trauma care. METHOD As part of this cross-sectional study, individuals (n = 155) admitted to a Level-1 trauma center completed measures of perceived injustice, pain, depression, posttraumatic stress, and health related (physical and mental/emotional) quality of life (HRQoL) outcomes 12 months after trauma admission. RESULTS Bivariate analyses revealed significant associations between perceived injustice and demographic variables (education, income, race, and age) as well as injury-related variables (type of injury and length of hospital stay). Perceived injustice was correlated with greater pain intensity, depression, and PTSD symptoms, as well as poorer physical and mental HRQoL. Controlling for relevant demographic and injury-related variables, perceived injustice accounted for unique variance in pain intensity, depression severity, the presence and intensity of PTSD symptoms, mental HRQoL, and was marginally significant for physical HRQoL. CONCLUSIONS This is the first study to examine perceived injustice in a trauma sample. Results support the presence of injustice perception in this group and its associations with pain and quality of life outcomes. Additional research is suggested to explore the impact of perceived injustice on recovery outcomes among individuals who have sustained traumatic injury.

Posttraumatic stress disorder following traumatic injury at 6 months: associations with alcohol use and depression.

BACKGROUND Posttraumatic stress disorder (PTSD) is progressively recognized as a psychological morbidity in injured patients. Participants in a longitudinal study were identified as PTSD positive or PTSD negative at 6 months following injury. Risky alcohol use, depression, demographic, and injury-related variables were explored. METHODS This prospective cohort included patients 18 years or older, admitted to our Level I trauma center. Outcome measures included PTSD Checklist—Civilian Version (PCL-C), Alcohol Use Disorders Identification Test (AUDIT-C), and Patient Health Questionnaire (PHQ-8). Demographic and injury variables were collected. RESULTS A total of 211 participants enrolled in the study, and 118 participants completed measures at both baseline and 6 months. Of the participants, 25.4% (n = 30) screened positive for PTSD at 6 months. The entire sample showed a decline in risky alcohol use at 6 months (p = 0.0043). All PTSD-positive participants at 6 months were also positive for depression (p < 0.0001). For the entire sample, there was a 10% increase in depression from baseline to 6 months (p = 0.03). However, for those participants who were PTSD positive at 6 months, there was a 53% increase in depression from baseline (p = 0.0002) as compared with the group at 6 months without PTSD. Statistically significant differences were found between PTSD-positive and PTSD-negative participants regarding age (40.1 [15.9] vs. 50.9 [18.2], p = 0.0047), male (77% vs. 50%, p = 0.0109), penetrating injury (30% vs. 4%, p < 0.0001), PTSD history (17% vs. 4%, p = 0.0246), or other psychiatric condition (63% vs. 19%, p ⩽ 0.001). CONCLUSION PTSD was not associated with risky alcohol use at 6 months. Surprisingly, risky alcohol use declined in both groups. Incidence of PTSD (25.4%, n = 30) and risky alcohol use (25%, n = 29) were equal at 6 months. Although the American College of Surgeons’ Committee on Trauma requires brief screening and intervention for risky alcohol use owing to societal impact, reinjury rates, and cost effectiveness, our study suggests that screening for psychological conditions may be equally important. LEVEL OF EVIDENCE Prognostic study, level III.

Predictors of PTSD symptoms in adults admitted to a Level I trauma center: a prospective analysis

Trauma centers are an ideal point of intervention in efforts to prevent posttraumatic stress disorder (PTSD). In order to assist in the development of prevention efforts, this study sought to identify early predictors of PTSD symptoms among adults admitted to a Level I trauma center using a novel analytic strategy (Fournier et al., 2009). Upon admission, participants (N=327) were screened for PTSD symptoms and provided information on potential predictor variables. Their PTSD symptoms were assessed again 3 months later (N=227). Participants were classified as symptomatic (positive PTSD screen) or asymptomatic (negative PTSD screen) at the follow-up assessment. Multinomial logistic regression showed that age, depression, number of premorbid psychiatric disorders, gunshot wound, auto vs. pedestrian injury, and alcohol use predicted who had PTSD symptoms at FU with 76.3% accuracy. However, when controlling for PTSD severity at baseline, only age, number of premorbid psychiatric disorders, and gunshot wounds predicted PTSD symptoms at FU but with 78.5% accuracy. These findings suggest that psychological prevention efforts in trauma centers may be best directed toward adults who are young, have premorbid psychiatric disorders, and those admitted with gunshot wounds.

Does caring for trauma patients lead to psychological stress in surgeons

BACKGROUND Symptoms identical to posttraumatic stress disorder (PTSD) have been shown to occur in caregivers of trauma patients. Secondary traumatic stress (STS) characterizes those who exhibit PTSD symptoms related to indirect exposure to a stressor. We hypothesized that caring for trauma patients is associated with symptoms of PTSD/STS. METHODS Surgeons in various specialties (n = 133) were surveyed from January to May 2012 at two regional surgical conferences. Symptoms of PTSD were identified using the Secondary Traumatic Stress Scale (STSS) using specific diagnostic criteria to measure the psychological impact of exposure to trauma patients. Resilience was measured using the Connor-Davidson Resilience Scale 10 items. The amount of time caring for trauma patients was used as a measure of risk exposure. The relationship between STSS, resilience, and exposure to trauma patients was measured with p < 0.05 considered significant. RESULTS Twenty-eight surgeons (22%) met diagnostic symptom criteria for PTSD as measured by the STSS. Approximately two thirds of the surgeons (86 of 133, 65%) exhibited at least one symptom of STS. However, the magnitude of exposure to trauma patients was similar between surgeons with and without PTSD symptoms (p = 0.2177). Higher resilience scores were associated with lower STS scores (r = −0.369, p < 0.0001). Most importantly, surgeons who met symptom criteria for PTSD exhibited significantly lower resilience scores (31 [3.4] vs. 34 [3.9], p < 0.0001). CONCLUSION Symptoms of PTSD as measured by the STSS were reported in two thirds of study participants but did not correlate with time spent for caring for trauma patients. One in five reported symptoms consistent with a PTSD. Lower resilience scores correlated with risk of symptoms and may be used to identify those surgeons most at risk. Efforts to better identify, address, and moderate these psychological consequences of surgical care may improve both the emotional well-being and the vocational performance of surgeons. LEVEL OF EVIDENCE Epidemiologic study, level IV.

The effect of depressive symptoms on social support one year following traumatic injury

BACKGROUND Depression is a common mental health outcome after traumatic injury, negatively impacting physical outcomes and increasing the cost of care. Research shows that the presence and quality of support is a leading protective factor against depression post-injury; however, research is vague on the directional effects of both factors over the course of recovery. METHODS 130 patients admitted to a Level I Trauma Center were recruited to a prospective study examining overall outcomes one-year after injury. Effects of social support and depression at baseline and 12-months post-injury were examined using correlational and cross-lagged path model analyses. Additional follow-up analyses were conducted for depression on specific types of social support. RESULTS Findings replicated previous research suggesting depression and social support were inversely related. Initial depression at time of traumatic injury was predictive of social support 12-months after their injury, but initial social support levels did not significantly predict depression at 12-months. Additionally, initial depression significantly predicted attachment, social integration, reassurance of worth, and guidance 12-months later. LIMITATIONS Findings of the analyses are limited by lack of experimentation and inability to control for other related variables. CONCLUSIONS Findings of the present study support the notion that initial depression predicts poorer social support in recovery, in lieu of prevailing theory (i.e., initial support buffers against later depression) in a sample of trauma patients. These findings highlight the need for medical staff to target specific factors during inpatient stay, such as addressing depressive symptoms and preparing family members and caregivers prior to discharge.

Caregiver expectations of recovery among persons with spinal cord injury at three and six months post-injury: A brief report

Objective: Caregivers of patients with spinal cord injury (SCI) have increased risk of depression, anxiety, and diminished quality of life. Unmet expectations for recovery may contribute to poorer outcomes. Design: Prospective, longitudinal observation study. Settings: Trauma/Critical care ICU at baseline, telephone for follow-ups. Participants: Caregivers of patients with SCI (n = 13). Interventions: None. Outcome Measures: Expectations for recovery were assessed across four primary domains identified in a review of the literature including: pain severity, level of engagement in social/recreational activities, sleep quality, and ability to return to work/school. Caregivers’ forecasts of future recovery were compared to later perceived actual recovery. Results: At three months, 75% of caregivers had unmet expectations for social engagement recovery, 50% had unmet expectations for pain decrease, and 42% had unmet expectations for sleep improvement and resuming work. Rates of unmet expectations were similar at six months, with 70% of caregivers reporting unmet expectations for social engagement recovery, 50% with unmet expectations for pain decrease, and 40% with unmet expectations for sleep improvement. Conclusion: Unmet caregiver expectations for recovery could pose a risk for caregiver recovery and adjustment. Our results show that caregiver expectations merit further investigation for their link with caregiver mental health.