Injury-specific predictors of posttraumatic stress disorder

MacGregor, Andrew J.; Corson, Karen S.; Larson, Gerald E.; Shaffer, Richard A.; Dougherty, Amber L.; Galarneau, Michael R.; Raman, Rema; Baker, Dewleen G.; Lindsay, Suzanne P.; Golomb, Beatrice A.

doi:10.1016/j.injury.2009.04.006

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Volume 40, Issue 9 , Pages 1004-1010, September 2009

Injury-specific predictors of posttraumatic stress disorder

Andrew J. MacGregor
- Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA, United States
Karen S. Corson
- Behavioral Sciences and Epidemiology, Naval Health Research Center, San Diego, CA, United States
Gerald E. Larson
- Behavioral Sciences and Epidemiology, Naval Health Research Center, San Diego, CA, United States
Richard A. Shaffer
- DoD HIV/AIDS Prevention Program, Naval Health Research Center, San Diego, CA, United States
Amber L. Dougherty
- Health Research and Applied Technologies Division, Science Applications International Corporation, San Diego, CA, United States
- Corresponding author at: Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106, USA. Tel.: +1 619 553 7026; fax: +1 619 553 8378.
Michael R. Galarneau
- Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA, United States
Rema Raman
- Department of Family and Preventive Medicine, University of California, San Diego, CA, United States
Dewleen G. Baker
- Department of Psychiatry, University of California, San Diego, CA, United States
- Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, United States
Suzanne P. Lindsay
- Graduate School of Public Health, San Diego State University, San Diego, CA, United States
Beatrice A. Golomb
- Department of Medicine, University of California, San Diego, CA, United States

Accepted 16 April 2009.

Abstract

Objective

Posttraumatic stress disorder (PTSD) is an important source of morbidity in military personnel, but its relationship with characteristics of battle injury has not been well defined. The aim of this study was to characterise the relationship between injury-related factors and PTSD among a population of battle injuries.

Patients and methods

A total of 831 American military personnel injured during combat between September 2004 and February 2005 composed the study population. Patients were followed through November 2006 for diagnosis of PTSD (ICD-9 309.81) or any mental health outcome (ICD-9 290-319).

Results

During the follow-up period, 31.3% of patients received any type of mental health diagnosis and 17.0% received a PTSD diagnosis. Compared with minor injuries those with moderate (odds ratio [OR], 2.37; 95% confidence interval [CI], 1.61–3.48), serious (OR, 4.07; 95% CI, 2.55–6.50), and severe (OR, 5.22; 95% CI, 2.74–9.96) injuries were at greater risk of being diagnosed with any mental health outcome. Similar results were found for serious (OR, 3.03; 95% CI, 1.81–5.08) and severe (OR, 3.21; 95% CI, 1.62–6.33) injuries with PTSD diagnosis. Those with gunshot wounds were at greater risk of any mental health diagnosis, but not PTSD, in comparison with other mechanisms of injury (OR 2.07; 95% CI, 1.35, 3.19). Diastolic blood pressure measured postinjury was associated with any mental health outcome, and the effect was modified by injury severity.

Conclusions

Injury severity was a significant predictor of any mental health diagnosis and PTSD diagnosis. Gunshot wounds and diastolic blood pressure were significant predictors of any mental health diagnosis, but not PTSD. Further studies are needed to replicate these results and elucidate potential mechanisms for these associations.

Keywords: Combat injury, Military, Posttraumatic stress disorder, Operation Iraqi Freedom