- PhD student
- Main activities
- Incidence, prediction, prevention of post-trauma psychopathology, Early intervention, E-health
- Focus of research
Trauma TIPS: The Incidence, Prediction and Prevention of Post-trauma Psychopathology Study
Traumatic injury patients who present to casualty departments and trauma centres are at risk of developing chronic psychiatric disorders as a consequence of their traumatic experience. International studies found that 33% to 58% of injury patients develop a psychiatric disorder within 4 to 6 months after trauma, such as major depressive disorder, posttraumatic stress disorder (PTSD), or other anxiety disorders. The incidence of post-trauma psychopathology among Dutch injury patients is yet unknown. The project “Trauma TIPS” focuses on the incidence, prediction, and prevention of post-trauma psychopathology in traumatic injury patients. Our main goal is to identify predictive factors of post-trauma psychopathology in traumatic injury patients in order to select individuals at high risk for posttraumatic symptoms in the early stages of their recovery. These patients can then be offered the appropriate support to increase their recovery rate. In this light, the study also focuses on developing and testing the effectiveness of a brief early intervention. Growing randomized clinical trial (RCT) evidence suggests that cognitive behavioural techniques delivered in the first days and weeks after injury can prevent the development of chronic PTSD. Based on cognitive behavioural techniques, we have developed a brief multimedia intervention. It is an internet-based programme containing interactive elements and visual and auditory materials. The early intervention aims to reduce acute psychological distress and long-term symptoms of PTSD in trauma victims. The following core and elective modules are included: psycho-education, self-directed exposure exercises, cognitive restructuring and stress management. The intervention will be tested in a RCT on its effectiveness in the prevention of PTSD, and cost-effectiveness.
The research questions of the Trauma TIPS project are:
1. What is the incidence of post-trauma psychopathology in traumatic injury patients and what psychological and biological factors contribute to the development of post-trauma psychopathology?
a. What is the incidence of post-trauma psychopathology in traumatic injury patients?
b. To what extent does the acute psychological and biological stress response predict the development of post-trauma psychopathology?
c. To what extent do somatic factors (injury severity, length of hospital stay) predict the development of post-trauma psychopathology?
d. To what extent do background factors (ethnicity/ cultural background, age, sex) predict the development of post-trauma psychopathology?
2. What is the effect of a brief multimedia early intervention on the prevention of post-trauma psychopathology in traumatic injury patients?
a. What effect does a brief multimedia early intervention have on the development of post-trauma psychopathology?
b. To what extent does the acute psychological and biological stress response predict the effect of the multimedia intervention on the prevention of post-trauma psychopathology?
During 12 months after their traumatic injury, patients of the Level I trauma centre of the Academic Medical Centre (AMC) and the Free University medical centre (VUmc) in Amsterdam, the Netherlands, are followed in their mental health recovery. The goal is to approach 2,000 patients with an expected inclusion rate of 50%. At five assessment time points during the first year of their recovery (i.e. at 1-7 days, 1 month, 3, 6, and 12 months), the development of psychiatric disorders is assessed by structured clinical interviews, performed by trained clinicians. Self-report questionnaires are administered on the severity of depressive, anxiety, and PTSD symptoms, quality of life, functional status, social support, coping, and litigation. Neuropsychological tests for attention and memory are also performed during the interviews. Upon arrival at the trauma centre, hospital staff collects blood samples for analysis of stress hormones and genetics after written and oral informed consent. Other predictors in the study concern, among others, injury-related variables (i.e. injury severity, trauma mechanism), attention and memory functioning, medical and psychiatric history, prior traumatic experiences, and peritraumatic experiences. For the study of the multimedia intervention, 300 traumatic injury patients will be randomly assigned to the intervention condition and a control condition without intervention (care as usual). The intervention will be offered within the first month after trauma. A pre-intervention assessment of post-trauma psychopathology is at 1-7 days after trauma, and immediately before the intervention, present levels of tension and anxiety are assessed online. Immediately after the intervention, present levels of tension and anxiety are assessed online again. Post-intervention assessments of post-trauma psychopathology are at 1 month, 3, 6, and 12 months. The content of the assessments is similar to the study of incidence and prediction described above.
From September 2005, traumatic injury patients are included consecutively in the incidence and prediction study. From September 2007, the inclusion of patients in the RCT started. In total, 944 patients are included in the project, of which 300 are randomized in the RCT. We expect the follow-up assessments to end in Spring 2010.