Physical injury and illness

How is physical injury and illness related to PTSD?

Exposure to at least one trauma is required for a diagnosis of PTSD. The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) determines direct traumas as threatened death, actual or threatened serious injury, or actual or threatened sexual violence. Indirect traumas include witnessing the trauma, or learning that a relative or close friend was exposed to a trauma. Differences in trauma characteristics, including the severity and type of exposure, can affect the risk of developing PTSD. Personal characteristics such as age and sex also influence risk.

What is the evidence for risk of PTSD in people exposed to physical illness and injury?

Moderate quality evidence found the prevalence of PTSD following a coronavirus infection was around 29-32%. Rates of PTSD were highest in female patients, in infected healthcare workers, in patients with a previous physical illness, and in patients with avascular necrosis. They were highest in patients with functional impairment, pain, and a sense of lack of control. Rates were highest when measured during coronavirus outbreaks, in patients with MERS rather than SARS, and in studies using the Impact of Event scale to measure PTSD.

A medium-sized increase in PTSD was found in people with a traumatic brain injury (TBI) than in people with no TBI. Rates were higher in military than civilian samples, in samples with more males than females, in samples exposed to a blast rather than a motor vehicle accident, in samples from the USA, and in samples with a TBI rather than another physical injury. Shorter post-trauma amnesia and more memory of the traumatic event were associated with increased risk of PTSD following a TBI.

The prevalence of PTSD after a fall in the elderly was 27.5%. This represents a small increased risk in PTSD compared to older people with no fall history. The prevalence of PTSD after any acute orthopaedic trauma was around 26.6%. Rates were higher in females, and higher in patients with lower versus higher extremity fractures.

The prevalence of PTSD symptoms in critical illness survivors was between 25% and 44% up to 6 months post-ICU, and between 17% and 34% by 12 months. ICU risk factors for PTSD symptoms included benzodiazepine administration and post-ICU memories of frightening ICU experiences.

The prevalence of PTSD in people with chronic pain was around 9.7%. PTSD prevalence was higher in people with chronic widespread pain and headache, and lower in people with back pain. Prevalence was higher in studies using self-reported PTSD symptoms than in studies using clinical interviews to assess PTSD.

The prevalence of PTSD in people with cancer was around 11%. This represents a small increase in the risk of PTSD in people with cancer compared to people without cancer. Rates of PTSD were higher in studies using self-report instruments than clinical assessments, in samples with brain cancer, in samples undergoing chemotherapy, in Middle Eastern samples, in samples with prior trauma, in younger samples, and in samples with a longer time since cancer diagnosis.

The prevalence of PTSD in children after an injury was around 20.5%. Rates were highest in girls, in older children and in children injured in hurricanes. A large effect of more PTSD symptoms was found in parents of chronically ill children. Rates were highest in parents of children with epilepsy or diabetes, in mothers, in parents of children with more illness severity, longer treatment duration and intensity, and in parents of children with PTSD symptoms. Rates were lowest in parents of children with longer illness duration, longer time since active treatment, and in parents with more social support.

Risk factors associated with PTSD following a burn injury include (in descending order of effect); more life threat perception, intrusion symptoms, pain, low socioeconomic status, alcohol use disorders, increased age, avoidance symptoms, dissociation, negative emotions or distress, acute stress symptoms, having previous psychiatric disorders, substance use disorders, need for psychological treatment, being injured by an explosion, more body surface area affected, more anxiety and depression, longer hospitalisation stay, having low openness, being female, having more surgeries, low narcissism, and feeling responsible for the burn injury. Risk factors associated with PTSD symptoms after a spinal cord injury include (in descending order of effect); depressed mood, poor cognition, distress, anxiety, pain, history of previous trauma, being female, having less time since the trauma, and having a higher education.

August 2021

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