Ioannou L, Cameron P A, Gibson S J, Ponsford J, Jennings P A, Georgiou-Karistianis N, Giummarra M J
School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia.
Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.
Injury. 2018 May;49(5):990-1000. doi: 10.1016/j.injury.2018.03.013. Epub 2018 Mar 15.
Levels of stress post-injury, especially after compensable injury, are known to be associated with worse long-term recovery. It is therefore important to identify how, and in whom, worry and stress manifest post-injury. This study aimed to identify demographic, injury, and compensation factors associated with worry about financial and recovery outcomes 12 months after traumatic injury.
Participants (n = 433) were recruited from the Victorian Orthopaedic Trauma Outcomes Registry and Victorian State Trauma Registry after admission to a major trauma hospital in Melbourne, Australia. Participants completed questionnaires about pain, compensation experience and psychological wellbeing as part of a registry-based observational study.
Linear regressions showed that demographic and injury factors accounted for 11% and 13% of variance in financial and recovery worry, respectively. Specifically, lower education, discharge to inpatient rehabilitation, attributing fault to another and having a compensation claim predicted financial worry. Worry about recovery was only predicted by longer hospital stay and attributing fault to another. In all participants, financial and recovery worry were associated with worse pain (severity, interference, catastrophizing, kinesiophobia, self-efficacy), physical (disability, functioning) and psychological (anxiety, depression, PTSD, perceived injustice) outcomes 12 months post-injury. In participants who had transport (n = 135) or work (n = 22) injury compensation claims, both financial and recovery worry were associated with sustaining permanent impairments, and reporting negative compensation system experience 12 months post-injury. Financial worry 12 months post-injury was associated with not returning to work by 3-6 months post-injury, whereas recovery worry was associated with attributing fault to another, and higher healthcare use at 6-12 months post-injury.
These findings highlight the important contribution of factors other than injury severity, to worry about finances and recovery post-injury. Having a compensation claim, failure to return to work and experiencing pain and psychological symptoms also contribute to elevated worry. As these factors explained less than half of the variance in worry, however, other factors not measured in this study must play a role. As worry may increase the risk of developing secondary mental health conditions, timely access to financial, rehabilitation and psychological supports should be provided to people who are not coping after injury.
已知受伤后，尤其是在可获赔偿的受伤情况之后，压力水平与较差的长期恢复情况相关。因此，确定受伤后担忧和压力如何表现以及在哪些人身上表现很重要。本研究旨在确定与创伤性损伤12个月后对经济和恢复结果的担忧相关的人口统计学、损伤和赔偿因素。
参与者（n = 433）是在澳大利亚墨尔本一家主要创伤医院入院后，从维多利亚州骨科创伤结果登记处和维多利亚州创伤登记处招募的。作为一项基于登记处的观察性研究的一部分，参与者完成了关于疼痛、赔偿经历和心理健康的问卷调查。
线性回归显示，人口统计学和损伤因素分别占经济担忧和恢复担忧方差的11%和13%。具体而言，较低的教育水平、转入住院康复、将过错归咎于他人以及提出赔偿要求可预测经济担忧。对恢复的担忧仅由较长的住院时间和将过错归咎于他人来预测。在所有参与者中，经济和恢复担忧与受伤后12个月时更严重的疼痛（严重程度、干扰、灾难化、运动恐惧、自我效能感）、身体（残疾、功能）和心理（焦虑、抑郁、创伤后应激障碍、感知到的不公正）结果相关。在有交通（n = 135）或工作（n = 22）受伤赔偿要求的参与者中，经济和恢复担忧均与持续存在永久性损伤以及报告受伤后12个月时负面的赔偿系统体验相关。受伤后12个月的经济担忧与受伤后3至6个月未重返工作相关，而恢复担忧与将过错归咎于他人以及受伤后6至12个月更高的医疗保健使用相关。
这些发现突出了除损伤严重程度之外的因素对受伤后经济和恢复担忧的重要贡献。提出赔偿要求、未能重返工作以及经历疼痛和心理症状也会导致担忧加剧。然而，由于这些因素解释的担忧方差不到一半，本研究未测量的其他因素肯定也起了作用。由于担忧可能会增加发生继发性心理健康问题的风险，对于受伤后无法应对的人，应及时提供经济、康复和心理支持。
