title: Depression and Posttraumatic Stress Disorder at Three Months After Mild to Moderate Traumatic Brain Injury Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury. Effectiveness of a web-based intervention for injured claimants: a randomized controlled trial Severe traumatic brain injury in New South Wales: comparable outcomes for rural and urban residents. The development of psychological changes following whiplash injury Reduced reactivity and enhanced negative feedback sensitivity of the hypothalamus–pituitary–adrenal axis in chronic whiplash-associated disorder Long-term outcomes after uncomplicated mild traumatic brain injury: a comparison with trauma controls. Does access to compensation have an impact on recovery outcomes after injury? Resilience following spinal cord injury: A prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation. Relationship between Stressfulness of Claiming for Injury Compensation and Long-Term Recovery: A Prospective Cohort Study Population-based, inception cohort study of the incidence, course, and prognosis of mild traumatic brain injury after motor vehicle collisions. The influence of fault on health in the immediate post-crash period following road traffic crashes. Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation. Course of psychological variables in whiplash injury — a 2-year follow-up with age, gender and education pair-matched patients Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation. A multisite analysis of the fluctuating course of posttraumatic stress disorder. The psychiatric sequelae of traumatic injury. One Year After Mild Injury: Comparison of Health Status and Quality of Life Between Patients with Whiplash Versus Other Injuries
abstract: To investigate the frequency and risk factors of major depressive disorder ( MDD )  after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the  intervention group ( n = 88 ) or the  control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls  , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and  pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries .  Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not support previous research showing that access to compensation is associated with poor recovery outcomes . The relationship between access to compensation and health outcomes is complex , and more high-level research is required PURPOSE To examine change in resilience in people with spinal cord injury ( SCI ) when  group cognitive behavior therapy ( GCBT ) was added to routine psychosocial rehabilitation ( RPR ) . RESEARCH METHOD / DESIGN A prospect i ve repeated- measures cohort design was used to determine the efficacy of the addition of  GCBT ( n = 50 ) . The control group consisted of individuals receiving RPR  , which included access to individual CBT ( ICBT ) when required  ( n = 38 ) . Groups were assessed on 3 occasions : soon after admission , within 2 weeks of discharge , and 6-months postdischarge . Measures included sociodemographic , injury , and psychosocial factors . The outcome variable was resilience , considered an important outcome measure for recovery . To adjust for baseline differences in self-efficacy , depressive mood and anxiety between the 2 groups , these factors were entered into a repeated measures multivariate analysis of covariance ( MANCOVA ) as covariates . Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups . RESULTS The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group . Trajectory data indicated over 60 % were demonstrating acceptable resilience irrespective of group . CONCLUSION / IMPLICATION S Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes . Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration . Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to underst and complex trajectories . Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience Importance : Each year , millions of persons worldwide seek compensation for transport accident and workplace injuries . Previous research suggests that these cl aim ants have worse long-term health outcomes than persons whose injuries fall outside compensation schemes . However , existing studies have substantial method ological weaknesses and have not identified which aspects of the cl aim ing experience may drive these effects . Objective : To determine aspects of cl aims processes that cl aim ants to transport accident and workers ’ compensation schemes find stressful and whether such stressful experiences are associated with poorer long-term recovery . Design , Setting , and Participants : Prospect i ve cohort study of a r and om sample of 1010 patients hospitalized in 3 Australian states for injuries from 2004 through 2006 . At 6-year follow-up , we interviewed 332 participants who had cl aim ed compensation from transport accident and workers ’ compensation schemes ( “ cl aim ants � ? )  to determine which aspects of the cl aim ing experience they found stressful . We used multivariable regression analysis to test for associations between compensation-related stress and health status at 6 years , adjusting for baseline determinants of long-term health status and predisposition to stressful experiences ( via propensity scores ) . Main Outcomes and Measures : Disability , quality of life , anxiety , and depression . Results : Among cl aim ants , 33.9 % reported high levels of stress associated with underst and ing what they needed to do for their cl aim ; 30.4 % , with cl aim delays ; 26.9 % , with the number of medical assessment s ; and 26.1 % , with the amount of compensation they received . Six years after their injury , cl aim ants who reported high levels of stress had significantly higher levels of disability ( 6.94 points , World Health Organization Disability Assessment Schedule sum score ) , anxiety and depression ( 1.89 points and 2.61 points , respectively , Hospital Anxiety and Depression Scale ) , and lower quality of life ( -0.73 points , World Health Organization Quality of Life instrument , overall item ) , compared with other cl aim ants . Adjusting for cl aim ants ’ vulnerability to stress attenuated the strength of these associations , but most remained strong and statistically significant . Conclusions and Relevance : Many cl aim ants experience high levels of stress from engaging with injury compensation schemes , and this experience is positively correlated with poor long-term recovery . Intervening early to boost resilience among those at risk of stressful cl aims experiences and re design ing compensation processes to reduce their stressfulness may improve recovery and save money OBJECTIVE To determine the incidence , course , and prognosis of adult mild traumatic brain injury ( MTBI ) caused by motor vehicle collisions . DESIGN Prospect i ve , population -based , inception cohort study . SETTING The province of Saskatchewan , Canada , with a population of about 1,000,000 inhabitants . PARTICIPANTS All adults ( N=1716 ) incurring an MTBI in a motor vehicle collision between November 1997 and December 1999 in Saskatchewan . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Age- and sex-stratified incidence rates , time to self-reported recovery , and prognostic factors over a 1-year follow-up . RESULTS Of 7170 adults injured in a motor vehicle collision over the 2-year inception period , 1716 ( 24 % ) met our cohort definition of MTBI . There were more women affected ( 53 % ) , and MTBI was most common in the 18- to 23-year-old group . Most were not hospitalized ( 73 % ) , but 28 % reported loss of consciousness and 23 % reported posttraumatic amnesia . The annual incidence of MTBI per 100,000 adults was 106.1 ( 95 % confidence interval [ CI ] , 98.9 - 113.6 ) in the first year and 118.3 ( 95 % CI , 110.8 - 126.3 ) in the second year of the study . The 1-year follow-up rate was 84 % . The median time to recovery was 100 days ( 95 % CI , 97 - 103 ) , and about 23 % reported not having recovered by 1 year . Factors associated with delayed recovery included being older than 50 years , having less than a high school education , having poor expectations for recovery , having depressive symptoms , having arm numbness , having hearing problems , having headaches , having low back pain , and having thoracic back pain . Loss of consciousness and posttraumatic amnesia were not associated with recovery . CONCLUSIONS MTBI affects almost a quarter of persons reporting an injury after a traffic collision . The median time to recovery is 100 days , but 23 % have still not recovered by 1 year . A mix of biopsychosocial factors is associated with recovery , including a strong effect of poor expectations for recovery OBJECTIVE To compare the early health status of people who sustained injuries during road traffic crashes ( RTC ) in which they were at fault ( AF ) , with people who sustained injuries in RTC in which they were not at fault ( NAF ) . DESIGN Prospect i ve cohort study . SUBJECTS People presenting to the emergency department with mild to moderate musculoskeletal injuries following RTC . MAIN OUTCOME MEASURES Physical Component Score ( PCS ) and Mental Component Score ( MCS ) of the Short Form 36 ( SF-36 ) health status measure ; Hospital Anxiety and Depression Scale ( HADS ) and the Functional Rating Index ( FRI ) recorded immediately post-crash . RESULTS 193 people participated in the study and were enrolled a mean of 9.3 days following the crash . The mean age was 37 years and 60 % were female . 71 % were NAF . There was a significantly higher number of females in the NAF group ( 65 % compared with 35 % males ; p<0.001 ) . Neck and back injuries were reported by 90.4 % of the NAF group compared to 69.1 % of the AF group ( p<0.001 ) . There were no significant differences in PCS , FRI or pain intensity between the two groups at a mean of 9.3 days after the crash . The mean MCS for the NAF group was significantly worse than for the AF group ( 31.4 compared to 37.3 ; p = 0.005 ) . The SF-36 domain revealed a significantly worse adjusted mean role emotional score for the NAF group ( 23.4 compared to 32.5 , p = 0.002 ) . Females had significantly worse MCS score than males ( 30.6 and 38.1 respectively ; p<0.001 ) and worse adjusted mean anxiety and depression scores ( 10 compared to 7.8 ; p = 0.002 and 7.6 compared to 5.5 ; p = 0.002 respectively ) . CONCLUSIONS Despite there being no difference in physical health status , the NAF group demonstrated more emotional and mental disturbance than the AF group ; and this was significantly worse for females . Treatment strategies should focus on addressing early pain and disability as well as providing appropriate psychological interventions , particularly for people not at fault following RTC OBJECTIVES Spinal cord injury ( SCI ) is a catastrophic event that may result in diminished physical , social , and mental health . The main objective of this research was to establish inpatient factors that contribute to  social participation  following discharge into the community . DESIGN Prospect i ve longitudinal design with measures taken three times , soon after admission to rehabilitation ( N = 88 ) , at discharge from the inpatient phase ( N = 81 ) and 6 months following discharge ( N = 71 ) . METHODS Participants included adults with SCI admitted into three SCI units over a 33-month period . Assessment included demographic , injury , and psychosocial health measures . Adjustment was defined by the extent of social re-integration or participation post-discharge after 6 months in the community .  Social participation  was measured by the Impact on Participation and Autonomy Question naire ( IPAQ ) .  Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge . RESULTS Six months after discharge , around 55 % of the sample had difficulties with social participation . The odds against being employed for an adult with poor social participation was found to be 8.4 to 1 . Factors that predicted social participation included a younger age , having less severe secondary medical complications like bladder and bowel dysfunction , having a higher cognitive capacity , perceiving one has control ( self-efficacy ) over one 's life and environment , and having greater perceived social support . CONCLUSIONS These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation , affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation . Statement of contribution What is already known on this subject ? Spinal cord injury ( SCI ) is associated with significant challenges to wellbeing , including a high risk of secondary chronic illnesses , risk of co-morbid mental health problems , financial insecurity and social isolation . Research has shown poor social participation can lead to problems in re-integration into society following discharge from inpatient rehabilitation . Research to date has examined various factors related to poor social participation , but the majority of this research has been survey based with convenience sample s. What does this study add ? This study adds results of prospect i ve longitudinal research on adjustment following SCI , where adjustment was defined by the rate of social participation when living in the community . About one-third of SCI participants were found to have very poor social participation , and only one-third had found some form of employment 6 months after discharge . Multiple factors were found to predict and contribute to poor social participation , including older age when injured , more severe medical complications , cognitive deficits , poor perceptions of control or self-efficacy , and poor social support & NA ; This study evaluated the course of psychological variables during a 2‐year follow‐up in patients after common whiplash of the cervical spine . From a sample of 117 non‐selected patients with common whiplash ( investigated on average 7.2 ± 4.2 days after trauma ) a total of 21 suffered trauma‐related symptoms over 2 years following initial injury . These patients ( symptomatic group ) were compared with 21 age , gender and education  pair‐matched patients , who showed complete recovery from trauma‐related symptoms during the 2‐year follow‐up ( asymptomatic group ) . Both groups underwent st and ardised testing procedures ( i.e. , Freiburg Personality Inventory and Well‐Being Scale ) at referal , and at 3 , 6 and 24 months . In the symptomatic group during follow‐up no significant changes in ratings of neck pain or headache were found . Significant differences between the groups and significant deviation of scores over time were found on the Well‐Being and Nervousness Scales . There was a lack of significant difference between the groups on the Depression Scale , indicating a possible somatic basis for changes in psychological functioning in the investigated sample . With regard to scales of Extraversion or Neuroticism , there were neither significant differences between the groups nor significant deviation over time . These results highlight that patients ' psychological problems are rather a consequence than a cause ; of somatic symptoms in whiplash OBJECTIVE To identify the frequency and manifestations of depression after traumatic brain injury ( TBI ) and the factors that contribute to developing this mood disorder . DESIGN A prospect i ve , nationwide , multicenter study ; 17 centers supplied data from medical records and patient responses on a st and ardized criterion instrument . SETTING Traumatic Brain Injury Model Systems programs . PARTICIPANTS A demographically diverse sample of 666 out patients with TBI was evaluated 10 to 126 months after injury . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Depressive symptoms were characterized with the Neurobehavioral Functioning Inventory by using the Diagnostic and Statistical Manual of Mental Disorders ( 4th ed ; DSM-IV ) diagnostic framework . Analysis of variance and Pearson correlations were used to identify factors that were significantly related to depression . RESULTS Fatigue ( 29 % ) , distractibility ( 28 % ) , anger or irritability ( 28 % ) , and rumination ( 25 % ) were the most commonly cited depressive symptoms in the sample . Twenty-seven percent of patients with TBI met the prerequisite number ( > /=5 ) of criterion A symptoms for a DSM-IV diagnosis of major depressive disorder . Feeling hopeless , feeling worthless , and difficulty enjoying activities were the 3 symptoms that most differentiated depressed from nondepressed patients . Patients who were unemployed at the time of injury and who were impoverished were significantly more likely to report DSM-IV criterion A symptoms than patients who were employed , were students , or were retired due to age . Time after injury , injury severity , and postinjury marital status were not significantly related to depression . CONCLUSIONS Patients with TBI are at great risk for developing depressive symptoms . Findings provide empirical support for the inclusion of depression evaluation and treatment protocol s in brain injury programs . Unemployment and poverty may be substantial risk factors for the development of depressive symptoms . Future research should develop biopsychosocial predictive models to identify high-risk patients and examine the efficacy of treatment interventions IMPORTANCE Delayed-onset posttraumatic stress disorder ( PTSD ) accounts for approximately 25 % of PTSD cases . Current models do not adequately explain the delayed increases in PTSD symptoms after trauma exposure . OBJECTIVE To test the roles of initial psychiatric reactions , mild traumatic brain injury ( MTBI ) , and ongoing stressors on delayed-onset PTSD . DESIGN , SETTING , AND PARTICIPANTS In this prospect i ve cohort study , patients were selected from recent admissions to 4 major trauma hospitals across Australia . A total of 1084 traumatically injured patients were assessed during hospital admission from April 1 , 2004 , through February 28 , 2006 , and 785 ( 72.4 % ) were followed up at 3 , 12 , and 24 months after injury . MAIN OUTCOME AND MEASURE Severity of PTSD was determined at each assessment with the  Clinician-Administered PTSD Scale .  RESULTS Of those who met PTSD criteria at 24 months , 44.1 % reported no PTSD at 3 months and 55.9 % had subsyndromal or full PTSD . In those who displayed subsyndromal or full PTSD at 3 months , PTSD severity at 24 months was predicted by prior psychiatric disorder , initial PTSD symptom severity , and type of injury . In those who displayed no PTSD at 3 months , PTSD severity at 24 months was predicted by initial PTSD symptom severity , MTBI , length of hospitalization , and the number of stressful events experienced between 3 and 24 months . CONCLUSIONS AND RELEVANCE These data highlight the complex trajectories of PTSD symptoms over time . This study also points to the roles of ongoing stress and MTBI in delayed cases of PTSD and suggests the potential of ongoing stress to compound initial stress reactions and lead to a delayed increase in PTSD symptom severity . This study also provides initial evidence that MTBI increases the risk of delayed PTSD symptoms , particularly in those with no acute symptoms OBJECTIVE Traumatic injury affects millions of people each year . There is little underst and ing of the extent of psychiatric illness that develops after traumatic injury or of the impact of mild traumatic brain injury ( TBI ) on psychiatric illness . The authors sought to determine the range of new psychiatric disorders occurring after traumatic injury and the influence of mild TBI on psychiatric status . METHOD In this prospect i ve cohort study , patients were drawn from recent admissions to four major trauma hospitals across Australia . A total of 1,084 traumatically injured patients were initially assessed during hospital admission and followed up 3 months ( N=932 , 86 % ) and 12 months ( N=817 , 75 % ) after injury . Lifetime psychiatric diagnoses were assessed in hospital . The prevalence of psychiatric disorders , levels of quality of life , and mental health service use were assessed at the follow-ups . The main outcome measures were 3- and 12-month prevalence of axis I psychiatric disorders , levels of quality of life , and mental health service use and lifetime axis I psychiatric disorders . RESULTS Twelve months after injury , 31 % of patients reported a psychiatric disorder , and 22 % developed a psychiatric disorder that they had never experienced before . The most common new psychiatric disorders were depression ( 9 % ) , generalized anxiety disorder ( 9 % ) , posttraumatic stress disorder ( 6 % ) , and agoraphobia ( 6 % ) . Patients were more likely to develop posttraumatic stress disorder ( odds ratio=1.92 , 95 % CI=1.08 - 3.40 ) , panic disorder ( odds ratio=2.01 , 95 % CI=1.03 - 4.14 ) , social phobia ( odds ratio=2.07 , 95 % CI=1.03 - 4.16 ) , and agoraphobia ( odds ratio=1.94 , 95 % CI=1.11 - 3.39 ) if they had sustained a mild TBI . Functional impairment , rather than mild TBI , was associated with psychiatric illness . CONCLUSIONS A significant range of psychiatric disorders occur after traumatic injury . The identification and treatment of a range of psychiatric disorders are important for optimal adaptation after traumatic injury Objective . To compare health status , effect on family , occupational consequences , and quality of life ( QOL ) 1 year after an accident between patients with whiplash versus other mild injuries , and to explore the relationship between initial injury (  whiplash  vs other ) and QOL . Methods . This was a prospect i ve cohort study . The study used data from the ESPARR cohort ( a representative cohort of road accident victims ) and included 173 individuals with “ pure ” whiplash and 207 with other mild injuries .  QOL at 1-year followup was assessed on the World Health Organization Quality of Life question naire . Correlations between explanatory variables and QOL were explored by Poisson regression to provide adjusted relative risks , with ANOVA for the various QOL scores explored . Results . One year post-accident , more patients who had whiplash  than other casualties complained of nonrecovery of health status ( 56 % vs 43 % ) and of the occupational effect of pain ( 31 % vs 23 % ) . QOL and posttraumatic stress disorder ( PTSD ) were similar in the 2 groups . Impaired QOL did not correlate with whiplash when models were adjusted on sociodemographic variables and history of psychological distress . Whatever the initial lesion , PTSD was a determining factor for poorer QOL . Conclusion . Sociodemographic factors , preaccident psychological history prior to the accident , and PTSD were the main factors influencing QOL , rather than whether the injury was whiplash . PTSD may also be related to pain
target: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC .
background: OBJECTIVE The aim of this meta- analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries .