School of Psychological Sciences, Monash University, Melbourne, Australia.
Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Melbourne, Australia.
Depress Anxiety. 2016 Jan;33(1):19-26. doi: 10.1002/da.22396. Epub 2015 Jul 28.
This study prospectively examined the relationship between preinjury, injury-related, and postinjury factors and posttraumatic stress disorder (PTSD) following moderate to severe traumatic brain injury (TBI).
Two hundred and three participants were recruited during inpatient admission following moderate to severe TBI. Participants completed an initial assessment soon after injury and were reassessed at 3, 6, and 12 months, 2, 3, 4, and 5 years postinjury. The Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-fourth edition was used to diagnose pre- and postinjury PTSD and other psychiatric disorders. The Glasgow Outcome Scale-Extended (GOSE) and the Quality of Life Inventory (QOLI) were used to evaluate functional and psychosocial outcome from 6 months postinjury.
The frequency of PTSD ranged between 0.5 and 9.4% during the 5-year period, increasing throughout the first 12 months and declining thereafter. After controlling for other predictors, shorter posttraumatic amnesia duration (odds ratio = 0.96, 95% CI = 0.92-1.00), other concurrent psychiatric disorder (odds ratio = 14.22, 95% CI = 2.68-75.38), and lower GOSE (odds ratio = 0.38, 95% CI = 0.20-0.72) and QOLI scores (odds ratio = 0.97, 95% CI = 0.95-0.97) were associated with greater odds of having injury-related PTSD.
The results of this study indicate that while shorter posttraumatic amnesia duration is associated with PTSD, greater TBI severity does not prevent PTSD from evolving. Patients with PTSD experienced high rates of psychiatric comorbidity and poorer functional and quality of life outcomes after TBI.
There is a need to direct clinical attention to early identification and treatment of PTSD following TBI to improve outcomes.
本研究前瞻性地考察了中度至重度创伤性脑损伤（TBI）后，受伤前、受伤相关和受伤后因素与创伤后应激障碍（PTSD）之间的关系。
在中度至重度 TBI 住院期间，共招募了 203 名参与者。参与者在受伤后不久进行了初始评估，并在受伤后 3、6、12 个月、2、3、4 和 5 年进行了重新评估。使用《精神障碍诊断与统计手册第四版的结构临床访谈》来诊断受伤前和受伤后的 PTSD 和其他精神障碍。格拉斯哥结局量表-扩展版（GOSE）和生活质量量表（QOLI）用于评估受伤后 6 个月的功能和社会心理结局。
在 5 年期间，PTSD 的频率在 0.5%至 9.4%之间波动，在前 12 个月内逐渐增加，此后逐渐下降。在控制其他预测因素后，较短的创伤后遗忘时间（优势比=0.96，95%置信区间=0.92-1.00）、其他同时存在的精神障碍（优势比=14.22，95%置信区间=2.68-75.38）、较低的 GOSE（优势比=0.38，95%置信区间=0.20-0.72）和 QOLI 评分（优势比=0.97，95%置信区间=0.95-0.97）与 PTSD 的发生几率增加相关。
本研究结果表明，尽管较短的创伤后遗忘时间与 PTSD 相关，但较高的 TBI 严重程度并不能阻止 PTSD 的发展。患有 PTSD 的患者在 TBI 后经历了较高的精神障碍共病率和较差的功能和生活质量结局。
需要将临床注意力集中在 TBI 后 PTSD 的早期识别和治疗上，以改善结局。
