The Psychiatric Sequelae of Traumatic Injury
The Psychiatric Sequelae of Traumatic Injury
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DOI：
10.1176/appi.ajp.2009.09050617
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发表时间：
2010-03-01
影响因子：
17.7
通讯作者：
Silove, Derrick
中科院分区：
文献类型：
--
作者：
Bryant, Richard A.;O'Donnell, Meaghan L.;Silove, Derrick
目的：创伤性损伤每年影响数百万人。人们对创伤性损伤后精神疾病的程度或轻度创伤性脑损伤（TBI）对精神疾病的影响了解甚少。作者试图确定创伤性损伤后发生的新的精神疾病的范围和轻度TBI对精神状态的影响。方法：在这项前瞻性队列研究中，患者来自澳大利亚四家主要创伤医院最近的入院。共有1，084名创伤患者在入院时进行了初步评估，并在受伤后3个月（N=932，86%）和12个月（N=817，75%）进行了随访。终生精神病诊断在医院进行评估。在随访时评估精神疾病的患病率、生活质量水平和精神卫生服务的使用情况。主要结果的措施是3个月和12个月的患病率轴I精神疾病，生活质量的水平，和精神卫生服务的使用和终身轴I精神disorders.Results：12个月后受伤，31%的患者报告精神疾病，和22%的精神疾病，他们从来没有经历过。最常见的新发精神疾病是抑郁症（9%）、广泛性焦虑症（9%）、创伤后应激障碍（6%）和广场恐怖症（6%）。患者更容易患上创伤后应激障碍（比值比=1.92，95% CI=1.08-3.40），惊恐障碍（比值比=2.01，95% CI=1.03-4.14），社交恐惧症（比值比=2.07，95%CI =1.03-4.16）和广场恐怖症（比值比=1.94，95%CI =1.11-3.39）。功能障碍，而不是轻微的TBI，与精神疾病。结论：一个显着的精神障碍范围内发生创伤性损伤后。一系列精神障碍的识别和治疗对于创伤后的最佳适应非常重要。
Objective: Traumatic injury affects millions of people each year. There is little understanding 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 prospective 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.