Psychiatric outcome at least 20 years after trauma: A survey on the status of subjective general health and psychiatric symptoms with a focus on posttraumatic stress disorder

Abstract

BACKGROUND
Information on long-term psychiatric sequelae after severe trauma is sparse. We therefore performed a survey addressing several symptoms related to post traumatic stress disorder (PTSD) in patients that sustained multiple injuries more than 20 years after trauma.
METHODS
Patients injured between January 1, 1973 and December 31, 1990 were contacted at least 20 years later. We included multiply injured patients aged between 3 and 60 years of age from a single level I Trauma center. A questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnostic criteria for PTSD, including individual symptoms related to intrusion, avoidance, and hyperarousal was sent to all patients.
RESULTS
359 (56.35%) patients received a questionnaire. Out of these, 337 (93.87%) returned the questionnaire and were included in the study (223 males (66.17%) and 114 females (33.82%)). Mean follow-up was 29.5 ± 8.5 years. Nearly half the study population (47.18%) experienced lasting psychiatric sequelae, such as intrusive recollection (n= 65, 19.28%), avoidance (n= 92, 27.29%), or hyperarousal (n=95, 28.18%) at least monthly. Ten patients (2.96%) fulfilled all DSM-IV diagnostic criteria for PTSD. A total of 131 (38.87%) patients reported fair or poor general health status. There was no difference in injury severity in patients with or without PTSD (Injury Severity Score (ISS) 18.33 vs. 20.36, respectively, p = 0.52) or PTSD-related symptoms including intrusion (19.88 vs. 20.32, p=0.74), avoidance (19.99 vs. 20.3, p=0.79) and hyperarousal (19.36 vs. 20.68, p=0.26).
CONCLUSION
At least 20 years after injury, no correlation was found between the development of psychiatric complications and the severity of injury. While the rate of full-blown PTSD was low, nearly half the study population regularly suffered from at least one psychiatric symptom attributable to the initial trauma. Awareness for the development of psychiatric complications and early initiation of psychiatric counseling is advisable.
LEVEL OF EVIDENCE
Level II, Prognostic and Epidemiologic.