Psychological distress associated with severe lower-limb injury

Melissa L. McCarthy, Ellen J. Mackenzie, David Edwin, Michael J. Bosse, Renan C. Castillo, Adam Starr

Research output: Contribution to journalArticle

153 Citations (Scopus)

Abstract

Background: Little is known about the psychological morbidity associated with limb-threatening injuries. It was hypothesized that a substantial proportion of patients who sustain a severe lower-limb injury will report serious psychological distress. Methods: Adult patients who were admitted to one of eight level-I trauma centers for treatment of an injury threatening the lower limb were enrolled during their initial hospitalization. Patients were recontacted at three, six, twelve, and twenty-four months after the injury and asked to complete the Brief Symptom Inventory (BSI), a fifty-three-item, self-reported measure of psychological distress. Patients who screen positive on the BSI are considered likely to have a psychological disorder and should receive a mental health evaluation. Longitudinal regression techniques were used to model positive case status (i.e., likely to have a psychological disorder) as a function of patient, injury, and treatment characteristics. Results: Of the 569 patients enrolled, 545 (96%) completed at least one BSI and 385 (68%) completed all four. Forty-eight percent of the patients screened positive for a likely psychological disorder at three months after the injury, and this percentage remained high (42%) at twenty-four months. Two years after the injury, almost one-fifth of the patients reported severe phobic anxiety and/or depression. While these two subscales reflected the highest prevalence of severe psychological distress, none of the BSI subscales reflected the prevalence expected from a normal sample (i.e., 2% to 3%). Factors associated with a likely psychological disorder included poorer physical function, younger age, non-white race, poverty, a likely drinking problem, neuroticism, a poor sense of self-efficacy, and limited social support. Relatively few patients reported receiving any mental health services following the injury (12% at three months and 22% at twenty-four months). Conclusions: Severe lower-limb injury is associated with considerable psychological distress. More attention to the psychological as well as the physical health of patients who sustain a limb-threatening injury may be needed to ensure an optimal recovery following these devastating injuries. Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.

Original languageEnglish (US)
Pages (from-to)1689-1697
Number of pages9
JournalJournal of Bone and Joint Surgery - Series A
Volume85
Issue number9
StatePublished - Sep 1 2003

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Lower Extremity
Psychology
Wounds and Injuries
Equipment and Supplies
Extremities
Trauma Centers
Mental Health Services
Self Efficacy
Poverty
Social Support
Drinking
Mental Health
Hospitalization
Anxiety
Prospective Studies
Depression
Morbidity
Health
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

McCarthy, M. L., Mackenzie, E. J., Edwin, D., Bosse, M. J., Castillo, R. C., & Starr, A. (2003). Psychological distress associated with severe lower-limb injury. Journal of Bone and Joint Surgery - Series A, 85(9), 1689-1697.

Psychological distress associated with severe lower-limb injury. / McCarthy, Melissa L.; Mackenzie, Ellen J.; Edwin, David; Bosse, Michael J.; Castillo, Renan C.; Starr, Adam.

In: Journal of Bone and Joint Surgery - Series A, Vol. 85, No. 9, 01.09.2003, p. 1689-1697.

Research output: Contribution to journalArticle

McCarthy, ML, Mackenzie, EJ, Edwin, D, Bosse, MJ, Castillo, RC & Starr, A 2003, 'Psychological distress associated with severe lower-limb injury', Journal of Bone and Joint Surgery - Series A, vol. 85, no. 9, pp. 1689-1697.
McCarthy ML, Mackenzie EJ, Edwin D, Bosse MJ, Castillo RC, Starr A. Psychological distress associated with severe lower-limb injury. Journal of Bone and Joint Surgery - Series A. 2003 Sep 1;85(9):1689-1697.
McCarthy, Melissa L. ; Mackenzie, Ellen J. ; Edwin, David ; Bosse, Michael J. ; Castillo, Renan C. ; Starr, Adam. / Psychological distress associated with severe lower-limb injury. In: Journal of Bone and Joint Surgery - Series A. 2003 ; Vol. 85, No. 9. pp. 1689-1697.
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abstract = "Background: Little is known about the psychological morbidity associated with limb-threatening injuries. It was hypothesized that a substantial proportion of patients who sustain a severe lower-limb injury will report serious psychological distress. Methods: Adult patients who were admitted to one of eight level-I trauma centers for treatment of an injury threatening the lower limb were enrolled during their initial hospitalization. Patients were recontacted at three, six, twelve, and twenty-four months after the injury and asked to complete the Brief Symptom Inventory (BSI), a fifty-three-item, self-reported measure of psychological distress. Patients who screen positive on the BSI are considered likely to have a psychological disorder and should receive a mental health evaluation. Longitudinal regression techniques were used to model positive case status (i.e., likely to have a psychological disorder) as a function of patient, injury, and treatment characteristics. Results: Of the 569 patients enrolled, 545 (96{\%}) completed at least one BSI and 385 (68{\%}) completed all four. Forty-eight percent of the patients screened positive for a likely psychological disorder at three months after the injury, and this percentage remained high (42{\%}) at twenty-four months. Two years after the injury, almost one-fifth of the patients reported severe phobic anxiety and/or depression. While these two subscales reflected the highest prevalence of severe psychological distress, none of the BSI subscales reflected the prevalence expected from a normal sample (i.e., 2{\%} to 3{\%}). Factors associated with a likely psychological disorder included poorer physical function, younger age, non-white race, poverty, a likely drinking problem, neuroticism, a poor sense of self-efficacy, and limited social support. Relatively few patients reported receiving any mental health services following the injury (12{\%} at three months and 22{\%} at twenty-four months). Conclusions: Severe lower-limb injury is associated with considerable psychological distress. More attention to the psychological as well as the physical health of patients who sustain a limb-threatening injury may be needed to ensure an optimal recovery following these devastating injuries. Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.",
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