effect of mental health on long-term recovery following a road traffic crash results from uq support...
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ACHRF 2014TRANSCRIPT
7/17/2019 Effect of Mental Health on Long-term Recovery Following a Road Traffic Crash Results From UQ SuPPORT Study Erin Brown ACHRF 2014
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Effect of mental health on long-term
recovery following a Road Traffic Crash:
Results from UQ SuPPORT study ACHRF 19th November, Melbourne
Justin Kenardy, Michelle Heron-Delaney, Jacelle Warren, Erin Brown
Centre of National Research on Disability and Rehabilitation Medicine (CONROD)
The University of Queensland
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• Research Team at CONROD – Justin Kenardy – Michelle Heron-Delaney – Jacelle Warren – Erin Brown
• Research Funding
– Motor Accident InsuranceCommission (MAIC)
• Acknowledgements
– The Policy and Research Team at MAIC
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– Joan Hendrikz – Luke Connelly – Michele Sterling – Nicholas Bellamy
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Background
• Worldwide, up to 50 million people suffer a non-fatalinjury from RTCs – Leads to long term disability in many individuals (WHO, 2009)
• The number of RTC fatalities has decreased in
Queensland over recent years More survivors of RTCs
• Most common psychological disorders seen in RTC
survivors are: – Posttraumatic stress disorder (PTSD) – prevalence 6% - 45%
– Depression – prevalence 8% - 19%
– Generalised Anxiety Disorder
– Driving phobias/other anxiety disorders
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UQ SuPPORT Study
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European Journal of Psychotraumatology 2014, 5: 22612
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Objectives of this analysis
• To describe the physical and mental health of CTP*claimants in Queensland who had sustained
predominately minor injuries
• To evaluate the impact of mental health on:
– Disability
– Physical health-related quality of life (HRQoL)
– Return to work
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*Note: QLD has a common law ‘fault’-based CTP scheme
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Eligibility criteria
1. Injured driver/passenger of a car/motorcycle, cyclist orpedestrian
2. Maximum Abbreviated Injury Scale (AIS) = 1-3
3. CTP claim made between April 2009 & September 2010
4. Aged ≥ 18 years
5. Claim notification < 3 months post injury date*
6. Proficient English speaking ability
7. No severe cognitive/physical impairment8. Australian resident
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* To ensure first assessment was as soon as
possible post-RTC
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Procedure
1. MAIC invited claimants to participate (~ 3 months post-RTC)2. Written consent obtained – Wave 1 survey mailed
3. Approx 1 month after survey - Wave 1 telephone interview
4. Same procedure of staggering survey and phone interviewsimplemented at Wave 2 and Wave 3.
Wave 1 = 6 months post-RTC
Wave 2 = 12 months post-RTC
Wave 3 = 2 years post-RTC
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Study participants
• Recruited from MAIC database (Apr 09-Sep10)
• 382 consented; 372 completed assessments at at least one
Wave
• Average age = 48 years
• 38% Male; 63% Female
• 63% Driver; 17% Passenger;
14% Cyclist; 6% Pedestrian
•Predominately minor injuries
• 65% had MAIS = 1
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238
65%
96
26%
35
9%
Maximum AIS for sample
MAIS=1 MAIS=2 MAIS=3
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Measures - Survey
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Measure Description
Orebro Musculoskeletal Pain
Questionnaire (OMPQ )
The OMPQ measures physical and functional level and adjustment to injury and
pain. It screens for factors that may hamper recovery including emotional state,
fear-avoidance beliefs and coping strategies.
Short Form 36v2 Health
Survey (SF-36v2)
The SF-36v2 measures physical and mental health constructs as well as
perceived health status and daily functioning. Respondents were instructed to
describe their health in the past 4 weeks.
Multidimensional Scale of
Perceived Social Support
(MSPSS)
The MSPSS is a 12-item self-report measure to assess perceptions of
interpersonal functioning and social support.
Return to Work An additional questionnaire at Wave 3 assessed whether the participant had
returned to work in a full- of part-time capacity and if they were performing full
or modified duties.
*Plus: IES-R, HADS, AUDIT
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Measures - Interview
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Measure DescriptionPerception of threat to life Threat to life perception was assessed by asking “How much did you
believe you were going to die during the accident?” The 5-point scale
ranged from “Not at all” to “Very strongly”.
World Health Organization Disability
Assessment Schedule, Second Edition,
12-item version (WHO-DAS-II)
The WHO-DAS-II is a 12-item disability and health measure. Six domains
are measured: cognition, mobility, self-care, getting along with others,
life activities and participation in society.
Composite International Diagnostic
Interview (CIDI-PTSD)
CIDI-PTSD was used to assess PTSD via a full structured diagnostic
interview based on the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) criteria.
Composite International Diagnostic
Interview Short Form (CIDI-SF)
CIDI-SF was used to assess Major Depressive Episode (MDE),
Generalized Anxiety Disorder (GAD), Agoraphobia and Panic Attack via a
full structured diagnostic interview based on the DSM-IV criteria.
Health Care Utilisation Patients reported the number of contacts with medical doctors/health
professionals since their accident for a physical injury or other problem.
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Strengths
• Longitudinal study design (2 year follow-up)
• High retention rate of participants over the course of the
study (65% @ 2 years)
• One of few studies focusing on those sustaining
predominantly minor injury following an RTC
• Wide array of validated measures, including psychiatric
diagnoses
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Size of the mental health issue
• Overall, 69% (n=256) of study participants met diagnosticcriteria for a psychiatric disorder at some stage during the
course of the study
• Compare this to figures from Australian National Survey ofMental Health and Wellbeing:
– 45% of Australians have a mental disorder during their lifetime
– 20% experienced a mental disorder in past 12 months
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Size of the mental health issue
• Point prevalence for each disorder at each wave:
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DSM-IV diagnosis Wave 1
(N = 350)
Wave 2
(N = 317)
Wave 3
(N = 329)
Posttraumatic Stress Disorder (PTSD) 25.4% 23.3% 24.9%
Major Depressive Episode (MDE) 31.1% 31.9% 27.4%
Generalized Anxiety Disorder (GAD) 20.6% 30.0% 21.0%
Specific Phobia - Travel 4.6% 2.8% 1.8%
At least 1 above DSM-IV diagnosis 50.0% 52.7% 48.6%
At least 2 above DSM-IV diagnoses 24.6% 26.8% 20.7%
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What about psych history?
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History of
mental
illness?
Psych diagnosis present?
Wave 1
N = 350
Wave 2
N = 317
Wave 3
N = 327
No Yes No Yes No Yes
Yes 34 (39%) 53 (61%) 28 (35%) 53 (65%) 22 (29%) 54 (71%)
No 120 (46%) 143 (54%) 111 (47%) 125 (53%) 136 (54%) 115 (46%)
• Of those with no history of mental illness: ~ 50% had a
subsequent mental health diagnosis
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What about psych history?
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History of
mental
illness?
Psych diagnosis present?
Wave 1
N = 350
Wave 2
N = 317
Wave 3
N = 327
No Yes No Yes No Yes
Yes 34 (10%) 53 (15%) 28 (9%) 53 (17%) 22 (7%) 54 (17%)
No 120 (34%) 143 (41%) 111 (35%) 125 (39%) 136 (41%) 115 (35%)
• Of those with no history of mental illness: ~ 50% had a
subsequent mental health diagnosis
• Of the total number of participants: ~ 40% were newly
diagnosed with a psych disorder
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Relationship between mental and physical health
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• Claimants with a psychiatric diagnosis over the course of
the study had:• Higher disability
• Lower physical health related quality of life
• Higher pain
Physical Health Measure
Psych diagnosis present?
Wave 1 Wave 2 Wave 3
No Yes No Yes No Yes
Disability 7.25 14.98*** 6.36 14.98*** 5.26 14.38***
Physical quality of life 41.53 38.06** 43.86 38.52*** 46.46 39.07***
Pain 38.22 52.55*** 26.83 38.59** 19.69 38.04***
* p < .05 , ** p < .01, *** p < .001
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Work absenteeism
• Approx 40% of all claimants had > 30 days sick leave
due to pain over the course of the study
– Impact of psych diagnosis Higher % with > 30 days sick
leave
Amount of sick leavePsych diagnosis present at any stage? (n(%))
No Yes
0 days 33 (41.8%) 26 (15.9%)
1-30 days 31 (39.2%) 57 (34.8%)
> 30 days 15(19.0%) 81 (49.4%)
7/17/2019 Effect of Mental Health on Long-term Recovery Following a Road Traffic Crash Results From UQ SuPPORT Study Erin Brown ACHRF 2014
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Self-reported disability: Recovery trajectories
0.00
5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
0 6 12 18 24 30Months
P r e d i c t e d W H O D A S s c o r e
Recovering
(62.5%)
Chronic
(31.5%)
Severe
(5.9%)
Australian Norm
3.1 (sd=5.3)
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Self-reported disability: Recovery trajectories
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5.00
10.00
15.00
20.00
25.00
30.00
35.00
40.00
45.00
0 6 12 18 24 30Months
P r e d i c t e d W H O D A S s c o r e
Recovering
(62.5%)
Chronic
(31.5%)
Severe
(5.9%)
Australian Norm
3.1 (sd=5.3)
Impact of comorbid PTSD
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Self-reported disability: Predictors
• The following were found to significantly predicthigher disability: – ↓ expectation to return to work – ↓ expectation to recover
– ↑ pain – ↑ perceived threat to life – ↑ age – but only for those with PTSD
– History of mental illness
– Presence of Anxiety
– Presence of Depression
– Presence of PTSD
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Physical health-related quality of life: Recovery Trajectories
20.00
25.00
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35.00
40.00
45.00
50.00
55.00
60.00
0 6 12 18 24 30Months
P r e d i c t e d P C S s c o
r e
Severe-
chronic
(17.9%)
Moderate
improving
(54.7%)
Recovering
(27.3%)
Austral ian Norm
Mean=49.8 (sd=10.3)
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Physical health-related quality of life: Recovery Trajectories
20.00
25.00
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35.00
40.00
45.00
50.00
55.00
60.00
0 6 12 18 24 30Months
P r e d i c t e d P C S s c o
r e
Severe-
chronic
(17.9%)
Moderate
improving
(54.7%)
Recovering
(27.3%)
Austral ian Norm
Mean=49.8 (sd=10.3)
Impact of comorbid PTSD
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Physical health-related quality of life: Predictors
• The following were found to significantlypredict lower physical health-related quality
of life:
– ↓ expectation to return to work – ↓ expectation to recover
– ↑ pain
– ↑ age
– ↑ perceived threat to life – PTSD diagnosis present
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Return to Work
• Of 194 participants who stated they were working
prior to the RTC
– 152 (78%) had returned to work within 2 years
– 42 (22%) had not returned to work within 2 years
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Pre-RTC Work StatusWave 3 work status
Working full time Working part-time Not working
Working full time (N = 129) 89 (69%) 14 (11%) 26 (20%)Working part time (N = 65) 7 (11%) 42 (65%) 16 (24%)
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Return to Work: Predictors
• At 6 months, the following were found to significantlypredict NOT returning to work by 2 years post-RTC:
• Early (<6 mo.) symptoms of depression
• low expectation to return to work
• poorer physical health, including
• Higher disability
• Lower physical health-related quality of life• Higher pain
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Conclusions
• The presence of a mental illness predicts poorer physicalhealth
• The proportion of claimants with mental illness is higher than
in the community
• The outcomes of this study can provide important indicators
for individuals at risk. These indicators may be used to
influence claims and injury management practices, such as
the development of screening tools and inform effective
interventions to optimise claimant recovery
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Questions?
Justin Kenardy| Professor
Centre of National Research on Disability and Rehabilitation
Medicine (CONROD)
Health and Behavioural Sciences Faculty| The University of
Queensland
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