Access to Care/Health Care Delivery

Collaborative care for acutely injured trauma survivors can reduce post-traumatic distress symptoms and alcohol abuse

Each year about 2.5 million Americans are so severely injured that they require hospitalization. Symptoms of posttraumatic stress disorder (PTSD) may develop in 10 to 40 percent of these acutely injured trauma survivors. Approximately 20 percent to 40 percent of injured patients admitted to trauma centers have current or lifetime alcohol abuse or dependence diagnoses.

Trauma centers can reduce PTSD symptoms and alcohol abuse/dependence among these patients by using a trauma support specialist to coordinate care in a collaborative care (CC) approach that includes case management, medication, and psychotherapy, according to a recent study. The study was supported in part by the Agency for Healthcare Research and Quality (HS11372) and led by Douglas Zatzick, M.D., of the University of Washington, Seattle.

The researchers recruited 120 male and female injured surgical patients 18 or older hospitalized at a level 1 trauma center in Washington State. They randomly assigned 59 patients to the CC group and 61 to the usual care (UC) group. The CC patients received stepped care that consisted of continuous post-injury case management tailored to the needs of the individual trauma survivor, motivational interviews targeting alcohol abuse/dependence, and evidence-based medication and/or cognitive behavioral therapy for patients with persistent PTSD at 3 months after injury. The researchers examined PTSD symptoms using the PTSD checklist at baseline and 1, 3, 6, and 12 months after injury and alcohol abuse/dependence at baseline and 6 and 12 months after injury.

At the 3-month assessment, 24 percent of CC patients were diagnosed with PTSD and offered medication and psychotherapy. Over time, CC patients had significantly fewer symptoms than UC patients with regard to PTSD and alcohol abuse/dependence. Patients in the CC group demonstrated no changes in PTSD from baseline to 12 months, but patients in the UC group had a 6 percent increase in PTSD during the year. The CC group showed on average a 24 percent decrease in the rate of alcohol abuse/dependence, while the UC group had on average a 13 percent increase during the year.

See "A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors," by Dr. Zatzick, Peter Roy-Byrne, M.D., Joan Russo, Ph.D., and others, in the May 2004 Archives of General Psychiatry 61, pp. 498-506.

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