Psychosocial recovery after serious injury

The 2010 iteration of the Global Burden of Disease statistics (Murray et al., 2012) points to the growing impact of injury and highlights the mounting burden of psychiatric disorder. It is essential to examine the intersection between these two contributors to disease burden. The Australian Injury Vulnerability Study collected data of over 1,000 injury patients from their initial hospitalization to 6 years post-injury. Structured clinical interviews were used to diagnose psychiatric disorder and self-report measures for disability and symptom severity. A wide range of psychiatric disorders developed following injury, which included posttraumatic stress disorder, agoraphobia, depression, and substance use disorders (Bryant, O'Donnell, Creamer, Silove, & McFarlane, 2010). Although prevalence rates for these disorders were generally consistent over time, examination of trajectory data showed that different people had the disorders at different times. Importantly, the data showed that early anxiety, depression, and PTSD symptoms played a significant role in the development of long term disability after injury (Carty, O'Donnell, Evans, Kazantzis, & Creamer, 2011; O'Donnell et al., 2013). These data support the view that transdiagnostic models for early intervention may be required to address the complex psychiatric disorder trajectories that develop after injury.

2010年版全球疾病负担（Global Burden of Disease）统计数据（Murray等，2012）显示，伤害对公众健康的影响日益加剧，同时精神障碍带来的疾病负担也持续攀升。探究这两类疾病负担核心影响因素之间的交叉关联，具有重要的学术意义。
澳大利亚伤害易感性研究（Australian Injury Vulnerability Study）收集了1000余名伤害患者从初次住院至伤后6年的完整随访数据：研究采用结构化临床访谈完成精神障碍诊断，并通过自我报告量表分别评估患者的残疾程度与症状严重程度。
伤后可并发多种精神障碍，包括创伤后应激障碍（posttraumatic stress disorder）、场所恐惧症、抑郁症及物质使用障碍（Bryant等，2010）。尽管此类障碍的患病率总体随时间保持相对稳定，但轨迹分析结果显示，不同患者的症状起病时间存在显著差异。
尤为关键的是，数据表明早期焦虑、抑郁及创伤后应激障碍症状，对伤后长期残疾的发生发展具有显著的预测作用（Carty等，2011；O'Donnell等，2013）。上述研究结果支持了这一学术观点：针对伤后出现的复杂精神障碍病程，或许需要采用跨诊断模型开展早期干预。