PSYCHOSOCIAL FACTORS LIMIT OUTCOMES AFTER TRAUMA

Background: Psychological morbidity compromises return to work after t rauma, We demonstrate this relationship and present methods to identif y risks for significant psychological morbidity. Methods: Thirty-five adults were evaluated prospectively for return to functional employmen t after injury using demographic data, validated psychological and hea lth measures, and the Michigan Critical Events Perception Scale. Evalu ation was conducted at admission and at 1 and 5 months after injury. R esults: Poor return to work at 5 months was attributable to physical d isability (p < 0.05) and psychological disturbances (p < 0.05) in a re gression model that controlled for preinjury employment and psychopath ologic factors as well as injury severity. A high score can the Impact of Events Scale administered during acute admission predicted develop ment of acute stress disorder at 1 month (p < 0.01, odds ratio (OR) = 9.4) and posttraumatic stress disorder at 5 months (p < 0.05, OR = 6.7 ). Peritraumatic dissociation on the Michigan Critical Events Percepti on Scale was predictive For development of acute stress disorder (p < 0.05, OR = 5.8) at 1 month and posttraumatic stress disorder (p < 0.05 , OR = 7.5) at 5 months. Conclusion: Psychological morbidity after inj ury compromises return to work independent of preinjury employment and psychopathologic condition, Injury Severity Score, or ambulation, A h igh Impact of Events Scale score or peritraumatic dissociation at admi ssion predicts this morbidity.