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Kendrick, Denise and Kellezi, Blerina and Coupland, Carol and Maula, A. and Beckett, Kate and Morriss, Richard K. and Joseph, Stephen and Barnes, Jo and Sleney, Jude and Christie, Nicola (2017) Psychological morbidity and health related quality of life after injury: multicentre cohort study. Quality of Life Research, 26 (5). pp. 1233-1250. ISSN 1573-2649

Abstract

Purpose: To demonstrate the impact of psychological morbidity one month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services.

Methods: Multicentre cohort study of 16-70 year olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and one, two, four and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity one month post-injury and MID in HRQoL over the 12 months after injury.

Results: 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% reported a MID at one month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores one month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study.



Conclusions: Hospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury.

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