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Abstract

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.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 312 - 320
PubMed: 20048022

History

Received: 5 May 2009
Accepted: 5 October 2009
Published online: 1 March 2010
Published in print: March 2010

Authors

Details

Richard A. Bryant, Ph.D.
Meaghan L. O'Donnell, Ph.D.
Alexander C. McFarlane, M.D.
C. Richard Clark, Ph.D.

Notes

Received May 5, 2009; revision received Aug. 11, 2009; accepted Oct. 5, 2009. From the School of Psychology and the School of Psychiatry, University of New South Wales, Sydney, Australia; the Department of Psychiatry, University of Melbourne; the Australian Centre for Posttraumatic Mental Health, East Melbourne; the National Trauma Research Institute, Melbourne; the Centre for Military and Veteran Health, University of Adelaide; and the School of Psychology and the Cognitive Neuroscience Laboratory, Flinders University, Adelaide. Address correspondence and reprint requests to Dr. Bryant, School of Psychology, University of New South Wales, Sydney, New South Wales 2052 Australia; [email protected] (e-mail).

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

Supported by National Health and Medical Research Council Program grant 300403, Victorian Trauma Foundation grant V-11, and National Health and Medical Research Council Australian Clinical Research Fellowship 359284.

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