PTSD in long-term follow-up after multiple trauma

Posttraumatic stress disorder (PTSD) appears to be much more common in patients after severe multiple trauma than might have been suspected, and may complicate the full rehabilitation even in long-term follow-up. We have investigated the relationship between physical and psychological parameters in victims of severe multiple trauma 10 to 20 years after the injury. 54% of 637 patients living participated in this cohort study done by means of standardized questionnaires. Psychological measures were the impact of event scale (IES) and the hospital anxiety and depression scale (HADS), functional outcome was measured by SF–12 and Hannover Score for Polytrauma Outcome (HASPOC). With regard to the traumatic situation of the injury 79 of the 326 patients (24%) fulfilled the criteria of PTSD. In addition 124 of the 326 (38%) suffered from a depressive disorder. 52 of these patients had symptoms of PTSD and depression as well. The posttraumatic disturbance did not correlate with gender, severity of the injury (ISS) and extreme body disturbance like amputation of the arms or the legs. Significant correlation was found with age (younger ones had less psychic trauma), and functional outcome as measured by SF–12 (more physical and psychological impairment in patients with depression and PTSD) but not by HASPOC. The correlation of PTSD with impaired functional outcome after multiple trauma even 20 years after the traumatic injury shows that it is a significant problem. Further research is required to discover personal predispositions for developing PTSD on the one hand and to determine whether an approach that combines physical and psychological treatment can improve patient outcomes on the other hand.

Key words

PTSD - trauma