People who suffer from posttraumatic stress disorder (PTSD) often have crippling recurrent flashbacks of the trauma, avoid related situations or people, and experience emotional numbness, nightmares, sleeping difficulty, irritability, and jumpiness. PTSD affects nearly a third (32 percent) of trauma victims and profoundly affects their recovery and quality of life, according to researchers involved in the Trauma Recovery Project, which was supported by the Agency for Healthcare Research and Quality (HS07611).
Led by Troy L. Holbrook, Ph.D., of the University of California, San Diego, the project team enrolled 1,048 adult trauma patients triaged at four trauma center hospitals between 1993 and 1996. These patients had been injured in a motor vehicle accident, been assaulted, or suffered a penetrating injury. The researchers assessed patients' quality of life after injury and early symptoms of acute stress reaction at discharge, and they diagnosed PTSD at 6, 12, and 18 months after discharge. Thirty-two percent of trauma patients were diagnosed with PTSD 6 months after discharge.
Early symptoms of acute stress reaction were substantially higher in patients who developed PTSD (52 vs. 26 percent). Scores on a Quality of Well-being Scale were markedly lower at 6, 12, and 18 months followup for patients with PTSD compared with trauma patients who did not suffer from PTSD (0.576 vs. 0.658, 0.620 vs. 0.691, and 0.620 vs. 0.700, respectively). Uninjured healthy adults usually score from 0.830 to 0.900, with 1.0 representing optimum functioning.
Patients who perceived a threat to their life during the traumatic event or felt there was a medium to high chance of the traumatic event happening again were nearly twice as likely to develop PTSD. PTSD was more frequent in women than in men (39 vs. 29 percent) and in younger low-income patients, as well as those who suffered penetrating trauma and assaults. Severity of injury or body region injured did not affect the likelihood of PTSD. These findings underscore an enormous, previously unrecognized problem in recovery from serious injury, conclude the researchers.
See "Perceived threat to life predicts posttraumatic stress disorder after major trauma: Risk factors and functional outcome," by Dr. Holbrook, David B. Hoyt, M.D., F.A.C.S., Murray B. Stein, M.D., and William J. Sieber, Ph.D., in the August 2001 Journal of Trauma 51(2), pp. 287-293.