1. Psychiatric comorbidities in adult survivors of major trauma:
Findings from the Midland Trauma Registry Network
Spijker E, Jones K, Duijff JW, Smith A, & Christey GR.

2. The Problem: Psycho-social needs of adult trauma survivors are poorly understood
10-39%
of trauma survivors experience PSTD
Those affected face 2-6-fold risks for developing psychiatric comorbidities
Common reports of diminished functioning, poor quality of life, hospitalisation, use of medical care, unemployment, and poverty
No national guidelines for psychiatric treatment of trauma survivors

3. Aim: What is the scope of the problem in NZ?
Enhance understanding of the nature of psychiatric comorbidities in the first year of recovery
Identify factors associated with poor outcomes
Survey of a retrospective, regional cohort of 65 adult (>15 yrs) major trauma survivors in the Waikato district (MTRS data)
01 June 2010 to 01 July 2011

4. Sample Mean age at injury 46.3 years (21.2) Male 42 (64.6%) Ethnicity
Maori 10 (15.4%)
Non-Maori 54 (83.0)
Marital status
Married 37 (56.9%)
Single/widow/divorced 27 (41.6%)
Higher education
9 (13.8)
Injury mechanism
Motor vehicle 23 (35.3%)
Fall 16 (24.6%)
Motorbike 8 (12.3%)
Psychiatric history
10 (15.0%)

5. Measures
EuroQol (EQ-5D-3L) assesses health-related QOL in five domains affected by injury (mobility, self-care, usual activities, pain/discomfort, anxiety/depression)
Posttraumatic Stress Disorder Checklist (PTSD checklist) – specifically aligns with DSM-IV criteria for PTSD, assessing three main syndromes: re-experiencing, avoidance, and hyperarousal.
The 21-item Beck Depression Inventory (BDI) screens for depression symptoms in the past two weeks (i.e. sense of failure, pessimism, guilt).
The Visual Analogue Scale for Pain is a single-item scale using a 10-cm vertical line. Ranging from 0 = ‘no pain’ and 10 = ‘worst possible pain’, participants indicate their pain level during the last 3-months.
The 10-item Alcohol Use Disorders Identification Test screens for harmful alcohol use.

6. Potential person and injury factors associated with outcomes
Education
Age
Gender
Ethnicity
Marital status
Psychiatric history
TBI
ICU
Days in hospital
Injury mechanism ICD-10 codes
Injury Severity Score (ISS)

7. Proportion of adults meeting criteria
Results
Research Themes
Proportion of adults meeting criteria

8. Proportion of adults meeting criteria
Results
Research Themes
Proportion of adults meeting criteria

9. Total number (%) of criteria met
Results
Research Themes
Patterns of comorbidity
Total number (%) of criteria met
N = 65
9 (13.8) 1
19 (29.2) 2
20 (30.8) 3 4
6 (9.2) 5
2 (3.1)

10. Factors associated with meeting criteria
Results
Research Themes
Factors associated with meeting criteria
ICU admission**
>10 days hospitalisation*
ICU admission*
Younger age (16-50 yrs)**
Depression
Harmful alcohol use
Psychiatric history**
Younger age (16-50 yrs)**
Substance use*
Younger age (16-50 yrs)*
P<.01**, p<.05*

11. Impaired QoL associated with…
Results
Research Themes
Impaired QoL associated with…
Time since trauma ≤ 6-months*
>10-days hospitalisation**
No associations between any outcomes and gender, ethnicity, marital status, education, injury mechanism, ISS score.

12. Discussion
Nearly half of adult survivors of major trauma experienced PTSD symptoms in first year after injury (similar to previous overseas reports)
Around one quarter reported harmful alcohol use and/or moderate- severe pain
1 in 5 adults reported 2 or more psychiatric comorbidities
Important for primary care and community health workers to be aware of increased risks and to consider ways to identify those at risk

13. Where to now?
A key challenge in hospitals is distinguishing between transient distress and risk for subsequent psychiatric disorder
One option – standardised review of patient records for known risk factors prior to discharge (i.e. Injured Trauma Survivor Screen, Post-traumatic Adjustment Scales)
Status indicated in discharge summaries to flag follow-up in primary care and prompt systematic provision of trauma patient- specific information at discharge
Primary care could use of predictive screeners (i.e. My Mood Monitor Checklist) and a trauma survivor template in electronic patient management systems
Those who screen positive can be engaged in further discussion and potential follow-up (i.e. psychological assessment)
Significant improvements in well-being and careful allocation of costly and limited mental health resources