Post-traumatic Morbidity Research Articles

Post-traumatic morbidity in a civilian community of litigants: A follow-up at 3 years

This paper examines post-traumatic morbidity in a community sample who had claimed compensation and been assessed 10-14 months after the Lockerbie Disaster. At 36 months 25 residents were reassessed by clinical interview and 35 by questionnaire. A chronic pattern of morbidity was found in 56% of this sample with the most frequent diagnoses being post traumatic stress disorder and depression, followed by other anxiety disorders. Only six cases were found to have "recovered" and there was only one case of delayed onset morbidity between 12 and 36 months. No unequivocal predictors of the presence of diagnosis or questionnaire scores were found.

Risk factors associated with pulmonary embolism despite routine prophylaxis: implications for improved protection.

Despite prophylaxis, pulmonary embolism (PE) remains a major cause of posttraumatic morbidity and mortality in high-risk patients. We studied injury-related risk factors associated with the occurrence of PE despite routine prophylaxis. A review of 9721 trauma patients discharged from January 1, 1985 through December 31, 1992, identified 36 patients (0.4%) who suffered clinically evident PE despite a policy of routine prophylaxis against deep venous thrombosis that included use of prophylactic inferior vena caval filters. (Twenty-nine patients had an inferior vena caval filter placed for prophylaxis against PE.) A detailed analysis of injury-related risk factors was performed. Four high-risk patterns of injury were identified, representing common combinations of significant risk factors. These patient groups have an absolute risk of PE despite prophylaxis ranging from 1.5% to 3.8%. The relative risk is approximately ten times that of control patients. Identification of appropriate high-risk groups is necessary to allow optimization of prophylactic measures, including placement of inferior vena caval filter.

Malignant Memories

Because attitudes signify how an individual organizes and integrates perceptions of self and social context, effects of a man-made disaster in the workplace on attitudes toward self, family, workplace, community, and social issues were surveyed in school personnel 6 and 18 months after a shooting and intervention to extend understanding of human response to stress. Results showed that attitudes were more positive than negative in this study group. Additionally, specific attitudes were associated with specific preexisting personality and familial variables, as well as posttraumatic and associated symptoms. Positive attitudes toward the self were associated with fewer maladaptive personality and family characteristics. Positive attitudes toward family correlated with fewer maladaptive personality features and fewer posttraumatic symptoms. Positive attitudes toward community and workplace, especially coworkers, were associated with fewer posttraumatic stress disorder (PTSD) and associated symptoms. Generally, the findings suggest that a variety of attitudes and their evolution in the wake of a disaster, some of which may be quite specific to the event, are associated with posttraumatic morbidity, subject variables, and with other attitudes. The authors discuss implications of these findings within the biopsychosocial framework of malignant memories.

The aetiology of post-traumatic morbidity: predisposing, precipitating and perpetuating factors.

A group of 469 firefighters were studied 4, 11 and 29 months after having an extreme exposure to a bushfire disaster. The relative importance of the impact of the disaster, personality and ways of coping were investigated as determinants of post-traumatic morbidity. Neuroticism and a past history of treatment for a psychological disorder were better predictors of post-traumatic morbidity than the degree of exposure to the disaster or the losses sustained. These results raise doubts about the postulated central aetiological role a traumatic event plays in the onset of morbidity.

The phenomenology of posttraumatic stress disorders following a natural disaster.

This study examined the utility of the DSM-III diagnostic criteria for posttraumatic stress disorder (PTSD) in a high-risk group of 50 firefighters who had had an intense exposure to a natural disaster 8 months before being interviewed. Follow-up over the next 3 years allowed examination of the ability of these diagnostic criteria to predict a pattern of chronic posttraumatic morbidity. They predicted a pattern of chronic disorder, demonstrated by the finding that eight of the 15 subjects who had definite or borderline PTSD at 8 months remained symptomatic 3 years later. A disturbance of attention and concentration appeared to be the best predictor of chronic PTSD. The longitudinal course of posttraumatic morbidity in these 50 firefighters was compared with a matched group of 96 uninterviewed subjects 11 and 29 months after the disaster. Although the interview provoked an emotional catharsis in a number of firefighters, the long-term morbidity in the two groups was comparable. Fourteen subjects who did not have PTSD continued to experience intense imagery 8 months after the disaster. This observation raises questions about whether such thoughts and feelings have adequate specificity as diagnostic criteria for PTSD in a group that has recently been exposed to a traumatic event.

The longitudinal course of posttraumatic morbidity. The range of outcomes and their predictors.

This study examined the longitudinal course, over a 25-month period, of posttraumatic morbidity in a group of 469 firefighters exposed to a bushfire disaster. The patterns of posttraumatic morbidity were defined by the General Health Questionnaire. Contrary to expectation, an acute pattern of morbidity was less common than the delayed-onset or chronic forms. Predisaster variables were found to be as important in the onset and course of the disorder as were the firefighters' losses or extent of exposure to the disaster. These data suggest that exposure to an extreme trauma is necessary but not sufficient to explain the onset and pattern of posttraumatic morbidity.

Family functioning and overprotection following a natural disaster: the longitudinal effects of post-traumatic morbidity.

The longitudinal impact of a natural disaster on the patterns of interaction in families with latency-aged children is examined. An 11-item questionnaire was developed and two factors were isolated: irritable distress and involvement. A group of 183 disaster-affected families were contrasted with 497 families who had not been exposed to the disaster. Eight months after the disaster, the interaction in the disaster-affected families was characterised by increased levels of conflict, irritability and withdrawal. Maternal overprotection was also a common feature of the pattern of care in these families. Post-traumatic morbidity in parents was the major determinant of the observed changes in family functioning and the overprotection.