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Association Between Posttraumatic Stress and Depressive Symptoms and Functional Outcomes in Adolescents Followed Up Longitudinally After Injury Hospitalization
Douglas F. Zatzick, MD;
Gregory J. Jurkovich, MD;
Ming-Yu Fan, PhD;
David Grossman, MD, MPH;
Joan Russo, PhD;
Wayne Katon, MD;
Frederick P. Rivara, MD, MPH
Arch Pediatr Adolesc Med. 2008;162(7):642-648.
Objective To assess the association between early posttraumatic stress disorder (PTSD) and depressive symptoms and functional and quality-of-life outcomes among injured youth.
Design Prospective cohort study.
Setting Combined pediatric-adult level I trauma center.
Participants Randomly sampled adolescent injury survivors aged 12 to 18 years (N = 108) were recruited from surgical inpatient units.
Main Exposures Posttraumatic stress disorder and depressive symptom levels in the days and weeks immediately following injury. We also collected relevant adolescent demographic, injury, and clinical characteristics.
Main Outcome Measure Multiple domains of adolescent functional impairment were assessed with the 87-item Child Health Questionnaire (CHQ-87) at 2, 5, and 12 months after injury.
Results The investigation attained greater than 80% adolescent follow-up at each assessment after injury. Mixed-model regression was used to assess the association between baseline levels of PTSD and depressive symptoms and subsequent functional outcomes longitudinally. High baseline PTSD symptom levels were associated with significant impairments in CHQ-87 Role/Social Behavioral, Role/Social Physical, Bodily Pain, General Behavior, Mental Health, and General Health Perceptions subscales. High baseline depressive symptoms were associated with significant impairments in CHQ-87 Physical Function, Role/Social Emotional, Bodily Pain, Mental Health, Self-esteem, and Family Cohesion subscales.
Conclusions Early PTSD and depressive symptoms are associated with a broad spectrum of adolescent functional impairment during the year after physical injury. Coordinated investigative and policy efforts that refine mental health screening and intervention procedures have the potential to improve the functioning and well-being of injured youth treated in the acute care medical setting.
Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Drs Zatzick, Fan, Russo, and Katon), Surgery (Dr Jurkovich), and Pediatrics (Dr Rivara), and Harborview Injury Prevention and Research Center (Drs Zatzick, Jurkovich, Grossman, and Rivara), University of Washington School of Medicine, Seattle.
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