Psychosocial factors in trauma patients : studies on trauma recurrence and trauma recovery

Sammanfattning: The present studies aimed to highlight the influence of psychosocial and psychiatric factors on trauma recurrence and trauma recovery. A subgroup of trauma patients, 820 victims of firearm injuries, were compared to an age- and sex-matched control group in a retrospective register study. The results showed that firearm victims were characterised by high mortality, morbidity and antisocial traits independent of the intention of the gunshot. Hospitalisation due to injuries as well as due to psychiatric disorders including alcohol abuse was common indicating a risk-taking life-style with risk of repeated trauma episodes. In order to further analyse the factors effecting trauma occurrence, a group of 345 patients hospitalised due to moderate injuries were studied prospectively. Patients with a history of repeated trauma had more often been victims of violence and more often reported a history of psychiatric problems and alcohol abuse, compared to patients with only one or no previous injury. These results indicate that among average injury victims subgroups of patients run an increased risk of recurrent trauma and might develop into "chronic" trauma victims. Psychiatric factors affecting recovery after trauma were studied in a group of 169 patients with moderate injuries. Patients who reported limitations in every-day activities one year after the injury had more pain and more often showed signs of depression already during hospitalisation. Patients lost to follow-up had a less favourable psychosocial situation including alcohol abuse when compared to all other patients and may share characteristics with trauma repeaters. In order to focus on female patients' reactions to injuries, a group of 115 women were studied separately. The women, who already during hospitalisation experienced the trauma event as stressful, more often reported psychiatric and somatic problems during the follow-up period and their sick-leave was longer when compared to the other women. The former also more often reported a history of psychiatric problems. These results suggest that depression and psychosocial distress can affect the rehabilitation process after an injury. The results indicate that psychosocial and psychiatric factors have an impact on trauma occurrence and recurrence as well as on the recovery process after an injury. Joint collaboration between health professionals could result in implementation of meaningful prevention and intervention strategies.