Williams Allison E, Newman Justin T, Ozer Kagan, Juarros Amanda, Morgan Steve J, Smith Wade R
Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA.
J Hand Surg Am. 2009 Mar;34(3):515-22. doi: 10.1016/j.jhsa.2008.11.008.
To estimate the prevalence of posttraumatic stress disorder (PTSD) and depression among hand-injured patients and assess the impact of these disorders on general health status.
A total of 106 adult hand-injured patients (40 women, 66 men) with a mean age of 42 years (range, 18-79 years) participated. Patients with a chronic mental illness or cognitive impairment were excluded. Psychological status was assessed using the Revised Civilian Mississippi Scale for PTSD and the Beck Depression Inventory. General health status was evaluated with the Short Form-36 health survey (SF-36). We obtained demographics and injury characteristics from the patient medical records.
Prominent mechanisms of injury included a fall (n = 38), traffic-related injuries (n = 14), machine versus operator (n = 8), gunshot wounds (n = 6), and assault (n = 6). Using the screening questionnaires, 32 persons qualified for PTSD and 19 for depression. Sixteen patients met the criteria for both PTSD and depression. The association between PTSD and depression was significant (p < .01). Patients with PTSD had significantly lower scores than those who did not endorse items consistent with PTSD or depression on the SF-36 subscales of role-emotional (p < .01), body pain (p = .013), social function (p = .028), and mental health (p < .01). We found no significant differences between groups for the subscales of role-physical (p = .289), general health (p = .147), vitality (p = .496), and physical functioning (p = .476). Patients who had concurrent PTSD and depression had significantly lower scores than patients who had neither PTSD nor depression on all subscales (p < .05 for all) except role-physical (p = .135). We found significant negative correlations between Beck Depression Inventory scores and all of the SF-36 subscales (p < .05 for all).
In this study, nearly one third of hand-injured patients met diagnostic criteria for PTSD, depression, or both, according to the thresholds of the instruments used to measure these psychological aspects of illness. PTSD and depression had a negative effect on general health status after hand injury. It may be important to consider psychological status when caring for patients with hand injuries.
评估手部受伤患者创伤后应激障碍（PTSD）和抑郁症的患病率，并评估这些疾病对总体健康状况的影响。
共有106名成年手部受伤患者（40名女性，66名男性）参与研究，平均年龄42岁（范围18 - 79岁）。排除患有慢性精神疾病或认知障碍的患者。使用修订后的平民版密西西比PTSD量表和贝克抑郁量表评估心理状态。通过简短健康调查问卷（SF - 36）评估总体健康状况。我们从患者病历中获取人口统计学和损伤特征信息。
主要受伤机制包括跌倒（n = 38）、交通相关损伤（n = 14）、机器与操作人员相关损伤（n = 8）、枪伤（n = 6）和袭击（n = 6）。使用筛查问卷，32人符合PTSD诊断标准，19人符合抑郁症诊断标准。16名患者同时符合PTSD和抑郁症标准。PTSD与抑郁症之间的关联具有统计学意义（p <.01）。在SF - 36量表的角色 - 情感（p <.01）、身体疼痛（p =.013）、社会功能（p =.028）和心理健康（p <.01）子量表上，患有PTSD的患者得分显著低于未认可与PTSD或抑郁症相关项目的患者。我们发现，在角色 - 身体（p =.289）、总体健康（p =.147）、活力（p =.496）和身体功能（p =.476）子量表上，两组之间没有显著差异。同时患有PTSD和抑郁症的患者在所有子量表（除角色 - 身体，p =.135）上的得分均显著低于既没有PTSD也没有抑郁症的患者（所有p <.05）。我们发现贝克抑郁量表得分与所有SF - 36子量表之间存在显著负相关（所有p <.05）。
在本研究中，根据用于测量这些心理疾病方面的工具阈值，近三分之一的手部受伤患者符合PTSD、抑郁症或两者的诊断标准。PTSD和抑郁症对手部受伤后的总体健康状况有负面影响。在护理手部受伤患者时考虑心理状态可能很重要。
