Injured body, injured soul? Predicting and preventing posttraumatic stress disorder after injury

Traumatic injury is common and may have a major impact on the survivor’s life. In the Netherlands alone, over 7 million injuries are registered yearly, caused by accidents in traffic, at home, at work, or by interpersonal violence. Besides physical recovery, survivors often deal with the psychological impact. Although most are resilient and show a natural psychological recovery within the first year, a proportion develops persistent psychological symptoms, among which posttraumatic stress disorder (PTSD). The studies in this thesis focused on how to predict and how to prevent the development of PTSD in the acute phase after traumatic injury. One out of every five injury patients who attended the trauma centers of the AMC and VUmc hospitals developed a psychological disorder, among which PTSD, depression and anxiety. For those with early psychological symptoms, performing a self-guided informative program online helped with psychological recovery. It is possible to identify patients at high risk for later PTSD early on using a short screening list of psychological symptoms. Patients with lower levels of the stress hormone cortisol showed a greater risk for later PTSD. Patients who were administered opiate pain medication, such as morphine, within the first 48 hours following injury were less likely to develop later PTSD.