Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries
Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries
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DOI：
10.1097/ta.0000000000001992
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发表时间：
2018-11-01
影响因子：
3.4
通讯作者：
Zarzaur, Ben L.
中科院分区：
文献类型：
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作者：
Bell, Teresa M.;Vetor, Ashley N.;Zarzaur, Ben L.
创伤幸存者的心理障碍是有据可查的。然而，人们对心理障碍治疗的普遍性知之甚少。我们的目的是确定受伤幸存者治疗抑郁症和创伤后应激障碍（PTSD）的比例，在一年后的伤害，以及确定潜在的障碍treatment.METHODS成人（18岁及以上）承认一级创伤中心的损伤严重程度评分大于10，但没有创伤性脑损伤或脊髓损伤有资格纳入研究。流行病学中心抑郁症和创伤后应激障碍检查表平民版调查在最初住院期间进行，并在受伤后1、2、4和12个月重复。在每次随访时，患者被问及是否接受了专门针对抑郁症或PTSD的治疗。与治疗相关的因素采用多变量logistic回归分析确定。结果五百受伤幸存者参加了这项前瞻性观察研究。其中，68.4%的患者在受伤后一年的某个时候筛查出抑郁症阳性（53.3%，1个月; 49.9%，2个月; 49.0%，4个月; 50.2%，12个月）。只有22.2%的抑郁症患者报告接受了抑郁症治疗; 44.4%的PTSD筛查阳性患者（26.6%，1个月; 27.8%，2个月; 29.8%，4个月; 30.0%，12个月），但只有9.8%的患者接受了PTSD治疗。在调整其他因素后，与商业保险相比，自费保险与创伤后应激障碍或抑郁的治疗呈负相关（比值比0.44; 95%可信区间0.21-0.95）。那些照顾受伤幸存者和行为健康专家之间的更大合作可能有助于改善受伤后的心理结果。证据等级治疗/护理管理，IV级。
BACKGROUND Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and posttraumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment.METHODS Adults (18 and older) admitted to a Level I trauma center with an injury severity score greater than 10 but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological StudiesDepression and PTSD CheckListCivilian Versions surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis.RESULTS Five hundred injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3%, 1 month; 49.9%, 2 months; 49.0%, 4 months; and 50.2%, 12 months). Only 22.2% of depressed patients reported receiving treatment for depression; 44.4% of patients screened positive for PTSD (26.6%, 1 month; 27.8%, 2 months; 29.8%, 4 months; and 30.0%, 12 months), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (odds ratio, 0.44; 95% confidence interval, 0.21-0.95).CONCLUSION Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury.LEVEL OF EVIDENCE Therapeutic/Care management, level IV.