Nicholson Victoria, Cole Elaine, Christie Robert
Queen Mary University of London, UK.
Queen Mary University of London, UK.
Injury. 2025 May;56(5):112080. doi: 10.1016/j.injury.2024.112080. Epub 2024 Dec 15.
Recovery after severe injury may be impacted by a range of psychological factors. This multi-site study investigated the prevalence and impact of anxiety and depression at one year after trauma critical care admission.
Adult trauma patients admitted to four Level 1 Critical Care Units were prospectively enrolled over 18 months. Survivors were followed-up at one year post discharge using EQ-5D-5L questionnaires. Multivariable logistic regression analysis was used to evaluate factors associated with anxiety and depression at follow up.
Of the 657 patients consented and alive at follow-up, 290 questionnaires were completed (44 % response rate). Two-thirds (63 %) reported anxiety or depression (AoD) at follow up, and this was associated with a worse overall health state (EQ-VAS No AoD: 80 vs. AoD: 60, p < 0.0001). Median ISS in both groups was 25 but those with AoD were younger (53 years vs. 60 years, p = 0.033), had previous psychological morbidities (16 % vs. 5 %, p = 0.0056) and longer hospital stays (32 vs. 24 days, p = 0.0027). All physical EQ-5D-5 L domains were worse in the presence of AoD and problems increased as anxiety or depression became more severe. Factors associated with anxiety and depression were younger age (OR 0.98 [95 % CI 0.96-0.99] p = 0.004), previous psychological morbidity (OR 3.30 [95 % CI 1.51-7.40] p = 0.004), penetrating injury (OR 10.10 [95 % CI 1.90 - 44.4] p = 0.007), ongoing pain (OR 1.61 [95 % CI 1.10-2.30] p = 0.003) or difficulties carrying out usual activities (OR 1.40 [95 % CI 1.02-2.29] p = 0.04).
Anxiety and depression are significant longer-term impacts after severe injury. Younger age, penetrating injury and psychological comorbidities may be identifiers of longer-term anxiety and depression following trauma critical care. Pain at one-year had a strong association and represents a modifiable target to improve psychological outcomes.
严重损伤后的恢复可能受到一系列心理因素的影响。这项多中心研究调查了创伤重症监护入院一年后焦虑和抑郁的患病率及其影响。
对入住四个一级重症监护病房的成年创伤患者进行了为期18个月的前瞻性研究。出院一年后，使用EQ-5D-5L问卷对幸存者进行随访。采用多变量逻辑回归分析来评估随访时与焦虑和抑郁相关的因素。
在随访时同意参与且存活的657例患者中，完成了290份问卷（回复率44%）。三分之二（63%）的患者在随访时报告有焦虑或抑郁（AoD），这与总体健康状况较差相关（EQ-VAS无AoD组：80 vs. AoD组：60，p < 0.0001）。两组的损伤严重程度评分中位数均为25，但有AoD的患者更年轻（53岁 vs. 60岁，p = 0.033），既往有心理疾病（16% vs. 5%，p = 0.0056），住院时间更长（32天 vs. 24天，p = 0.0027）。在存在AoD的情况下，所有身体方面的EQ-5D-5L领域情况都更差，并且随着焦虑或抑郁变得更严重，问题也会增加。与焦虑和抑郁相关的因素包括年龄较小（比值比0.98 [95%置信区间0.96 - 0.99]，p = 0.004）、既往有心理疾病（比值比3.30 [95%置信区间1.51 - 7.40]，p = 0.004）、穿透伤（比值比10.10 [95%置信区间1.90 - 44.4]，p = 0.007）、持续疼痛（比值比1.61 [95%置信区间1.10 - 2.30]，p = 0.003）或进行日常活动有困难（比值比1.40 [95%置信区间1.02 - 2.29]，p = 0.04）。
焦虑和抑郁是严重损伤后显著的长期影响因素。年龄较小、穿透伤和心理合并症可能是创伤重症监护后长期焦虑和抑郁的识别因素。一年时的疼痛有很强的关联性，是改善心理结局的一个可改变的目标。
