ABSTRACT
Background: Injuries account for a significant proportion of the health and economic burden for populations in low- and middle-income countries. However, little is known about psychological distress trajectories amongst injury survivors in low- and middle-income countries.Methods: Adult injury patients (n = 644) admitted to Kenyatta National Hospital in Nairobi, Kenya, were enrolled and interviewed in the hospital, and at 1, 2-3, and 4-7 months after hospital discharge through phone to assess depressive and anxiety symptoms and level of disability. Growth mixture modeling was applied to identify latent trajectories of depressive and anxiety symptoms.Results: Elevated depressive and moderate-level anxiety symptoms (13%) and low depressive and anxiety symptoms (87%) trajectories were found between hospitalization and up to seven months after hospital discharge. Being female, prior trauma experience, longer hospitalization, worse self-rated health status while in the hospital, and lack of monetary assistance during hospitalization were associated with the elevated symptoms trajectory. The higher symptoms trajectory associated with higher disability levels after hospital discharge and significantly lower proportion of resuming daily activities and work.Conclusion: The persistence of elevated depressive symptoms and associated reduced functioning several months after physical injury underscores the importance of identifying populations at risk for preventive and early interventions.Implications for RehabilitationHealth providers following up with injury survivors should screen for depressive and anxiety symptomsSpecial attention to women and people with a potential traumatic exposure historyIncorporation of evidence-based culturally adapted psychosocial interventions in rehabilitation and outpatient clinics.
Subject(s)
Anxiety Disorders , Anxiety , Adult , Anxiety/epidemiology , Depression/epidemiology , Female , Humans , Kenya/epidemiology , Longitudinal Studies , Risk FactorsABSTRACT
Potentially traumatic events (PTEs) have been consistently associated with posttraumatic stress disorder (PTSD). However, the extent of association and attribution to subsequent disability has varied, with limited studies conducted in urban low-income contexts. This longitudinal study estimated the trajectory of PTSD symptoms up to 7 months after hospitalization and the associated disability level among adult patients who had been hospitalized due to injury. Adult injury patients (N = 476) admitted to Kenyatta National Hospital in Nairobi, Kenya, were interviewed in person in the hospital, and via phone at 1, 2-3, and 4-7 months after hospital discharge. Using latent growth curve modeling, two trajectories of PTSD symptoms emerged: (a) persistently elevated PTSD symptoms (9.2%), and (b) low PTSD symptoms (90.8%). Number of PTEs experienced remained moderately associated with the elevated trajectory after controlling for in-hospital depressive symptoms. Having previously witnessed killings or serious injuries, AOR = 2.32, 95% CI [1.07, 5.05]; being female, AOR = 4.74, 95% CI [4.53, 4.96]; elevated depressive symptoms during hospitalization, AOR = 2.96, 95% CI [1.28, 6.83]; and having no household savings/assets, AOR = 1.28, 95% CI [1.13, 1.44], were associated with the elevated PTSD symptoms trajectory class after controlling for other risk factors. Latent membership in the elevated PTSD trajectory was associated with a significantly higher level of disability several months after hospital discharge, p < .001, after controlling for injury and demographic characteristics. These results underline the associations among in-hospital depressive symptoms, witnessing atrocities, and poverty, and an elevated PTSD symptoms trajectory.
Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Exposición al trauma, Trayectoria de los síntomas del trastorno de estrés postraumático y nivel de discapacidad entre los Sobrevivientes de lesiones hospitalizados en Kenia TRAYECTORIAS DE LOS SíNTOMAS DE TEPT EN SOBREVIVIENTES DE TRAUMAS DE KENIA Los eventos potencialmente traumáticos (EPT) se han asociado sistemáticamente con el trastorno de estrés postraumático (TEPT). Sin embargo, el grado de asociación y la atribución a la discapacidad posterior ha variado, con estudios limitados realizados en contextos urbanos de bajos ingresos. Este estudio longitudinal estimo la trayectoria de los síntomas de TEPT hasta 7 meses después de la hospitalización y el nivel de discapacidad asociado entre los pacientes adultos que habían sido hospitalizados debido a una lesión. Pacientes adultos con lesiones (n = 476) ingresados en el Hospital Nacional Kenyatta en Nairobi, Kenia, fueron entrevistados en persona en el hospital y por teléfono a 1, 2-3 y 4-7 meses después de que el hospital los dio de alta. Utilizando el modelo de curva de crecimiento latente, surgieron dos trayectorias de los síntomas de TEPT: síntomas de TEPT persistentemente elevados (9.2%) y (b) síntomas de TEPT bajos (90.8%). El número de las EPT experimentados permanecieron moderadamente asociados con la trayectoria elevada después de controlar los síntomas depresivos en el hospital. Haber previamente presenciado asesinatos o lesiones graves, AOR = 2,32; IC del 95% [1,07, 5,05]; ser mujer, AOR = 4.74, IC 95% [4.53, 4.96]; tener síntomas depresivos elevados durante la hospitalización, AOR = 2.96, IC 95% [1.28, 6.83]; y carencia de ahorros / activos de los hogares, AOR = 1.28, IC del 95% [1.13, 1.44], se asociaron con la clase de trayectoria de síntomas de trastorno de estrés postraumático elevados después de controlar otros factores de riesgo. La membresía latente en la trayectoria del trastorno de estrés postraumático elevada se asoció con un nivel de discapacidad significativamente mayor varios meses después del alta hospitalaria, p <.001, después de controlar por características de lesiones y demografía. Estos resultados subyacen a las asociaciones entre los síntomas depresivos intrahospitalarios, presenciar atrocidades y pobreza y una trayectoria de síntomas de TEPT elevada.
