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Psychological Impact of PTSD and Depression on Functional Status Following Hand Injury

This study examines the prevalence of PTSD and depression in patients with hand injuries and their effects on functional status. Findings indicate a notable percentage of patients experience these conditions, impacting their daily lives. Comorbid PTSD and depression have a more significant negative impact on functional status compared to PTSD alone.

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Psychological Impact of PTSD and Depression on Functional Status Following Hand Injury

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  1. Posttraumatic stress disorder (PTSD) and depression following hand injury: Impact on functional statusAllison Williams, ND, PhD, Justin Newman, BS, Kagan Ozer, MD*, Amanda Laufer, BS, Steve Morgan, MD, Wade Smith, MDDepartment of Orthopedics,Denver Health Medical Center, University of Colorado School of MedicineEaster Colorado Health Care System, VAMC-Denver

  2. DSM IV TR Criteria: PTSD • Anxiety disorder following exposure to event perceived as life threatening or with potential of serious harm • Symptoms fall into 3 categories • Intrusion • Avoidance • Arousal • Symptoms must persist for > 1 month

  3. DSM IV TR Criteria: Depression • Mood Disorder • Symptoms include alterations in: • May include thoughts of death or suicide • Symptoms longer than 2 weeks meet criteria for major depressive episode

  4. PTSD, Depression and Injury • PTSD prevalence in general and orthopaedic trauma populations ranges from 1.9% to 51% • Depression prevalence ranges from 4% to 78 % • No studies found that estimate prevalence of PTSD and Depression in hand injured orthopaedic population

  5. Hand Injury and Psychological Sequelae • Psychological sequelae of hand injury may be more prevalent and profound • Witnessing the incident • Hands are organs of sense, expression and agency • Injury may negatively impact work • Cosmetic concerns • Interpersonal relationships

  6. Purpose • Estimate the prevalence of PTSD and depression after hand injuries • Assess the impact of these disorders on functional outcome

  7. Methods • IRB approved prospective, epidemiological study • Patients 18 years or older and more than 1 month post injury recruited from Orthopaedic Hand clinic at a level one trauma center • Patients with documented psychiatric history or cognitive impairment excluded

  8. Outcome Measures • Administered 3 questionnaires: • SF-36 • Revised Civilian Mississippi Scale for PTSD (RCMS) • Beck Depression Inventory (BDI) • Demographic, clinical, and injury data retrieved from patient medical record

  9. Statistical Techniques • Chi-square and Fisher Exact tests • Analysis of Variance (ANOVA) with post hoc comparisons using Tukey’s test • Kruskal-Wallis followed by Mann-Whitney Tests • Data were analyzed using SPSS 11.5 (SPSS, Chicago)

  10. Results • 123 patients satisfied the inclusion and exclusion criteria • 10 refused to participate • Complete data available for 106 patients • 40 females and 66 males • Mean age = 41.8 years (range 18 – 79) • Median time since injury = 75 days

  11. Types of Injury

  12. Mechanism of Injury

  13. Prevalence of PTSD and/or Depression

  14. Impact of PTSD and Comorbid PTSD/Depression on Functional Status *statistically significant at P < 0.05,*difference between groups not significant

  15. Strengths • Prospective study design • First study examining prevalence of PTSD and depression among hand injured patients as well as their additive effect on the functional status • All study materials available in English and Spanish

  16. Limitations • Cross sectional design • Insufficient number of subjects with depression only to analyze its independent effect • Large percentage of subjects 1 to 3 months post injury—considered Acute PTSD phase • Use of self report instruments • Lack of information regarding history of trauma and exposure to violence

  17. Conclusions • PTSD and depression affect a notable percentage of patients with hand injuries. • PTSD and depression have a significant negative impact on functional status • Comorbid PTSD/Depression more negatively affect functional status than PTSD alone

  18. Implications for Practice • Hand injuries are common among military personnel and have increased in the post-conflict phase in Iraq • Psychological status should be addressed when caring for veterans as well as civilians with hand injuries • Health care providers need to be trained to recognize psychological needs of persons with hand injuries • Care delivery systems need to be designed to support appropriate referrals and interventions

  19. Thank You!

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