A simple eight-question survey administered soon after injury can help predict which of the 30 million Americans seeking hospital treatment for injuries each year may develop depression or post-traumatic stress, report Therese S. Richmond, PhD, CRNP, associate professor at the University of Pennsylvania School of Nursing, and her colleagues in General Hospital Psychiatry.
"Depression and PTSD exert a significant, independent, and persistent effect on general health, work status, somatic symptoms, adjustment to illness, and function after injury," the authors wrote, also emphasizing that even minor injuries can lead to traumatic stress responses. The findings allow healthcare providers to identify patients at highest risk for developing these disorders and to target appropriate resources to this vulnerable group.
This screening tool -- reportedly one of the first of its kind for adults in the U.S. -- could have a great impact on the judicious allocation of costly mental health resources.
Using an eight-question survey, all injured patients can be rapidly assessed for risk in the hospital. Healthcare providers can then provide patients classed as high-risk for developing depression or PTSD with information about symptoms to look for and advise them to contact their primary care provider should symptoms surface. This intervention can facilitate early diagnosis of these disabling disorders.
The study reported nearly 100 percent accuracy in negative results. Only five percent of injured patients who tested negative for risk of depression on the screening survey developed depression and no patients who tested negative for PTSD risk developed PTSD. At the same time, not all patients who screen positive will develop these disorders. The researchers do not suggest that all patients who screen positive receive mental health services, but rather that this finding prompt systematic provision of information and additional follow-up.
The authors caution that while the findings of this initial study are most promising, they need to be replicated in an independent sample.
With Dr. Richmond, the study authors are: Josef Ruzek, PhD; Theimann Ackerson, MSSW; Douglas J. Wiebe, PhD; Flaura Winston, MD, PhD; Nancy Kassam-Adams, PhD.
- Therese S. Richmond, Josef Ruzek, Theimann Ackerson, Douglas J. Wiebe, Flaura Winston, Nancy Kassam-Adams. Predicting the future development of depression or PTSD after injury. General Hospital Psychiatry, 2011; DOI: 10.1016/j.genhosppsych.2011.05.003
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