非神经损伤创伤患者中抑郁和创伤后应激障碍的患病率和治疗情况。
Prevalence and treatment of depression and posttraumatic stress disorder among trauma patients with non-neurological injuries.
机构信息
From the Department of Surgery (T.M., A.N., B.L.Z.), School of Medicine, Indiana University, Indianapolis, Indiana.
出版信息
J Trauma Acute Care Surg. 2018 Nov;85(5):999-1006. doi: 10.1097/TA.0000000000001992.
BACKGROUND
Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and posttraumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment.
METHODS
Adults (18 and older) admitted to a Level I trauma center with an injury severity score greater than 10 but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological Studies-Depression and PTSD CheckList-Civilian Versions surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis.
RESULTS
Five hundred injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3%, 1 month; 49.9%, 2 months; 49.0%, 4 months; and 50.2%, 12 months). Only 22.2% of depressed patients reported receiving treatment for depression; 44.4% of patients screened positive for PTSD (26.6%, 1 month; 27.8%, 2 months; 29.8%, 4 months; and 30.0%, 12 months), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (odds ratio, 0.44; 95% confidence interval, 0.21-0.95).
CONCLUSION
Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury.
LEVEL OF EVIDENCE
Therapeutic/Care management, level IV.
背景
创伤幸存者的心理障碍已得到充分记录。然而，人们对心理障碍的治疗患病率知之甚少。我们旨在确定创伤后一年接受抑郁和创伤后应激障碍（PTSD）治疗的创伤幸存者的比例，并确定治疗的潜在障碍。
方法
年龄在 18 岁及以上、损伤严重程度评分大于 10 但无颅脑损伤或脊髓损伤的患者符合入组条件。在初次住院期间进行了流行病学研究中心抑郁和 PTSD 清单-平民版本的调查，并在创伤后 1、2、4 和 12 个月重复进行。在每次随访时，患者均被问及是否接受过针对抑郁或 PTSD 的专门治疗。使用多变量逻辑回归分析确定与治疗相关的因素。
结果
本前瞻性观察研究共纳入 500 名创伤幸存者。其中，68.4%的患者在创伤后 1 年内的某个时间点出现抑郁症状（53.3%，1 个月；49.9%，2 个月；49.0%，4 个月；50.2%，12 个月）。仅有 22.2%的抑郁患者报告接受了抑郁治疗；44.4%的患者出现 PTSD 症状（1 个月时为 26.6%，2 个月时为 27.8%，4 个月时为 29.8%，12 个月时为 30.0%），但仅有 9.8%的患者接受了 PTSD 治疗。调整其他因素后，与商业保险状况相比，自付保险状况与 PTSD 或抑郁治疗呈负相关（优势比，0.44；95%置信区间，0.21-0.95）。
结论
在创伤后 1 年内，非神经创伤患者中抑郁和 PTSD 很常见。照顾创伤幸存者的人员与行为健康专家之间加强合作，可能有助于改善创伤后的心理结局。
证据等级
治疗/护理管理，IV 级。
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