Background
Method
Participants
Procedure
Measures
Demographic and clinical information
Psychosocial screening instrument for physical trauma patients (PSIT)
Patient health questionnaire-9 (PHQ-9)
Impact of events scale-revised (IES-R)
State-trait anxiety inventory - state anxiety subscale (STAI-S)
Rosenberg self-esteem scale (RSES)
World Health Organization quality of life assessment instrument - Bref (WHOQOL-Bref)
Sample size
Statistical analyses
No. | Hypothesis |
---|---|
1 | Strong and positive correlations (r ≥ 0.50) were expected between PSIT subscale 1 and the PHQ-9, STAI-S, IES-R, and a strong and negative correlation (r ≥ − 0.50) between PSIT subscale 1 and domain 2 of the WHOQOL-Bref. |
2 | Strong and positive correlations (r ≥ 0.50) were expected between PSIT subscale 2 and the STAI-S, IES-R, and the PHQ-9. |
3 | A moderate and negative correlation (r ≥ −0.30 but < −0.50) was expected between PSIT subscale 2 and domain 1 of the WHOQOL-Bref. |
4 | Strong and negative correlations (r ≥ −0.50) were expected between PSIT subscale 3 and the RSES and domains 2 and 3 of the WHOQOL-Bref. |
5 | A moderate and negative correlation (r ≥ −0.30 but < −0.50) was expected between PSIT subscale 3 and domain 1 of the WHOQOL-Bref. |
Results
Patient characteristics
Responders (n = 364) | Non-responders (n = 1084) | Difference between responders and non-responders | |
---|---|---|---|
Median (IQR) | Median (IQR) | Mann-Whitney U (p-value) | |
Age at time of injury (years) | 64.4 (52.0–78.0) | 62.0 (41.0–77.0) | U = 181,211 (p = 0.02, r = 0.06) |
ISS | 5 (4–9) | 5 (2–9) | U = 173,292 (p = 0.14) |
Missing (n, %) | 3 (0.8%) | 71 (6.5%) | |
N (%) | N (%) | χ2 (p-value) | |
Gender | |||
Female | 152 (41.8%) | 474 (43.7%) | χ2 = 0.43 (p = 0.50) |
Male | 212 (58.2%) | 610 (56.3%) | |
ISS | |||
< 16 | 320 (87.9%) | 993 (91.6%) | χ2 = 2.86 (p = 0.09) |
≥ 16 | 41 (11.3%) | 91 (8.4%) | |
Missing | 3 (0.8%) | 0 (0.0%) | |
Injury cause | |||
Falls | 193 (53.0%) | 548 (50.6%) | χ2 = 9.251 (p = 0.24) |
Road traffic injury | 108 (29.7%) | 268 (23.7%) | |
Work-related | 24 (6.6%) | 51 (4.7%) | |
Sports-related | 26 (7.1%) | 60 (5.5%) | |
Violence | 5 (1.4%) | 37 (3.4%) | |
Intentional injury | 3 (0.8%) | 14 (1.3%) | |
Other | 1 (0.3%) | 8 (0.8%) | |
Missing | 4 (1.1%) | 98 (9.0%) | |
Injury mechanism | |||
Blunt | 358 (98.4%) | 1029 (94.9%) | χ2 = 5.95 (p = 0.02, phi = −0.06) |
Penetrating | 6 (1.6%) | 48 (4.4%) | |
Missing | 0 (0.0%) | 7 (0.6%) | |
ICU admission (yes) | 61 (16.8%) | 156 (14.4%) | χ2 = 1.2 (p = 0.27) |
Total group (n = 364) | Test-retest group (n = 128) | |
---|---|---|
Mean ± SD | Mean ± SD | |
Age at time of injury (years) | 62.7 ± 17.3 | 64.4 ± 15.0 |
ISS | 7.5 ± 6.5 | 8.5 ± 7.1 |
Time since injury (months) | 7.9 ± 3.6 | 7.3 ± 3.7 |
Time between baseline and retest (days) | 19.5 ± 6.8 | |
N (%) | N (%) | |
Gender | ||
Female | 152 (41.8%) | 59 (46.1%) |
Male | 212 (58.2%) | 69 (53.9%) |
Level of education | ||
Low | 173 (47.5%) | 57 (44.5%) |
Middle | 104 (28.6%) | 38 (29.7%) |
High | 83 (22.8%) | 30 (23.4%) |
Unclassified | 3 (0.8%) | 0 (0%) |
Missing | 1 (0.3%) | 3 (2.4%) |
Current living situation | ||
Alone | 109 (29.9%) | 36 (28.1%) |
With partner/family | 255 (70.1%) | 92 (71.9%) |
Currently a paid job (yes) | 136 (37.4%) | 44 (35.4%) |
Missing | 1 (0.3%) | 0 (0%) |
ISS | ||
< 16 | 320 (87.9%) | 107 (83.6%) |
≥ 16 | 41 (11.3%) | 21 (16.4%) |
Missing | 3 (0.8%) | 0 (0%) |
Injury cause | ||
Falls | 193 (53.0%) | 65 (50.8%) |
Road traffic injury | 108 (29.7%) | 41 (32%) |
Work-related | 24 (6.6%) | 5 (3.9%) |
Sports-related | 26 (7.1%) | 8 (6.3%) |
Violence | 5 (1.4%) | 1 (0.8%) |
Intentional injury | 3 (0.8%) | 0 (0%) |
Other | 1 (0.3%) | 1 (0.8%) |
Missing | 4 (1.1%) | 7 (5.5%) |
Injury mechanism | ||
Blunt | 358 (98.4%) | 125 (97.7%) |
Penetrating | 6 (1.6%) | 3 (2.3%) |
ICU admission (yes) | 61 (16.8%) | 24 (18.8%) |
Pre-injury psychological problems (yes) | 52 (14.3%) | 15 (11.7%) |
Pre-injury psychological treatment (yes) | 51 (14.0%) | 13 (10.2%) |
Current psychological treatment (yes) | 54 (14.8%) | 23 (18%) |
Internal structure
Item | Content | Component 1: Negative affect | Component 2: Anxiety and PTSS | Component 3: Social and self-image |
---|---|---|---|---|
14 | Anger | 0.867 | ||
11 | Frustration | 0.844 | ||
12 | Disappointment | 0.839 | ||
13 | Feeling powerless | 0.825 | ||
10 | Less social/leisure activities than desired | 0.756 | ||
15 | Relationship | 0.683 | ||
2 | Depressed mood | 0.493 | ||
7 | Returning memories, nightmares, and/or flashbacks of the injury | 0.853 | ||
8 | Feeling upset when thinking about the trauma | 0.815 | ||
1 | Anxiety, feeling tensed | 0.686 | ||
9 | Increased watchfulness | 0.636 | ||
3 | Intimacy/sexual problems | 0.887 | ||
4 | Feeling less attractive | 0.753 | ||
6 | Decreased self-confidence | 0.507 | ||
5 | Inadequate social support | 0.462 |
Reliability
Possible min - max | Observed min - max | Median | IQR | Cronbach’s alpha | Floor (%) | Ceiling (%) | |
---|---|---|---|---|---|---|---|
Total PSIT | 0–45 | 0–42 | 5 | 2–13 | 0.92 | 9.9 | 0.0 |
Subscale 1: Negative affect | 0–21 | 0–21 | 2 | 0–7 | 0.91 | 26.9 | 0.3 |
Subscale 2: Anxiety and PTSS | 0–12 | 0–12 | 2 | 1–4 | 0.77 | 20.3 | 0.8 |
Subscale 3: Social and self-image | 0–12 | 0–12 | 1 | 0–2 | 0.79 | 47.0 | 0.3 |
Floor and ceiling effects
PSIT subscale 1: Negative affect | PSIT subscale 2: Anxiety and PTSS | PSIT subscale 3: Social and self-image | |
---|---|---|---|
PSIT subscale 2: Anxiety and PTSS | 0.58* | ||
PSIT subscale 3: Social and self-image | 0.66* | 0.50* | |
PHQ-9 | 0.75* | 0.59* | 0.60* |
STAI-S | 0.66* | 0.53* | 0.55* |
IES-R | 0.66* | 0.75* | 0.52* |
RSES | −0.50* | −0.32* | −0.49* |
WHOQOL-Bref facet 1: Overall QoL and general health | −0.65* | −0.38* | −0.49* |
WHOQOL-Bref Domain 1 | −0.66* | −0.40* | −0.49* |
WHOQOL-Bref Domain 2 | −0.67* | −0.44* | −0.56* |
WHOQOL-Bref Domain 3 | −0.46* | −0.21* | −0.45* |
WHOQOL-Bref Domain 4 | −0.50* | −0.31* | −0.38* |
Construct validity
ROC analyses and cut-off values
Sensitivity | Specificity | J | PPV | NPV | |
---|---|---|---|---|---|
Subscale 1: Negative affect | |||||
5 | 0.958 | 0.742 | 0.700 | 0.377 | 0.991 |
6 | 0.938 | 0.79 | 0.728 | 0.421 | 0.987 |
7 | 0.896 | 0.834 | 0.730 | 0.467 | 0.980 |
8 | 0.833 | 0.864 | 0.697 | 0.500 | 0.970 |
9 | 0.729 | 0.892 | 0.621 | 0.522 | 0.953 |
10 | 0.625 | 0.915 | 0.54 | 0.953 | 0.938 |
Subscale 2: Anxiety and PTSS | |||||
2 | 0.958 | 0.672 | 0.630 | 0.515 | 0.978 |
3 | 0.944 | 0.903 | 0.846 | 0.779 | 0.978 |
4 | 0.817 | 0.954 | 0.771 | 0.866 | 0.935 |
5 | 0.620 | 0.985 | 0.605 | 0.936 | 0.877 |
Subscale 3: Social and self-image | |||||
2 | 0.929 | 0.712 | 0.641 | 0.218 | 0.991 |
3 | 0.929 | 0.824 | 0.753 | 0.313 | 0.992 |
4 | 0.857 | 0.907 | 0.764 | 0.444 | 0.987 |
5 | 0.607 | 0.935 | 0.542 | 0.447 | 0.965 |