Post-traumatic psychopathology and recovery after musculoskeletal injury
Introduction: Psychological disturbances after combat and major civil accident has long been recognised, but it has become clear that more "everyday" trauma such as road traffic accidents can lead to similar problems. Post-traumatic Stress Disorder (PTSD) is the extreme of a spectrum of Post-traumatic Psychopathology (PTP), is known to influence the Metabolic Response to Trauma (MRT), and may affect physical recovery after injury. This thesis details the results of a large study of accident victims, following their physical, physiological and psychological recovery. Methods: Cohort study of 200 patients aged 16-60 y with musculoskeltal injuries. The patients completed questionnaires that examined their psychological health (GHQ), and their physical and pyschosocial health (SIP, SF-36, MFA), and trauma scores were calculated. Assessments were made on admission (vice health before the accident), and were repeated at two and six months. A subgroup of 82 patients also gave blood samples at each of the follow up points, and these were analysed for pro-inflammatory markers of the MRT (CRP, IL-6, soluble IL-6 receptor, and TNF-a). Results: Follow up was 79% and 75% at two and six months for the main group, and 82% and 59% respectively for the Metabolic Markers subgroup. PTP was found in 11% of patients at initial assessment, 46% at two months and 22% at six months. It was strongly related to impaired physical and psychosocial functioning There were also associations between PTP and sIL-6r and TNF-a at six months. Injury Severity Score was predictive of PTP at two and six months. Discussion: There are strong associations between psychological and physical health after musculosketal trauma. Injury Severity Score is predictive of this psychological disturbance, which is also associated with disturbance of pro-inflammatory markers. Truly holistic care of patients who have suffered musculoskeletal trauma must include management of the psychological injury as well as the more obvious physical injuries.