PTSD Risk Factors Can Be Treated Cognitively Factors Seen in Military Personnel and Domestic Violence Victims May Apply to Other Trauma Victims

Article excerpt

HUNTINGTON BEACH, CALIF. -- Three things have been found to be strong predictors of whether a patient will develop posttraumatic stress disorder following physical trauma, researchers reported.

Patients are more likely to develop PTSD if they were victims of violence; if they perceive they were grievously injured, regardless of their injury severity score; and if they think they were almost killed, whether that's true or not.

The researchers used surveys to determine what factors predict PTSD in trauma patients, fourth-year medical student Jessica Anderson of the Medical College of Wisconsin, Milwaukee, said when she presented the findings at the conference, which was sponsored by the Association for Academic Surgery and the Society of University Surgeons.

Within about 72 hours of admission, 403 trauma patients completed the 17-question Post-Traumatic Stress Disorder checklist and the Short Form-36 - a quality of life survey that assesses mental and physical function; 129 filled out the forms when requested to do so 6 months later.

A previous study found severe PTSD symptoms in 22.5% of patients admitted to the trauma service; in the new study, 18.6% of the 6-month respondents had checklist scores above 44, indicating PTSD.

Victims of violence - shootings, stabbings, or assaults - had mean 6-month checklist scores of 45.79; mean score for accident victims was 32.27 (P = .005).

Higher PTSD scores correlated with lower quality of life scores. Assault victims also scored lower on mental functioning at 6 months (P = .001).

"The variables that were statistically significant in predicting PTSD severity at 6 months included assaultive type of mechanism, scene heart rate, perceived injury severity score, and perceived life threat," Ms. Anderson said.

Age and gender were not predictive. On multiple regression analysis, scene heart rate was no longer significant.

Such studies of PTSD in trauma patients are relatively new, said Dr. Karen Brasel, a surgery professor at the college and a trauma surgeon at its associated Froedtert Memorial Lutheran Hospital, also in Milwaukee.

These three factors have been identified before among military personnel and domestic violence victims, but they appear to apply to other trauma victims, as well, she said.

"People don't really think about PTSD in relation to garden-variety car crashes or getting stabbed in a gang fight," said Dr. Brasel, who is helping to lead efforts at the hospital to address PTSD in trauma patients.

Although nothing can be done about the injury mechanism, the other two contributing factors - the perceptions about injury severity and death risk -may be amenable to cognitive-behavioral therapy (CBT). …