Psychological Sequelae in Orofacial Trauma Patients

Article Outline

• Statement
• Materials and Methods
• Method of Data Analysis
• Results
• Description of variables
• Conclusion
• References
• Copyright

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Statement 

The specific purposes for this investigation were: 1) To determine the prevalence and detection rate of psychological sequelae (PTSD) post-trauma in a group of adult patients with orofacial injuries. 2) To determine the strength of the independent variables such as age, gender, substance abuse, and employment status in predicting high posttraumatic stress disorder symptom levels at the 1 month follow up. 3) To determine the correlation to developing posttraumatic stress disorders and the levels of stress at the 1 month follow up.

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Materials and Methods 

This study was conducted over a period of 3 months at Howard University Hospital Dental Outpatient Clinic. Patients were considered eligible for recruitment if they were adults and had traumatic orofacial injuries as determined by clinical history, examination and/or radiographic interpretation. Medical records were utilized in this study for clinical history and examination. Patients with previous psychiatric disorders or in psychiatric treatment were excluded as well as patients that were unable or unwilling to return to the hospital for follow visits. Along with the necessary treatment, patients were interviewed using the Zung self-rating depression scale and the Impact of event scale.

In addition to the data collected at the initial visit, the questionnaires were administered at the initial visit and at the 1 month follow up visit. Variables such as age, gender, substance abuse, and employment status were considered. A Wilcoxon and a McNemar statistical analysis of all significant predictors were conducted to determine the relative strength of the independent variables in predicting high PTSD symptom levels at 1 month.The data from the questionnaires and interviews were used to classify cases into PTSD positive or negative status.

Impact of Event Scale

The IES was developed by Psychiatrists to parallel the criteria for PTSD. The IES is a self-report measure designed to assess current subjective distress for any specific life event.The respondents are asked to rate each item in the questionnaire on a scale of 0 (not at all), 1 (a little bit), 2 (moderate), 3 (quite a bit), 4 (extremely) according to a 1 month period.

Zung Self-Rating Depression Scale

The Zung self-rating depression scale is designed to assess whether a patient is depressed or not based on a twenty item questionnaire. Each item is scored from 1 to 4 and the highest possible added score is 80. Most people with depression scored between 50 and 69.

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Method of Data Analysis 

Statistical Analysis

Two non-parametric statistical procedures, the Wilcoxon test and the McNemar test, were used to measure change in the two related variables (Impact of Event scale and Zung depression scale) of interest. With these test, the focus is on whether the medians differ significantly.

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Results 

The study group included 15 patients with orofacial injuries. The one month data were available for all 100% of the patients. The sample consisted of 80% (N=12) males, 20 % females (N=3), 73% reported being employed, and 40% reported using illegal drugs. While the average respondent was 40 years old, females were 1.83 years younger.

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Description of variables 

Variables N % Mean SD Range

Gender

Male 12 80

Female 3 20

Employment Status

Unemployed 4

Employed 11

Substance Abuse

No. 9

Yes 6

Age 40.133 14.88 20-68

Under 40, 7

Over 40, 8

First visit Impact of event scale; 1.731, 0.74, 0.5-30

1 month Impact of event scale; 1.739, 0.68, 0.25-3.8

First visit Zung depression scale; 46.2, 10.3, 23-58

1 month Zung depression scale; 46.1, 8.8, 26-60

Out of the 12 males, 9 were employed and out of the 3 females, 2 were employed.

Out of the 12 males, 5 had substance abuse and out of the 3 females, 1 had substance abuse.

The means for Impact of event scale of 1.732 and 1.739 indicate moderate stress form the traumatic events.

The means for Zung depression scale of 46.2 and 46.1 indicate no depression.

Prevalence of types of Traumatic events:

Event No. (%)

Zygomatic arch fracture 1 (6.6)

Bilateral mandible fracture 7 (6.6)

One-sided mandible fracture 4 (16.6)

Gun shot to face 1 (6.6)

Maxilla and mandible fractures 1 (6.6)

Orbital fracture 1 (6.6)

All traumatic events shown above, regardless of gender were the result of altercations between patients and known /unknown assailants.

None of the females were victims of domestic abuse.

From all the clinical data and the two psychological questionnaires analysis, we concluded that at initial presentation to the hospital, 53.3% (8/15) patients showed symptoms from the orofacial injury consistent with current acute PTSD diagnoses. 40% (6/15) had PTSD symptoms at 1 month following the traumatic event.

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Conclusion 

A substantial sample of these traumatized Oral surgery patients had negative psychological outcomes at 1 month (40%) from 53% at initial visit, but with no statistical significance. As shown by the statistical analysis .Being employed and with no substance abuse problems decreases the risk of developing PTSD after a life altering traumatic event. This result underscores the potential use of screening survivors of orofacial injuries at Level I trauma centers for PTSD and developing systems of care that facilitate referrals to needed psychological treatment.

Finally, this study reported only results at 1 month follow up and on a very small group of patients. It will be beneficial to determine whether a larger group of individuals appear PTSD positive at 1 month intervals and at 1 year and if they recover (acute PTSD) or continue on a negative course (chronic PTSD). Hence we conclude that there was no significant difference in depression scales and stress levels after 1 month of treatment.

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References 

1. Glynn SM, at al. The development of Acute Posttraumatic Stress Disorder after
2. R, Bryant B, Ehlers A. Prediction of psychological outcomes one year after