Risk and protective factors that predict posttraumatic stress disorder after traumatic injury: A systematic review

Abstract

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders following traumatic injury, affecting up to 51 % of adults admitted to trauma centres. Identification of people at risk of PTSD is an important component of holistic, evidence-based care in trauma centres. This is also increasingly becoming a recommendation across Level 1 Trauma Centres worldwide. The purpose of this paper was to systematically review published literature regarding factors that increase or decrease one's risk of PTSD within a year of admission to a trauma hospital. Systematic review methodology was implemented with utilisation of extensive search criteria. This broadened search strategy was used to address some identified limitations in titles and abstracts of relevant papers. Forward and backward citation of included papers was implemented to ascertain secondary sources. Titles, abstracts, and full texts were independently reviewed by two authors. Sixty-one papers met inclusion criteria and 58 predictors were analysed with at least one analysis. There was strong scientific evidence for assault, acute stress disorder, and baseline pain as predictors of PTSD. There was strong scientific evidence that age, education, ethnicity, premorbid health concerns, marital status, injury severity, mechanism of injury, and length of stay were not predictors. Several methodological concerns were identified across the included papers, such as heterogeneity in operational definitions of predictors and lack of application to theoretical frameworks of PTSD. Gaps remain in the literature regarding the impact of risk factors included in well-known frameworks such as the cognitive model of PTSD, requiring future research to inform appropriate early intervention in this at-risk population.