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DSM IV TR Criteria: PTSD

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  1. Posttraumatic stress disorder (PTSD) and depression following hand injury: Impact on functional statusAllison Williams, ND, PhD, Justin Newman, BS, Kagan Ozer, MD*, Amanda Laufer, BS, Steve Morgan, MD, Wade Smith, MDDepartment of Orthopedics,Denver Health Medical Center, University of Colorado School of MedicineEaster Colorado Health Care System, VAMC-Denver

  2. DSM IV TR Criteria: PTSD • Anxiety disorder following exposure to event perceived as life threatening or with potential of serious harm • Symptoms fall into 3 categories • Intrusion • Avoidance • Arousal • Symptoms must persist for > 1 month

  3. DSM IV TR Criteria: Depression • Mood Disorder • Symptoms include alterations in: • May include thoughts of death or suicide • Symptoms longer than 2 weeks meet criteria for major depressive episode

  4. PTSD, Depression and Injury • PTSD prevalence in general and orthopaedic trauma populations ranges from 1.9% to 51% • Depression prevalence ranges from 4% to 78 % • No studies found that estimate prevalence of PTSD and Depression in hand injured orthopaedic population

  5. Hand Injury and Psychological Sequelae • Psychological sequelae of hand injury may be more prevalent and profound • Witnessing the incident • Hands are organs of sense, expression and agency • Injury may negatively impact work • Cosmetic concerns • Interpersonal relationships

  6. Purpose • Estimate the prevalence of PTSD and depression after hand injuries • Assess the impact of these disorders on functional outcome

  7. Methods • IRB approved prospective, epidemiological study • Patients 18 years or older and more than 1 month post injury recruited from Orthopaedic Hand clinic at a level one trauma center • Patients with documented psychiatric history or cognitive impairment excluded

  8. Outcome Measures • Administered 3 questionnaires: • SF-36 • Revised Civilian Mississippi Scale for PTSD (RCMS) • Beck Depression Inventory (BDI) • Demographic, clinical, and injury data retrieved from patient medical record

  9. Statistical Techniques • Chi-square and Fisher Exact tests • Analysis of Variance (ANOVA) with post hoc comparisons using Tukey’s test • Kruskal-Wallis followed by Mann-Whitney Tests • Data were analyzed using SPSS 11.5 (SPSS, Chicago)

  10. Results • 123 patients satisfied the inclusion and exclusion criteria • 10 refused to participate • Complete data available for 106 patients • 40 females and 66 males • Mean age = 41.8 years (range 18 – 79) • Median time since injury = 75 days

  11. Types of Injury

  12. Mechanism of Injury

  13. Prevalence of PTSD and/or Depression

  14. Impact of PTSD and Comorbid PTSD/Depression on Functional Status *statistically significant at P < 0.05,*difference between groups not significant

  15. Strengths • Prospective study design • First study examining prevalence of PTSD and depression among hand injured patients as well as their additive effect on the functional status • All study materials available in English and Spanish

  16. Limitations • Cross sectional design • Insufficient number of subjects with depression only to analyze its independent effect • Large percentage of subjects 1 to 3 months post injury—considered Acute PTSD phase • Use of self report instruments • Lack of information regarding history of trauma and exposure to violence

  17. Conclusions • PTSD and depression affect a notable percentage of patients with hand injuries. • PTSD and depression have a significant negative impact on functional status • Comorbid PTSD/Depression more negatively affect functional status than PTSD alone

  18. Implications for Practice • Hand injuries are common among military personnel and have increased in the post-conflict phase in Iraq • Psychological status should be addressed when caring for veterans as well as civilians with hand injuries • Health care providers need to be trained to recognize psychological needs of persons with hand injuries • Care delivery systems need to be designed to support appropriate referrals and interventions

  19. Thank You!