This Article Full Text Full Text (PDF) [Supplementary Material] Letters to the Editor: Submit a response Alert me when this article is cited Alert me when Letters to the Editor are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Reprints and Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by McCarthy, M. L. Articles by Patterson, B. M. Search for Related Content PubMed PubMed Citation Articles by McCarthy, M. L. Articles by Patterson, B. M. Social Bookmarking             What's this?

Psychological Distress Associated with Severe Lower-Limb Injury

Investigation performed at MetroHealth Medical Center, Cleveland, Ohio; R Adams Cowley Shock Trauma Center, Baltimore, Maryland; Carolinas Medical Center, Charlotte, North Carolina; Vanderbilt University, Nashville, Tennessee; Tampa General Hospital, Tampa, Florida; Harborview Medical Center, Seattle, Washington; North Carolina Baptist Hospital, Winston-Salem, North Carolina; and Parkland Memorial Hospital, Dallas, Texas

Melissa L. McCarthy, MS, ScD
Ellen J. MacKenzie, PhD
David Edwin, PhD
Renan C. Castillo, MS
Departments of Emergency Medicine (M.L.McC.), Health Policy and Management (E.J. MacK. and R.C.C.), and Psychiatry (D.E.), Johns Hopkins University, Baltimore, MD 21205. E-mail address for M.L. McCarthy: mmccarth{at}jhmi.edu

Michael J. Bosse, MD
Department of Orthopaedic Surgery, Carolinas Medical Center, MEB 503, 1000 Blythe Boulevard, Charlotte, NC 28203

Adam Starr, MD
Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390

*The LEAP (Lower Extremity Assessment Project) Study Group included Ellen J. MacKenzie, PhD, Michael J. Bosse, MD, James F. Kellam, MD, Andrew R. Burgess, MD, Lawrence X. Webb, MD, Marc F. Swiontkowski, MD, Roy W. Sanders, MD, Alan L. Jones, MD, Mark P. McAndrew, MD, Brendan M. Patterson, MD, Melissa L. McCarthy, MS, ScD

In support of their research or preparation of this manuscript, one or more of the authors received Grant R01 AR42659 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

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.

CiteULike    Connotea    Del.icio.us    Technorati    What's this?

This article has been cited by other articles:

				P. E. Levin and E. J. Levin The Experience of an Orthopaedic Traumatologist When the Trauma Hits Home: Observations and Suggestions J. Bone Joint Surg. Am., September 1, 2008; 90(9): 2026 - 2036. [Full Text] [PDF]

				R. V. O'Toole, R. C. Castillo, A. N. Pollak, E. J. MacKenzie, M. J. Bosse, and the LEAP Study Group Determinants of Patient Satisfaction After Severe Lower-Extremity Injuries J. Bone Joint Surg. Am., June 1, 2008; 90(6): 1206 - 1211. [Abstract] [Full Text] [PDF]

				A. J. Starr Fracture Repair: Successful Advances, Persistent Problems, and the Psychological Burden of Trauma J. Bone Joint Surg. Am., February 1, 2008; 90(Supplement_1): 132 - 137. [Abstract] [Full Text] [PDF]

				E. J. MacKenzie, F. P. Rivara, G. J. Jurkovich, A. B. Nathens, B. L. Egleston, D. S. Salkever, K. P. Frey, and D. O. Scharfstein The Impact of Trauma-Center Care on Functional Outcomes Following Major Lower-Limb Trauma J. Bone Joint Surg. Am., January 1, 2008; 90(1): 101 - 109. [Abstract] [Full Text] [PDF]

				B. R. Moed and J. C. McMichael Outcomes of Posterior Wall Fractures of the Acetabulum J. Bone Joint Surg. Am., June 1, 2007; 89(6): 1170 - 1176. [Abstract] [Full Text] [PDF]

				J. A. Fauerbach, J. McKibben, O. J. Bienvenu, G. Magyar-Russell, M. T. Smith, R. Holavanahalli, D. R. Patterson, S. A. Wiechman, P. Blakeney, and D. Lezotte Psychological Distress After Major Burn Injury Psychosom Med, June 1, 2007; 69(5): 473 - 482. [Abstract] [Full Text] [PDF]

				H. R Holtslag, M. W Post, C. van der Werken, and E. Lindeman Return to work after major trauma Clinical Rehabilitation, April 1, 2007; 21(4): 373 - 383. [Abstract] [PDF]

				E. J. MacKenzie and M. J. Bosse Factors Influencing Outcome Following Limb-Threatening Lower Limb Trauma: Lessons Learned From the Lower Extremity Assessment Project (LEAP) J. Am. Acad. Ortho. Surg., September 1, 2006; 14(10): S205 - S210. [Abstract] [Full Text] [PDF]

				R. J. Crichlow, P. L. Andres, S. M. Morrison, S. M. Haley, and M. S. Vrahas Depression in Orthopaedic Trauma Patients. Prevalence and Severity J. Bone Joint Surg. Am., September 1, 2006; 88(9): 1927 - 1933. [Abstract] [Full Text] [PDF]

				P. V. Giannoudis, C. Papakostidis, and C. Roberts A review of the management of open fractures of the tibia and femur J Bone Joint Surg Br, March 1, 2006; 88-B(3): 281 - 289. [Full Text] [PDF]

				R. C. Silver, A. J. Starr, W. H. Frawley, and C. M. Reinert Clarifying the Presence of Posttraumatic Stress Symptoms Following Orthopaedic Trauma * A.J. Starr, W.H. Frawley, and C.M. Reinert reply: J. Bone Joint Surg. Am., March 1, 2005; 87(3): 673 - 675. [Full Text] [PDF]

				C. S. Roberts, H.-C. Pape, A. L. Jones, A. L. Malkani, J. L. Rodriguez, and P. V. Giannoudis Damage Control Orthopaedics. Evolving Concepts in the Treatment of Patients Who Have Sustained Orthopaedic Trauma J. Bone Joint Surg. Am., February 1, 2005; 87(2): 434 - 449. [Full Text] [PDF]

				P. A. Cole and M. Bhandari What's New in Orthopaedic Trauma J. Bone Joint Surg. Am., December 1, 2004; 86(12): 2782 - 2795. [Full Text] [PDF]

				A. J. Starr, W. R. Smith, W. H. Frawley, D. S. Borer, S. J. Morgan, C. M. Reinert, and M. Mendoza-Welch Symptoms of Posttraumatic Stress Disorder After Orthopaedic Trauma J. Bone Joint Surg. Am., June 1, 2004; 86(6): 1115 - 1121. [Abstract] [Full Text] [PDF]

Stanford University Libraries' HighWire Press (TM) assists in the publication of JBJS Online.
Copyright © 2003 by The Journal of Bone and Joint Surgery, Inc. Online ISSN: 1535-1386.
The Journal of Bone and Joint Surgery®, JBJS®, JB&JS®, and eJBJS® are registered in the U.S. Patent and Trademark Office.