Posttraumatic disorders following injury: Assessment and other methodological considerations

Abstract

Physical injury in civilian populations is a frequent event. In 2000, 11% of the U.S. population (approximately 30 million people) were treated in emergency departments following nonfatal injuries (National Centre for Injury Prevention and Control-Electronic Database, 2000). Not only does injury occur frequently, but it often occurs at a severity to be classified as a traumatic event. Breslau et al. (1991) found that a lifetime prevalence of serious injury or serious motor vehicle crash was 41.9%, rating second in frequency of traumatic events. The conditional risk for developing Posttraumatic Stress Disorder (PTSD) following serious accidents and injury is relatively low (Kessler et al., 1995); that is, the risk of developing PTSD in all those who are exposed to traumatic injury is low relative to other traumatic events such as interpersonal violence (Breslau et al., 1998). Nevertheless, serious injury is a leading cause of PTSD because of the frequency with which injury occurs. For example, Breslau et al. (1998) found that serious injury accounted for nearly one-quarter of the PTSD cases in their community sample. This was also the case in both the National Comorbidity Survey (Kessler et al., 1995) and the equivalent Australian study (Creamer et al., 2001). Taken together, although the conditional risk of developing PTSD following serious injury is low, the substantial frequency with which injury occurs makes injury one of the most frequent causes of PTSD. This chapter aims to orient both practitioner and researcher to the current status of research regarding PTSD following injury. However, when evaluating this literature and when conducting assessments with injury survivors, researchers and practitioners alike must be cognizant of a number of key issues that may impact on the diagnosis of PTSD. These factors include the following: differentiating among the physical, psychological, and environmental origin of symptoms; head injury and how it complicates assessment; the impact of secondary stressors; the influence of medications on symptom presentation; and the role of litigation. Appropriate attention to these factors will help to optimize the reliability and consistency of mental health assessments following injury.