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Medical Trauma Research

Traumatic injury is the leading cause of death in people under the age of 50 and accounts for a substantial part of yearly medical care costs. In the year 2000 alone, 50 million injuries in the United States required medical treatment, costing $80.2 billion. The societal burden of traumatic injury is great. Costs for loss of productivity because of these injuries were $326 billion, four times the amount of acute medical care costs. Loss of life and physical disabilities contribute to these costs and so do the mental health effects leading to psychological disability account for a large part of the burden. Psychiatric disorders after traumatic injury are common. International studies found rates of posttraumatic stress disorder (PTSD) between 17.5% and 42%, rates of depression between 14% and 17%, and rates of other anxiety disorders between 15% and 37% within the first 6 months after trauma. Also, comorbidity is highly prevalent, with depression rates as high as 53% in injury patients with a PTSD diagnosis.

This entry discusses the current state of knowledge in the field of medical trauma and psychological reactions, including the impact of injury characteristics, traumatic brain injury, and hospital-related factors on the psychological reactions of people dealing with medical trauma.

Psychopathology following Injury

Traumatic injury patients often face more than just their physical recovery. The sudden and unexpected exposure to physical harm, as well as other threatening or horrific aspects of the traumatic event, leave most overwhelmed or in a state of shock during the first moments after the event. Psychiatric problems can arise when the intensity of this initial response does not subside during the first weeks. The most common psychiatric illness diagnosed after traumatic injury is PTSD. Depending on the specifics of the sample of injury survivors (in terms of more or less severely injured, gender distribution, types of traumatic events), PTSD prevalence rates of 17.5% to 42% have been found 1 to 6 months post-injury. At 12 months post-injury, studies reported rates of PTSD of between 2% and 36%. Despite the variation in prevalence between studies, the rates tend to decline over time.

PTSD is not the only psychiatric disorder that frequently develops after traumatic exposure. It is common for survivors of traumatic injury to be diagnosed with more than one psychiatric disorder, with comorbidity rates of as great as 85% in people with PTSD in a community sample. In their meta-analysis, Edson S. Brown and colleagues reported an increase in generalized anxiety disorder, substance abuse, phobias, and major depressive disorder following civilian traumatic exposure. Most studies rely on self-report instruments to assess comorbid mood or anxiety symptoms, so unfortunately a thorough view of the prevalence of these disorders is lacking.

Injury Characteristics and Psychological Reactions in Medical Trauma

Physical injury during a traumatic event is considered an important part of the first criterion (A1) of the Posttraumatic Stress Disorder diagnosis according to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Being threatened with and/or having sustained bodily harm constitutes one of the precursors of psychological trauma. Because of the large prevalence of traumatic injury on an annual basis, much attention has been spent in recent years on studying the impact of injury on the development of consequent psychopathology. Studies on the influence of injury characteristics on PTSD have so far found inconsistent results. Some showed a positive relationship between the presence or severity of injury and symptoms of PTSD, whereas others found no direct relationship between them. One explanation for the discrepancies in results is the timing of the assessment of PTSD symptoms: In the immediate days and weeks following the injury, patients are likely to be occupied with their physical recovery and the psychological processing of the event probably occurs later. Moreover, most of them are still in the hospital in the first days after trauma, and they are often not exposed to the cues and triggers of normal life that could cause symptoms at a later stage. It is also necessary to consider the mediating impact of other important trauma-related factors in assessing the relationship between injury and PTSD. Gender, threat to life, specific type of trauma (e.g., traffic accident, physical abuse, burn injury), and peritraumatic dissociation (dissociative symptoms experienced during and directly after the traumatic event, such as looking down at oneself as though from overhead, feeling detached from oneself) are factors found to interact with the impact of injury severity on PTSD symptoms.

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