Factors identifying risk for psychological distress in the civilian trauma population

Objectives: The emergency department (ED) is a valuable setting to initiate intervention to prevent future complications following traumatic injury. Posttraumatic stress disorder (PTSD) occurs in 10% to 40% of patients after single-incident civilian trauma. Prior research suggests that young age is associated with increased risk. We hypothesized that other factors correlated with age may be responsible. The aim of this study was to determine if factors identifiable in the ED can better explain the relationship between younger age and PTSD, therefore more specifically identifying those at risk for long-term distress. Methods: The influence of age on PTSD severity scores was isolated using data from an established screening program for all admitted trauma patients at a Level I trauma center. The PTSD Checklist-Civilian (PCLC) was administered prospectively to 527 adult trauma patients to measure PTSD symptom severity immediately posttrauma. Patient and trauma characteristics were then reviewed using medical records. Hierarchical linear regression modeled and evaluated the independent association of age with PTSD symptom severity and explored additional variables as better predictors of risk. Results: PTSD symptom severity was associated individually with younger age, ethnic minority status, assaultive trauma, unemployment, low household income, and being unmarried, but not with sex, Injury Severity Score (ISS), or Glasgow Coma Scale (GCS) score at the scene. Multivariate analysis demonstrated assaultive trauma and lower socioeconomic status (SES) were best associated with greater PCLC scores, accounting for 9.3% of the variance. Age did not account for additional variance. Conclusions: Although young age is associated with increased PTSD symptom severity scores, characteristics associated with young age, specifically assaultive trauma and low SES, account for this risk. Young age is not an independent risk factor for PTSD. Psychological assessment in the ED can be targeted toward assaultive trauma patients, especially those of low SES, to establish early intervention and hopefully prevent the development of PTSD.