Topic: B. Clinical Burns/Trauma
A National Study of Posttraumatic Stress Disorder, Depression, and Work and Functional Outcomes after Injury Hospitalization
Douglas F Zatzick, Gregory Jurkovich, Frederick Rivara, Jin Wang, Ming-Yu Fan, Jutta Joesch, David Salkever, Ellen Mackenzie
University of Washington, Seattle, WA
OBJECTIVE(S): Factors other than injury severity are likely to influence the ability to return to work following injury. The purpose of this study is to examine the association between posttraumatic stress disorder (PTSD) and depression after injury, and returning to work (RTW) and development of functional impairments.
METHODS: A total of 2,707 surgical inpatients who were representative of 9,374 injured patients were recruited from 69 hospitals across the United States. Symptoms consistent with PTSD and depression were assessed at 12-months post-injury as was work status and functional limitations. Regression analyses assessed the association between PTSD and depression, with RTW and functional outcomes while adjusting for relevant clinical and demographic characteristics.
RESULTS: At 12-months after injury 20.7% of patients had PTSD and 6.6% had depression. In adjusted analyses, both disorders were independently associated with impairments across all work and functional outcome domains. A dose response relationship was observed such that previously working patients with one disorder had a 3 fold increased odds of not RTW 12-months after injury (Odds Ratio [OR]= 3.23 95% Confidence Interval [95% CI]= 2.4,5.98) and patients with both disorders had a 5-6 fold increased odds of not RTW after injury (OR=5.66 [95% CI 2.56,12.48]), when compared to previously working patients without PTSD or depression.
CONCLUSIONS: PTSD and depression are highly prevalent after injury and are associated with enduring work impairment and functional limitations. Recognizing the importance of PTSD and depressive co-morbidities may be essential to improving work and functional outcomes after injury hospitalization.