Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2022 Oct;56(10):1344-1356. doi: 10.1177/00048674211060747. Epub 2021 Nov 25.
Post-traumatic stress disorder following injuries unrelated to mass casualty events has received little research attention in New Zealand. Internationally, most studies investigating predictors of post-injury post-traumatic stress disorder focus on hospitalised patients although most survivors are not hospitalised. We compared the prevalence and predictors of symptoms suggestive of post-traumatic stress disorder 12 months following injury among hospitalised and non-hospitalised entitlement claimants in New Zealand's Accident Compensation Corporation. This government-funded universal no-fault insurance scheme replaced tort-based compensation for injuries in 1974 since when civil litigation (which can bias post-traumatic stress disorder estimates) has been rare.
A total of 2220 Accident Compensation Corporation claimants aged 18-64 years recruited to the Prospective Outcomes of Injury Study were interviewed at 12 months post-injury to identify symptoms suggestive of post-traumatic stress disorder using the Impact of Events Scale. Multivariable models examined the extent to which baseline sociodemographic, injury, health status and service interaction factors predicted the risk of post-traumatic stress disorder symptoms among hospitalised and non-hospitalised groups.
Symptoms suggestive of post-traumatic stress disorder were reported by 17% of hospitalised and 12% of non-hospitalised participants. Perceived threat to life at the time of the injury doubled this risk among hospitalised (adjusted relative risk: 2.0; 95% confidence interval: 1.2-3.2) and non-hospitalised (relative risk: 1.8; 95% confidence interval: 1.2-2.8) participants. Among hospitalised participants, other predictors included female gender, Pacific and 'other' minority ethnic groups, pre-injury depressive symptoms, financial insecurity and perceived inadequacies in healthcare interactions, specifically information and time to discuss problems. Among non-hospitalised survivors, predictors included smoking, hazardous drinking, assault and poor expectations of recovery.
One in six hospitalised and one in eight non-hospitalised people reported post-traumatic stress disorder symptoms 12 months following injury. Perceived threat to life was a strong predictor of this risk in both groups. Identifying early predictors of post-traumatic stress disorder, regardless of whether the injury required hospitalisation, could help target tailored interventions that can reduce longer-term psychosocial morbidity.
在新西兰，与大规模伤亡事件无关的创伤后应激障碍受到的研究关注甚少。在国际上，大多数研究调查的是受伤后创伤后应激障碍的预测因素，这些研究主要集中在住院患者身上，尽管大多数幸存者没有住院。我们比较了新西兰事故赔偿公司中住院和非住院权益索赔人在受伤后 12 个月时出现创伤后应激障碍症状的患病率和预测因素。自 1974 年以来，这种由政府资助的全民无过错保险计划取代了基于侵权的赔偿，自那时以来，民事诉讼（这可能会影响创伤后应激障碍的估计）就很少见了。
共有 2220 名年龄在 18-64 岁之间的事故赔偿公司索赔人被招募参加前瞻性伤害研究，在受伤后 12 个月时通过事件影响量表对创伤后应激障碍症状进行访谈。多变量模型检查了基线社会人口统计学、伤害、健康状况和服务交互因素在多大程度上预测了住院和非住院组创伤后应激障碍症状的风险。
住院组和非住院组分别有 17%和 12%的人报告出现创伤后应激障碍症状。受伤时感知到的生命威胁使住院组（调整后的相对风险：2.0；95%置信区间：1.2-3.2）和非住院组（相对风险：1.8；95%置信区间：1.2-2.8）的风险增加一倍。在住院组中，其他预测因素包括女性、太平洋和“其他”少数民族群体、受伤前的抑郁症状、经济不安全以及对医疗保健互动的不满，特别是信息和讨论问题的时间。在非住院幸存者中，预测因素包括吸烟、酗酒、袭击和对康复的期望不佳。
在受伤后 12 个月，六分之一的住院患者和八分之一的非住院患者报告出现创伤后应激障碍症状。两组人群中，感知到的生命威胁是这种风险的一个强有力预测因素。无论受伤是否需要住院治疗，及早识别创伤后应激障碍的预测因素都可以帮助确定有针对性的干预措施，从而减少长期的心理社会发病率。
