title: Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury. Posttraumatic stress disorder after injury: does admission to intensive care unit increase risk? Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. A comparison of posttraumatic stress disorder in veterans with and without spinal cord injury. Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. Co-occurring traumatic brain injury and acute spinal cord injury rehabilitation outcomes. The relationship of caregiver coping to family outcomes during the initial year following pediatric traumatic injury.
abstract: 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 This study aim ed to index the prevalence of posttraumatic stress disorder ( PTSD ) after injury requiring intensive care unit ( ICU ) admission to investigate whether an ICU admission after injury increases risk for PTSD and to identify predictors of PTSD after ICU admission . METHODS A two-group ( those admitted to the ICU vs. those not admitted to ICU ) , prospect i ve , cohort study of 829 r and omly selected injury patients from five major trauma hospitals across Australia . We collected information on factors that may increase risk for PTSD including demographic variables ( gender , age , income , education , and marital status ) , preinjury mental health status ( prior trauma , psychiatric history , and prior social support ) , and injury characteristics ( mild traumatic brain injury , injury severity , length of hospital admission , discharge destination , pain , and perceived threat ) . PTSD was measured at 12 months by structured clinical interview .  RESULTS ICU patients were significantly more likely to have PTSD at 12 months than trauma controls ( 17 % vs. 7 % ) . Stepwise logistic regressions showed that an ICU admission significantly contributed to the development of PTSD after controlling for demographic , preinjury mental health status , and injury characteristic variables . CONCLUSIONS Injury patients are three times more likely to develop later PTSD if they have an ICU admission . Given we controlled for many risk variables , it seems that an ICU admission itself may contribute to the development of PTSD . Mental health services such as screening and early intervention may be particularly useful for this population OBJECTIVE To extend the findings of a pilot study that evaluated a brief group-based psychological intervention aim ed at improving psychological adjustment , self-perception and enhancing adaptive coping following spinal cord injury . The theoretical underpinnings of the Coping Effectiveness Training ( CET ) Programme are Lazarus and Folkman 's ( 1984 ) cognitive theory of stress and coping , and cognitive behavioural therapy techniques . DESIGN A controlled trial comparing patients that received the CET intervention with matched controls on measures of psychological adjustment and coping . METHOD A total of 45 intervention group participants and 40 matched controls were selected from in patients at a hospital-based spinal cord injury centre . Outcome measures of anxiety and depression , self-perception and coping were collected before , immediately after and 6 weeks following the intervention . RESULTS Intervention group participants showed a significant reduction in depression and anxiety , compared to the matched controls following the intervention . There was no evidence of a significant change in the pattern of coping strategies used by the intervention group compared to controls . The intervention group alone completed measures of self-perception . There was a significant decrease in the discrepancy between participants ' ' ideal ' self and ' as I am ' , and between ' as I would be without the injury ' and ' as I am ' following the intervention and at follow-up . Significant correlations were also found between self-perception , and anxiety and depression over time . CONCLUSIONS These results confirm the findings of the pilot study , that the CET intervention facilitated a significant improvement in psychological adjustment to spinal cord injury . It is proposed that this improvement may be understood in terms of changing participants ' negative appraisal s of the implication s of spinal cord injury with the result of increasing the perceived manageability of its consequences . Such decatastrophizing alters appraisal s which are associated with current mood . Participants found shared discussion and problem-solving to be particularly helpful . Avenues for further research are discussed The authors assessed effects of  paraplegic and quadriplegic spinal cord injuries ( SCIs )  on posttraumatic stress disorder ( PTSD ) by comparing severity and prevalence of PTSD in these groups to a sample of controls who experienced traumatic injuries other than SCI . The authors found that veterans with quadriplegia reported significantly less severe current PTSD symptoms than controls who were not significantly different from veterans with paraplegia . These results suggest that sustaining a quadriplegic SCI decreases risk of current PTSD , whereas sustaining a paraplegic SCI is associated with greater risk of PTSD , although the risk is no greater than that incurred from experiencing the trauma itself OBJECTIVE With the exception of a few reports of higher rates of childhood trauma in Vietnam veterans with posttraumatic stress disorder ( PTSD ) , little is known about the influence of previous exposure to trauma on the PTSD effects of subsequent trauma . The authors examine interrelated questions about the effects of previous exposure to trauma . METHOD A representative sample of 2,181 individuals in southeast Michigan were interviewed by telephone  to record  lifetime history of traumatic events specified in DSM-IV as potentially leading to PTSD . PTSD was assessed with respect to a r and omly selected index trauma from the list of events reported by each respondent . RESULTS History of any previous exposure to traumatic events was associated with a greater risk of PTSD from the index trauma . Multiple previous events had a stronger effect than a single previous event . The effect of previous assaultive violence persisted over time with little change . When they examined several features of the previous exposure to trauma , the authors found that subjects who experienced multiple events involving assaultive violence in childhood were more likely to experience PTSD from trauma in adulthood . Furthermore , previous events involving assaultive violence -- single or multiple , in childhood or later on -- were associated with a higher risk of PTSD in adulthood . CONCLUSIONS Previous exposure to trauma signals a greater risk of PTSD from subsequent trauma . Although these results are consistent with a sensitization hypothesis , like the results from previous research on PTSD , they do not address the mechanism of increased responsivity to trauma . Long-term observational studies can further eluci date these observations OBJECTIVE To determine the impact of co-occurring traumatic brain injury ( TBI ) on functional motor outcome and cognition during  acute spinal cord injury ( SCI ) rehabilitation .  DESIGN Prospect i ve , longitudinal cohort . SETTING Single-center National Institute of Disability and Rehabilitation Research SCI Model System . PARTICIPANTS Persons aged 16 to 59 years ( N=189 ) admitted for acute SCI rehabilitation during the 18-month recruitment window who met inclusion criteria . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES FIM Motor Scale ( Rasch transformed ) and acute rehabilitation length of stay ( LOS ) . RESULTS In the tetraplegia sample , co-occurring TBI was not related to FIM Motor Scale scores or acute rehabilitation LOS despite having negative impacts on memory and problem solving . Persons with paraplegia who sustained co-occurring severe TBI had lower admission and discharge FIM Motor Scale scores and longer acute rehabilitation LOS than did persons with paraplegia and either no TBI or mild TBI . Persons with paraplegia and severe TBI had lower functional comprehension , problem solving , and memory and impairments on tests of processing speed compared with persons with paraplegia and no TBI , mild TBI , and moderate TBI . Persons with paraplegia and co-occurring mild and moderate TBI had equivalent acute rehabilitation motor outcomes and cognitive functioning compared with persons with paraplegia and no TBI . CONCLUSIONS This study provides evidence that persons aged 16 to 59 years with paraplegia and co-occurring severe TBI had worse motor outcomes and longer acute rehabilitation LOS than did persons with paraplegia and no TBI . Impairments in processing speed , comprehension , memory , and problem solving may explain suboptimal motor skill acquisition . Research with larger sample s is required to determine whether mild and moderate TBI impact acute rehabilitation motor outcomes and LOS This study identified coping strategies associated with  caregiver outcomes following pediatric injury and examined injury type as a moderator of coping efficacy . Families of 103 children with traumatic brain injury ( TBI ) and 71 children with orthopedic injuries were followed prospect ively during the initial year postinjury . The groups had comparable preinjury characteristics and hospitalization experiences but differed on neurological insult . In hierarchical regression analyses , acceptance was associated with lower burden and denial was associated with greater distress in both groups . Active coping result ed in higher distress following TBI but not orthopedic injuries . Conversely , the use of humor was related to diminishing distress following TBI but unrelated to distress following orthopedic injuries . Results are discussed in terms of the implication s for intervention following TBI
target: Conclusion : Combinations of peri- and post-injury factors appear to be influential in the development of PTSD among persons with SCI .
background: Objectives : To summarise quantitatively the available evidence relating to pretraumatic , peritraumatic and posttraumatic characteristics that may increase or decrease the risk of developing posttraumatic stress disorder ( PTSD ) following spinal cord injury ( SCI ) .