Klinik für Psychiatrie und Psychotherapie

The multicenter-study evaluates the psychological sequelae of accidental injury, its early identification, and systematic clinical management for risk-patients. The implementation of a screening-based algorithm for diagnosis and treatment of mental health problems was studied under routine conditions in 18 trauma departments. Symptom courses and 6 months’ results were compared for 3 different risk-groups – derived from patients’ results in a 10-item screening questionnaire (non-risk- ”green”, risk- “yellow” and high-risk-patients “red”) - and for 2 phases of the study (treatment as usual (TAU)/ intervention phase). In addition to symptom self-ratings “objective” data from the employer’s liability insurance were collected 6 months after the accident. Outcome and process data by patients, surgeons and employer’s liability insurance services were analysed.

1800 patients with at least 6 days of in-patient treatment were included, with a quota of 22 % risk- patients. 62 % of risk-patients initially showed high PTBS scores, 40 % had depressive symdromes and 25 % showed panic-attacks. 6-months outcome for risk-patients in the intervention phase was not significantly superior compared to TAU. In both phases patients with more severe symptoms and high-risk status showed a chronic course of their PTBS and anxiety symptoms after 6 months. 50 % (phase 1) vs. 34 % (phase 2) showed high functional impairments in everday-life due to mental health problems. Compared to “non-risk-”, “risk-patients” had significant and clinically relevant higher levels of psychopathology at follow-up. An analysis of the implementation process revealed practical problems at the transition from inpatient identification of risk status and actual management of subsequent diagnostic and therapeutic steps initiated by the employer’s liability insurance services. The potential of the screening-based procedure for mental health problems could be enhanced by compensating organisational deficits and by a specific algorithm for diagnostic and therapeutic intervention. The management of mental health problems in the aftermath of severe injuries should comprise different tools within a stepped-care approach, starting with early identification in surgery departments. Existing clinical guidelines for acute traumatization have to be considered and implemented in the management of severe accidents. The diagnostic and therapeutic algorithm under examination is compatible with a concept of the DGUV, the so called “Modellverfahren Psychotherapy”, which follows the idea of early diagnosis and indicative intervention for patients at risk for the development of chronic psychopathology.