创伤后精神后遗症。

The psychiatric sequelae of traumatic injury.

机构信息

School of Psychology, University of New South Wales, Sydney, New South Wales 2052, Australia.

出版信息

Am J Psychiatry. 2010 Mar;167(3):312-20. doi: 10.1176/appi.ajp.2009.09050617. Epub 2010 Jan 4.

DOI:10.1176/appi.ajp.2009.09050617

PMID:20048022

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.

摘要

目的

创伤性损伤每年影响数百万人。人们对创伤后发生的精神疾病的程度以及轻度创伤性脑损伤（TBI）对精神疾病的影响知之甚少。作者试图确定创伤后发生的新精神障碍的范围以及轻度 TBI 对精神状态的影响。

方法

在这项前瞻性队列研究中，患者来自澳大利亚四家主要创伤医院的近期入院患者。共有 1084 名创伤患者在入院时接受了初步评估，并在受伤后 3 个月（N=932，86%）和 12 个月（N=817，75%）进行了随访。在医院评估终生精神科诊断。在随访中评估精神障碍的患病率、生活质量水平和精神卫生服务的使用情况。主要观察指标为 3 个月和 12 个月时的轴 I 精神障碍患病率、生活质量水平和精神卫生服务使用情况以及终生轴 I 精神障碍。

结果

受伤 12 个月后，31%的患者报告有精神障碍，22%的患者出现了以前从未经历过的精神障碍。最常见的新精神障碍是抑郁症（9%）、广泛性焦虑症（9%）、创伤后应激障碍（6%）和广场恐惧症（6%）。如果患者发生轻度 TBI，则更有可能发生创伤后应激障碍（优势比=1.92，95%CI=1.08-3.40）、惊恐障碍（优势比=2.01，95%CI=1.03-4.14）、社交恐惧症（优势比=2.07，95%CI=1.03-4.16）和广场恐惧症（优势比=1.94，95%CI=1.11-3.39）。功能障碍而不是轻度 TBI 与精神疾病有关。