Perceived threat to life predicts posttraumatic stress disorder after major trauma: Risk factors and functional outcome

Background: The importance of psychological morbidity after major trauma, s uch as posttraumatic stress disorder (PTSD), is continuing to gain attentio n in trauma outcomes research. The Trauma Recovery Project is a large prosp ective epidemiologic study designed to examine multiple outcomes after majo r trauma, including quality of life (QoL) and PTSD. The specific objectives of the present report are to examine risk factors for PTSD and to assess t he impact on QoL, at the 6-, 12-, and 18-month follow-up time points in the Trauma Recovery Project population. Methods. Between December 1, 1993, and September 1, 1996, 1,048 eligible tr auma patients triaged to four participating trauma center hospitals in the San Diego Regionalized Trauma System were enrolled in the study. The enroll ment criteria for the study included age IS years and older, admission Glas gow Coma Scale score of 12 or greater, and length of stay > 24 hours. QoL w as measured after injury using the Quality of Well-being scale, a sensitive index to the well end of the functioning continuum (range, 0 = death to 1. 000 = optimum functioning). Early symptoms of acute stress reaction (SASR) at discharge were assessed using the Impact of Events Scale (score > 30 = S ASR). PTSD at 6-month follow-up was diagnosed using standardized Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria. Patient outcomes were assessed at discharge and at 6, 12, and 18 months after disc harge. Results. PTSD was diagnosed in 32% (261 of 824) patients at 6-month follow- up. Perceived threat to life predicted PTSD onset (odds ratio [OR], 1.6; p < 0.01) and early SASR (OR, 2.2; p < 0.001). PTSD was more frequent in wome n (39%) than in men (29%) and in younger low-income patients. Other major r isk factors were penetrating trauma (OR, 2.3;p < 0.001) and assaults (OR, 1 .5; p < 0.05). PTSD had a major impact on QoL at 6-, 12-, and 18-month foll ow-up (Quality of Well-being scale score: 6 months, 0.576 vs. 0.658; 12 mon ths, 0.620 vs. 0.691; 18 months, 0.620 vs. 0.700; p < 0.0001). Conclusion. These results provide new and provocative evidence that perceiv ed threat to life and mechanism predict PTSD after major traumatic injury. PTSD had a prolonged and profound impact on short- and long-term outcome an d QoL.