How can we
identify or predict which trauma victims will develop psychological problems:
Hugh Koch
A recent paper by Mason Etal (2006)
followed up a series of 210 adults who attended a hospital casualty department
with physical trauma. They were followed up at 1 month and 6 months and 18
months and assessed for psychological difficulties.
The strongest predictors of negative
psychological outcome were the following: -
1) Initial levels of anxiety
and depression on attendance.
2) Early PTSD symptoms.
3) Previous history of
mental health problems.
4) Involvement with
Litigation.
Those in the study had experienced a
variety of trauma: Falls (28%) Road traffic accident (17%) and Assault (13%).
Some researchers and clinicians have
argued that intervention ought to be targeted at those who are unable to
recover naturally from trauma i.e, 6, 12 or 18 months later.
There is conflicting evidence over
the role of pre-accident psychological difficulties in the development of post
accident responses. This study lent support for an association. Although
research does not show a link between injury severity and psychological
distress, there was a correlation between high pain scores at 1 month and
psychological symptoms.
Hardly surprisingly, higher levels
of anxiety and depression and stress related symptoms in the peri-event period
were predictive of psychological distress at 6 and 18 months. Emphasis was on
the importance of the subjective response to trauma and the individual
interpretation of what had happened (Koch and Kevan 2005),
On a non-clinical note, involvement
in the legal process is found to be predictor of stress symptoms at 6 and 18
months. The legal process involves detailed recall of events, tendency to
polarise blame, and stressful consequences of an adversarial system. It
encourages repeated event recall and can restrict natural adaptation.
Implications for Lawyers and Clinicians
This area of discussion is important
as it highlighted ways of identifying at –risk individuals in both a clinical
and a medico-legal context. The ability to screen individuals within weeks of
injury enables the appropriate interventions to be considered at the
appropriate stage.
References
Mason S (Etal) (2006) Risk Factors
for Psychological Distress Following Injury. BR. J. Clinical Psychologist
45,217-430.
Koch HCH & Kevan T (2005)
Psychological injury XPL Press St Albans.
More information can be found
obtained from www .hughkochassociates.co.uk
