Purpose
To estimate the prevalence of posttraumatic stress disorder (PTSD) and depression
among hand-injured patients and assess the impact of these disorders on general health
status.
Methods
A total of 106 adult hand-injured patients (40 women, 66 men) with a mean age of 42
years (range, 18–79 years) participated. Patients with a chronic mental illness or
cognitive impairment were excluded. Psychological status was assessed using the Revised
Civilian Mississippi Scale for PTSD and the Beck Depression Inventory. General health
status was evaluated with the Short Form-36 health survey (SF-36). We obtained demographics
and injury characteristics from the patient medical records.
Results
Prominent mechanisms of injury included a fall (n = 38), traffic-related injuries
(n = 14), machine versus operator (n = 8), gunshot wounds (n = 6), and assault (n
= 6). Using the screening questionnaires, 32 persons qualified for PTSD and 19 for
depression. Sixteen patients met the criteria for both PTSD and depression. The association
between PTSD and depression was significant (p < .01). Patients with PTSD had significantly
lower scores than those who did not endorse items consistent with PTSD or depression
on the SF-36 subscales of role–emotional (p < .01), body pain (p = .013), social function
(p = .028), and mental health (p < .01). We found no significant differences between
groups for the subscales of role–physical (p = .289), general health (p = .147), vitality
(p = .496), and physical functioning (p = .476). Patients who had concurrent PTSD
and depression had significantly lower scores than patients who had neither PTSD nor
depression on all subscales (p < .05 for all) except role–physical (p = .135). We
found significant negative correlations between Beck Depression Inventory scores and
all of the SF-36 subscales (p < .05 for all).
Conclusions
In this study, nearly one third of hand-injured patients met diagnostic criteria for
PTSD, depression, or both, according to the thresholds of the instruments used to
measure these psychological aspects of illness. PTSD and depression had a negative
effect on general health status after hand injury. It may be important to consider
psychological status when caring for patients with hand injuries.
Type of study/level of evidence
Prognostic II.
Key words
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References
- Posttraumatic stress disorder after injury: impact on general health outcome and early risk assessment.J Trauma. 1999; 47: 460-467
- Outcome from injury: general health, work status, and satisfaction 12 months after trauma.J Trauma. 2000; 48: 841-880
- Posttraumatic stress, problem drinking, and functional outcomes after injury.Arch Surg. 2002; 137: 200-205
- Incidence and prediction of posttraumatic stress disorder symptoms in severely injured accident victims.Am J Psychiatry. 2001; 158: 594-599
- Posttraumatic stress reactions after injury.J Trauma. 2000; 48: 490-494
- Symptoms of posttraumatic stress disorder after orthopaedic trauma.J Bone Joint Surg. 2004; 86A: 1115-1121
- Posttraumatic disorders following injury: an empirical and methodological review.Clin Psychol Rev. 2003; 23: 587-603
- Prospective study of posttraumatic stress disorder and depression following trauma.Am J Psychiatry. 1998; 155: 630-637
- Psychological adjustment to hand injuries: nursing management.Plast Surg Nurs. 1993; 13: 72-76
- Posttraumatic stress disorder and traumatic hand injuries: a neuro-occupational view.Am J Occup Ther. 2002; 56: 527-537
- Sexual dysfunction following traumatic hand injury.Ann Plast Surg. 1988; 21: 46-48
- Diagnostic and statistical manual of mental disorders: DSM-IV.in: 4th ed. American Psychiatric Association, Washington, DC1994: xxvii
- The revised Civilian Mississippi Scale for PTSD: reliability, validity, and cross-language stability.J Trauma Stress. 1996; 9: 285-298
- BDI-II: Beck depression inventory manual.in: 2nd ed. Psychological Corp, San Antonio1996: vi
- Scale for Suicide Ideation: psychometric properties of a self-report version.J Clin Psychol. 1988; 44: 499-505
- Psychometric properties of the Spanish Beck Depression Inventory-II in a medical sample.Psychol Assess. 2003; 15: 569-577
- Measurement of depression in Mexican patients with rheumatoid arthritis: validity of the Beck Depression Inventory.Arthritis Care Res. 1997; 10: 194-199
- Validity and reliability of symptom checklist '90 in an Argentine population sample.Soc Psychiatry Psychiatr Epidemiol. 1997; 32: 332-338
- SF-36 health survey: manual and interpretation guide.The Health Institute, New England Medical Center, Boston1993
- The SF-36 health survey.in: Spilker B. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Raven Press, New York1996: 337-345
- Testing the measurement properties of the Spanish version of the SF-36 Health Survey among male patients with chronic obstructive pulmonary disease.J Clin Epidemiol. 1998; 51: 1087-1094
- [Internal and external validity of the Spanish version of SF-36].Med Clin (Barc). 1999; 113: 37
- A psychophysical evaluation of the relationship between trait anxiety, pain perception, and induced state anxiety.J Pain. 2005; 6: 612-619
- Problems experienced during the first year of an acute traumatic hand injury: a prospective study.J Clin Nurs. 2004; 13: 986-995
- The orthopaedic surgeon and post-traumatic psychopathology.J Bone Joint Surg. 2000; 82B: 486-488
- Health status, somatization, and severity of posttraumatic stress disorder in Vietnam combat veterans with posttraumatic stress disorder.Am J Psychiatry. 1998; 155: 1565-1569
- Physician-diagnosed medical disorders in relation to PTSD symptoms in older male military veterans.Health Psychol. 2000; 19: 91-97
- Modeling physical health and functional health status: the role of combat exposure, posttraumatic stress disorder, and personal resource attributes.J Trauma Stress. 1999; 12: 3-23
- Civilian-based posttraumatic stress disorder and physical complaints: evaluation of depression as a mediator.J Trauma Stress. 2002; 15: 297-301
- Posttraumatic stress disorder and war-zone exposure as correlates of perceived health in female Vietnam War veterans.J Consult Clin Psychol. 1994; 62: 1235-1240
- Diseases among men 20 years after exposure to severe stress: implications for clinical research and medical care.Psychosom Med. 1997; 59: 605-614
- Outcome after major trauma: 12-month and 18-month follow-up results from the Trauma Recovery Project.J Trauma. 1999; 46 (765–713)
Article info
Publication history
Accepted:
November 11,
2008
Received:
December 5,
2007
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2009 Published by Elsevier Inc.