Skip to main content
SpringerLink
Log in

Psychiatric Issues in the Treatment of Severe Trauma

  • Chapter
  • First Online:
Textbook of Polytrauma Management

  • 1543 Accesses

Abstract

This chapter addresses psychiatric issues in the care of patients with traumatic injuries. Psychiatric illness is the proverbial “elephant in the room” for the care of these patients, as the prevalence of psychopathology in this patient population is highly prevalent, and its effects on medical outcomes and treatment are substantive. Research from 17 studies of adult patient samples and 7 studies of pediatric patient samples is reviewed in this chapter, revealing that about one-half of both adult and pediatric patients receiving care for traumatic injuries have diagnosable psychiatric disorders following their injuries, although few of the patients with psychiatric disorders received treatment. Similar proportions of these patients also had pre-existing psychiatric disorders, which may have not only contributed to the risk for trauma but also persisted into the post-injury period to complicate medical treatment. This chapter also provides a summary of common psychiatric disorders and outlines psychiatric treatment for them. Recognition of psychiatric needs in these patients and linkage to appropriate care is an important part of their post-injury treatment, addressing not only psychiatric outcomes but also likely optimizing medical outcomes.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wiseman T, Foster K, Curtis K. Mental health following traumatic physical injury: an integrative literature review. Injury. 2013;44:1383–90.

    Article  PubMed  Google Scholar 

  2. Qi W, Gevonden M, Shalev A. Prevention of post-traumatic stress disorder after trauma: current evidence and future directions. Curr Psychiatry Rep. 2016;18:20.

    Article  PubMed  PubMed Central  Google Scholar 

  3. deRoon-Cassini TA, Hunt JC, Geier TJ, Warren AM, Ruggiero KJ, Scott K, George J, Halling M, Jurkovich G, Fakhry SM, Zatzick D, Brasel KJ. Screening and treating hospitalized trauma survivors for posttraumatic stress disorder and depression. J Trauma Acute Care Surg. 2019;87:440–50.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Heron-Delaney M, Kenardy J, Charlton E, Matsuoka Y. A systematic review of predictors of posttraumatic stress disorder (PTSD) for adult road traffic crash survivors. Injury. 2013;44:1413–22.

    Article  PubMed  Google Scholar 

  5. Palmu R, Suominen K, Vuola J, Isometsa E. Mental disorders among acute burn patients. Burns. 2010;36:1072–9.

    Article  PubMed  Google Scholar 

  6. North CS, Pfefferbaum B. Mental health response to community disasters: a systematic review. JAMA. 2013;310:507–18.

    Article  CAS  PubMed  Google Scholar 

  7. North CS. Disaster mental health epidemiology: methodological review and interpretation of research findings. Psychiatry. 2016;79:130–46.

    Article  PubMed  Google Scholar 

  8. Dyster-Aas J, Willebrand M, Wikehult B, Gerdin B, Ekselius L. Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity. J Trauma. 2008;64:1349–56.

    PubMed  Google Scholar 

  9. Fauerbach JA, Lawrence J, Haythornthwaite J, McGuire M, Munster A. Preinjury psychiatric illness and postinjury adjustment in adult burn survivors. Psychosomatics. 1996;37:547–55.

    Article  CAS  PubMed  Google Scholar 

  10. Fauerbach JA, Lawrence JW, Schmidt CW Jr, Munster AM, Costa PT Jr. Personality predictors of injury-related posttraumatic stress disorder. J Nerv Ment Dis. 2000;188:510–7.

    Article  CAS  PubMed  Google Scholar 

  11. Fauerbach JA, Lawrence J, Haythornthwaite J, Richter D, McGuire M, Schmidt C, Munster A. Preburn psychiatric history affects posttrauma morbidity. Psychosomatics. 1997;38:374–85.

    Article  CAS  PubMed  Google Scholar 

  12. Bryant RA. Predictors of post-traumatic stress disorder following burns injury. Burns. 1996;22:89–92.

    Article  CAS  PubMed  Google Scholar 

  13. Blanchard EB, Hickling EJ, Taylor AE, Loos WR, Forneris CA, Jaccard J. Who develops PTSD from motor vehicle accidents? Behav Res Ther. 1996;34:1–10.

    Article  CAS  PubMed  Google Scholar 

  14. Richmond TS, Amsterdam JD, Guo W, Ackerson T, Gracias V, Robinson KM, Hollander JE. The effect of post-injury depression on return to pre-injury function: a prospective cohort study. Psychol Med. 2009;39:1709–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ter Smitten MH, de Graaf R, Van Loey NE. Prevalence and co-morbidity of psychiatric disorders 1–4 years after burn. Burns. 2011;37:753–61.

    Article  PubMed  Google Scholar 

  16. Dersh J, Mayer T, Theodore BR, Polatin P, Gatchel RJ. Do psychiatric disorders first appear preinjury or postinjury in chronic disabling occupational spinal disorders? Spine (Phila Pa 1976). 2007;32:1045–51.

    Article  Google Scholar 

  17. Jorge RE, Robinson RG, Moser D, Tateno A, Crespo-Facorro B, Arndt S. Major depression following traumatic brain injury. Arch Gen Psychiatry. 2004;61:42–50.

    Article  PubMed  Google Scholar 

  18. Epstein RS. Avoidant symptoms cloaking the diagnosis of PTSD in patients with severe accidental injury. J Trauma Stress. 1993;6:451–8.

    Article  Google Scholar 

  19. Whitman JB, North CS, Downs DL, Spitznagel EL. A prospective study of the onset of PTSD symptoms in the first month after trauma exposure. Ann Clin Psychiatry. 2013;25:163–72.

    PubMed  Google Scholar 

  20. Öster C, Sveen J. The psychiatric sequelae of brain injury. Gen Hosp Psychiatry. 2014;36:516–22.

    Article  PubMed  Google Scholar 

  21. Poole GV, Lewis JL, Devidas M, Hauser CJ, Martin RW, Thomae KR. Psychopathologic risk factors for intentional and nonintentional injury. J Trauma. 1997;42:711–5.

    Article  CAS  PubMed  Google Scholar 

  22. Wisely JA, Wilson E, Duncan RT, Tarrier N. Pre-existing psychiatric disorders, psychological reactions to stress and the recovery of burn survivors. Burns. 2010;36:183–91.

    Article  CAS  PubMed  Google Scholar 

  23. Ahmadi J, Tabatabaee F, Gozin Z. Physical trauma and substance abuse: a comparative study on substance abuse in patients with physical trauma versus general population. J Addict Dis. 2006;25:51–63.

    Article  PubMed  Google Scholar 

  24. Ramchand R, Marshall GN, Schell TL, Jaycox LH, Hambarsoomians K, Shetty V, Hinika GS, Cryer HG, Meade P, Belzberg H. Alcohol abuse and illegal drug use among Los Angeles County trauma patients: prevalence and evaluation of single item screener. J Trauma. 2009;66:1461–7.

    PubMed  PubMed Central  Google Scholar 

  25. Breslau N, Davis GC, Andreski A. Risk factors for PTSD-related traumatic events: a prospective analysis. Am J Psychiatry. 1995;152:529–35.

    Article  CAS  PubMed  Google Scholar 

  26. Breslau N, Schultz L. Neuroticism and post-traumatic stress disorder: a prospective investigation. Psychol Med. 2013;43:1697–702.

    Article  CAS  PubMed  Google Scholar 

  27. Breslau N, Davis GC, Andreski P, Peterson E. Traumatic events and posttraumatic stress disorder in an urban population of young adults. Arch Gen Psychiatry. 1991;48:216–22.

    Article  CAS  PubMed  Google Scholar 

  28. North CS. Current research and recent breakthroughs on the mental health effects of disasters. Curr Psychiatry Rep. 2014;16:481.

    Article  PubMed  Google Scholar 

  29. Breslau N. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatr. 2002;47:923–9.

    Article  Google Scholar 

  30. Yehuda R, LeDoux J. Response variation following trauma: a translational neuroscience approach to understanding PTSD. Neuron. 2007;56:19–32.

    Article  CAS  PubMed  Google Scholar 

  31. Shah AA, Sandler A, Nizam W, Kane T, Williams M, Cornwell EE III, Petrosyan M. National estimates and factors influencing trauma recidivism in children leading to hospital readmission. J Pediatr Surg. 2019;xxx:e1–6.

    Google Scholar 

  32. Gerrish AW, Hamill ME, Locklear TM, Bower KL, Lollar DI, Faulks ER, Matos M, Nussbaum MS, Collier BR. Trauma recidivism postdischarge mortality: important differences exist between the adult and geriatric populations. Am Surg. 2019;85:685–9.

    Article  PubMed  Google Scholar 

  33. Strong BL, Greene CR, Smith GS. Trauma recidivism predicts long-term mortality: missed opportunities for prevention (retrospective cohort study). Ann Surg. 2017;265:847–53.

    Article  PubMed  Google Scholar 

  34. Sims DW, Bivins BA, Obeid FN, Horst HM, Sorensen VJ, Fath JJ. Urban trauma: a chronic recurrent disease. J Trauma. 1989;29:940–6.

    Article  CAS  PubMed  Google Scholar 

  35. van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. Long-term posttraumatic stress following accidental injury in children and adolescents: results of a 2–4-year follow-up study. J Clin Psychol Med Settings. 2019;26:597–607.

    Article  PubMed  PubMed Central  Google Scholar 

  36. van Meijel EPM, Gigengack MR, Verlinden E, van der Steeg AFW, Goslings JC, Bloemers FW, Luitse JSK, Boer F, Grootenhuis MA, Lindauer RJL. The association between acute pain and posttraumatic stress symptoms in children and adolescents 3 months after accidental injury. J Clin Psychol Med Settings. 2019;26:88–96.

    Article  PubMed  Google Scholar 

  37. Bloom DR, Levin HS, Ewing-Cobbs L, Saunders AE, Song J, Fletcher JM, Kowatch RA. Lifetime and novel psychiatric disorders after pediatric traumatic brain injury. J Am Acad Child Adolesc Psychiatry. 2001;40:572–9.

    Article  CAS  PubMed  Google Scholar 

  38. De Young AC, Kenardy JA, Cobham VE, Kimble R. Prevalence, comorbidity and course of trauma reactions in young burn-injured children. J Child Psychol Psychiatry. 2012;53:56–63.

    Article  PubMed  Google Scholar 

  39. Max JE, Keatley E, Wilde EA, Bigler ED, Schachar RJ, Saunders AE, Ewing-Cobbs L, Chapman SB, Dennis M, Yang TT, Levin HS. Depression in children and adolescents in the first 6 months after traumatic brain injury. Int J Dev Neurosci. 2012;30:239–45.

    Article  PubMed  Google Scholar 

  40. Zink KA, McCain GC. Post-traumatic stress disorder in children and adolescents with motor vehicle-related injuries. J Spec Pediatr Nurs. 2003;8:99–106.

    Article  PubMed  Google Scholar 

  41. Stallard P, Velleman R, Baldwin S. Prospective study of post-traumatic stress disorder in children involved in road traffic accidents. BMJ. 1998;317:1619–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Stoddard FJ Jr, Sorrentino E, Drake JE, Murphy JM, Kim AJ, Romo S, Kagan J, Snidman N, Saxe G, Sheridan RL. Posttraumatic stress disorder diagnosis in young children with burns. J Burn Care Res. 2017;38:e343–51.

    Article  PubMed  Google Scholar 

  43. De Los RA, Augenstein TM, Wang M, Thomas SA, Drabick DAG, Burgers DE, Rabinowitz J. The validity of the multi-informant approach to assessing child and adolescent mental health. Psychol Bull. 2015;141:858–900.

    Article  Google Scholar 

  44. Kashani JH, Orvaschel H, Burk JP, Reid JC. Informant variance: the issue of parent-child disagreement. J Am Acad Child Psychiatry. 1985;24:437–41.

    Article  CAS  PubMed  Google Scholar 

  45. Pfefferbaum B, North CS, Narayanan P, Dumont CE. The relationship between maternal psychopathology and parental perceptions of their children’s reactions in survivors of the 1998 US Embassy bombing in Nairobi, Kenya. Ann Clin Psychiatry. 2019;31:260–70.

    PubMed  Google Scholar 

  46. Pfefferbaum B, Noffsinger MA, Wind LH. Issues in the assessment of children’s coping in the context of mass trauma. Prehosp Disaster Med. 2012;27:272–9.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Pfefferbaum B, Weems CF, Scott BG, Nitiema P, Noffsinger MA, Pfefferbaum RL, Varma V, Chakraburtty A. Research methods in child disaster studies: a review of studies generated by the September 11, 2001, terrorist attacks; the 2004 Indian Ocean tsunami; and Hurricane Katrina. Child Youth Care Forum. 2013;42:285–337.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry. 2018;5:175–86.

    Article  PubMed  Google Scholar 

  49. Swensen A, Birnbaum HG, Ben HR, Greenberg P, Cremieux PY, Secnik K. Incidence and costs of accidents among attention-deficit/hyperactivity disorder patients. J Adolesc Health. 2004;35:346–9.

    Article  PubMed  Google Scholar 

  50. North CS. Epidemiology of disaster mental health response. In: Ursano RJ, Fullerton CS, Weisæth L, Raphael B, editors. Textbook of disaster psychiatry. New York: Cambridge University Press; 2017. p. 27–42.

    Google Scholar 

  51. Downs DL, North CS. Trauma-related disorders. Overview of posttraumatic stress disorder. In: Black DW, editor. . Hamilton, ON: Decker Intellectual Properties, Scientific American Psychiatry; 2017. http://www.SciAmPsychiatry.com.

    Google Scholar 

  52. North CS, Yutzy SH. Posttraumatic stress disorder. In: Goodwin and Guze’s psychiatric diagnosis. 7th ed. New York: Oxford University Press; 2018. p. 125–66.

    Chapter  Google Scholar 

  53. Norris FH, Friedman MJ, Watson PJ, Byrne CM, Diaz E, Kaniasty K. 60,000 disaster victims speak: Part I. An empirical review of the empirical literature, 1981–2001. Psychiatry. 2002;65:207–39.

    Article  PubMed  Google Scholar 

  54. North CS, Yutzy SH. Mood (affective) disorders. In: Goodwin and Guze’s psychiatric diagnosis. 7th ed. New York: Oxford University Press; 2018. p. 15–59.

    Chapter  Google Scholar 

  55. North CS, Yutzy SH. Panic and phobic disorders. In: Goodwin and Guze’s psychiatric diagnosis. 7th ed. New York: Oxford University Press; 2018. p. 97–123.

    Chapter  Google Scholar 

  56. North CS, Yutzy SH. Alcohol use disorder. In: Goodwin and Guze’s psychiatric diagnosis. 7th ed. New York: Oxford University Press; 2018. p. 271–303.

    Chapter  Google Scholar 

  57. North CS, Yutzy SH. Drug use disorder. In: Goodwin and Guze’s psychiatric diagnosis. 7th ed. New York: Oxford University Press; 2018. p. 305–38.

    Chapter  Google Scholar 

  58. Robins LN, Helzer JE, Cottler L, Goldring E. NIMH diagnostic interview schedule, Version III-revised. St. Louis: Washington University; 1989.

    Google Scholar 

  59. Moore T, North C, Starr A. Post-traumatic stress disorder. In: Court-Brown CM, Hckman JD, McQueen MM, Ricci WM, Tornetta PI, editors. Rockwood and Green’s fractures in adults. 8th ed. Philadelphia, PA: Wolters Kluwer; 2015. p. 453–8.

    Google Scholar 

  60. Pilowsky DJ, Wu LT. Screening for alcohol and drug use disorders among adults in primary care: a review. Subst Abus Rehabil. 2012;3:25–34.

    Google Scholar 

  61. Pfefferbaum B, North CS. Child disaster mental health services: a review of the system of care, assessment approaches, and evidence base for intervention. Curr Psychiatry Rep. 2016;18:5.

    Article  PubMed  Google Scholar 

  62. Pfefferbaum B, North CS. Assessing children’s disaster reactions and mental health needs: screening and clinical evaluation. Can J Psychiatr. 2013;58:135–42.

    Article  Google Scholar 

  63. Geier TJ, Hunt JC, Nelson LD, Brasel KJ, deRoon-Cassini TA. Detecting PTSD in a traumatically injured population: the diagnostic utility of the PTSD Checklist for DSM-5. Depress Anxiety. 2019;36:170–8.

    Article  PubMed  Google Scholar 

  64. Lamoureux BE, Linardatos E, Fresco DM, Bartko D, Logue E, Milo L. Using the QIDS-SR16 to identify major depressive disorder in primary care medical patients. Behav Ther. 2010;41:423–31.

    Article  PubMed  Google Scholar 

  65. Bradley KA, DeBenedetti AF, Volk RJ, Williams EC, Frank D, Kivlahan DR. AUDIT-C as a brief screen for alcohol misuse in primary care. Alcohol Clin Exp Res. 2007;31:1208–17.

    Article  PubMed  Google Scholar 

  66. Brown RL, Leonard T, Saunders LA, Papasouliotis O. A two-item conjoint screen for alcohol and other drug problems. J Am Board Fam Pract. 2001;14:95–106.

    CAS  PubMed  Google Scholar 

  67. Balaban V. Psychological assessment of children in disasters and emergencies. Disasters. 2006;30:178–98.

    Article  PubMed  Google Scholar 

  68. Doric A, Stevanovic D, Stupar D, Vostanis P, Atilola O, Moreira P, Dodig-Curkovic K, Franic T, Davidovic V, Avicenna M, Noor M, Nussbaum L, Thabet A, Ubalde D, Petrov P, Deljkovic A, Antonio ML, Ribas A, Oliveira J, Knez R. UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries. Eur J Psychotraumatol. 2019;10:1605282.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Ivarsson T, Lidberg A, Gillberg C. The Birleson Depression Self-Rating Scale (DSRS). Clinical evaluation in an adolescent inpatient population. J Affect Disord. 1994;32:115–25.

    Article  CAS  PubMed  Google Scholar 

  70. American Psychiatric Association, editor. Diagnostic and statistical manual for mental disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.

    Google Scholar 

  71. Lee DJ, Schnitzlein CW, Wolf JP, Vythilingam M, Rasmusson AM, Hoge CW. Psychotherapy versus pharmacotherapy for posttraumatic stress disorder: systemic review and meta-analyses to determine first-line treatments. Depress Anxiety. 2016;33:792–806.

    Article  CAS  PubMed  Google Scholar 

  72. Thronson LR, Pagalilauan GL. Psychopharmacology. Med Clin North Am. 2014;98:927–58.

    Article  PubMed  Google Scholar 

  73. Cuijpers P, Ebert DD, Acarturk C, Andersson G, Cristea IA. Personalized psychotherapy for adult depression: a meta-analytic review. Behav Ther. 2016;47:966–80.

    Article  PubMed  Google Scholar 

  74. Soyka M, Kranzler HR, Hesselbrock V, Kasper S, Mutschler J, Moller HJ. Guidelines for biological treatment of substance use and related disorders, Part 1: Alcoholism, first revision. World J Biol Psychiatry. 2017;18:86–119.

    Article  PubMed  Google Scholar 

  75. Pfefferbaum B, North CS. Children and families in the context of disasters: implications for preparedness and response. Fam Psychol. 2008;24:6–10.

    PubMed  PubMed Central  Google Scholar 

  76. Polatin PB, Kinney RK, Gatchel RJ, Lillo E, Mayer TG. Psychiatric illness and chronic low-back pain. The mind and the spine—which goes first? Spine (Phila Pa 1976). 1993;18:66–71.

    Article  CAS  Google Scholar 

  77. Shalev AY, Peri T, Canetti L, Schreiber S. Predictors of PTSD in injured trauma survivors: a prospective study. Am J Psychiatry. 1996;153:219–25.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Altshuler Center for Education & Research at Metrocare Services, Dallas, TX, USA

    Carol S. North & Fatih Canan

  2. Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA

    Carol S. North & Fatih Canan

Authors
  1. Carol S. North
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fatih Canan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carol S. North .

Editor information

Editors and Affiliations

  1. Department of Trauma Surgery, University Hospital Zürich, Zürich, Switzerland

    Hans-Christoph Pape

  2. Department of Orthopaedic Surgery & Sports Medicine, The University of South Florida Morsani College of Medicine, Tampa, FL, USA

    Joseph Borrelli Jr.

  3. Ernest E. Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA

    Ernest E. Moore

  4. Klinik für Traumatologie, University Hospital of Zürich, Zürich, Switzerland

    Roman Pfeifer

  5. Rocky Vista University, College of Osteopathic Medicine, Parker, CO, USA

    Philip F. Stahel

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

North, C.S., Canan, F. (2022). Psychiatric Issues in the Treatment of Severe Trauma. In: Pape, HC., Borrelli Jr., J., Moore, E.E., Pfeifer, R., Stahel, P.F. (eds) Textbook of Polytrauma Management . Springer, Cham. https://doi.org/10.1007/978-3-030-95906-7_45

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-95906-7_45

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-95905-0

  • Online ISBN: 978-3-030-95906-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation