Effect of Mental Health on Long-term Recovery Following a Road Traffic Crash Results From UQ SuPPORT...

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



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



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



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



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

8

238

65%

96

26%

35

9%

Maximum AIS for sample

MAIS=1 MAIS=2 MAIS=3



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



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.



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%



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



What about psych history?

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History of

mental

illness?


Wave 1

N = 350

Wave 2

N = 317

Wave 3

N = 327


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



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


Wave 1 Wave 2 Wave 3


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



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%)



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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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2



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)

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

30.00

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

30.00

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

[email protected]

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Effect of Mental Health on Long-term Recovery Following a Road Traffic Crash Results From UQ SuPPORT...

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