• Douglas F Zatzick, Gregory J Jurkovich, Ming-Yu Fan, David Grossman, Joan Russo, Wayne Katon, and Frederick P Rivara.
• Department of Psychiatry and Behavioral Sciences, Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Campus Box 359896, 325 Ninth Ave, Seattle, WA 98104, USA. dzatzick@u.washington.edu
• Arch Pediatr Adolesc Med. 2008 Jul 1;162(7):642-8.

ObjectiveTo assess the association between early posttraumatic stress disorder (PTSD) and depressive symptoms and functional and quality-of-life outcomes among injured youth.DesignProspective cohort study.SettingCombined pediatric-adult level I trauma center.ParticipantsRandomly sampled adolescent injury survivors aged 12 to 18 years (N = 108) were recruited from surgical inpatient units.Main ExposuresPosttraumatic stress disorder and depressive symptom levels in the days and weeks immediately following injury. We also collected relevant adolescent demographic, injury, and clinical characteristics.Main Outcome MeasureMultiple domains of adolescent functional impairment were assessed with the 87-item Child Health Questionnaire (CHQ-87) at 2, 5, and 12 months after injury.ResultsThe investigation attained greater than 80% adolescent follow-up at each assessment after injury. Mixed-model regression was used to assess the association between baseline levels of PTSD and depressive symptoms and subsequent functional outcomes longitudinally. High baseline PTSD symptom levels were associated with significant impairments in CHQ-87 Role/Social Behavioral, Role/Social Physical, Bodily Pain, General Behavior, Mental Health, and General Health Perceptions subscales. High baseline depressive symptoms were associated with significant impairments in CHQ-87 Physical Function, Role/Social Emotional, Bodily Pain, Mental Health, Self-esteem, and Family Cohesion subscales.ConclusionsEarly PTSD and depressive symptoms are associated with a broad spectrum of adolescent functional impairment during the year after physical injury. Coordinated investigative and policy efforts that refine mental health screening and intervention procedures have the potential to improve the functioning and well-being of injured youth treated in the acute care medical setting.

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