Effect of mental health on long-term recovery following a Road Traffic Crash: Results from UQ SuPPORT study

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1 1 Effect of mental health on long-term recovery following a Road Traffic Crash: Results from UQ SuPPORT study ACHRF 19 th 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

2 2 Research Team at CONROD Justin Kenardy Michelle Heron-Delaney Jacelle Warren Erin Brown Joan Hendrikz Luke Connelly Michele Sterling Nicholas Bellamy Research Funding Motor Accident Insurance Commission (MAIC) Acknowledgements The Policy and Research Team at MAIC

3 3 Background Worldwide, up to 50 million people suffer a non-fatal injury 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

4 4 UQ SuPPORT Study European Journal of Psychotraumatology 2014, 5: 22612

5 5 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 *Note: QLD has a common law fault -based CTP scheme

6 6 Eligibility criteria 1. Injured driver/passenger of a car/motorcycle, cyclist or pedestrian 2. Maximum Abbreviated Injury Scale (AIS) = CTP claim made between April 2009 & September Aged 18 years 5. Claim notification < 3 months post injury date* 6. Proficient English speaking ability 7. No severe cognitive/physical impairment 8. Australian resident * To ensure first assessment was as soon as possible post-rtc

7 7 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 interviews implemented at Wave 2 and Wave 3. Wave 1 = 6 months post-rtc Wave 2 = 12 months post-rtc Wave 3 = 2 years post-rtc

8 8 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 Maximum AIS for sample 96 26% 35 9% % MAIS=1 MAIS=2 MAIS=3

9 9 Measure Orebro Musculoskeletal Pain Questionnaire (OMPQ) Short Form 36v2 Health Survey (SF-36v2) Multidimensional Scale of Perceived Social Support (MSPSS) Return to Work Measures - Survey Description 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. 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. The MSPSS is a 12-item self-report measure to assess perceptions of interpersonal functioning and social support. 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

10 10 Measure Perception of threat to life Measures - Interview Description 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) Composite International Diagnostic Interview Short Form (CIDI-SF) Health Care Utilisation 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. 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. Patients reported the number of contacts with medical doctors/health professionals since their accident for a physical injury or other problem.

11 Strengths Longitudinal study design (2 year follow-up) High retention rate of participants over the course of the study 2 years) One of few studies focusing on those sustaining predominantly minor injury following an RTC Wide array of validated measures, including psychiatric diagnoses

12 12

13 13 Size of the mental health issue Overall, 69% (n=256) of study participants met diagnostic criteria for a psychiatric disorder at some stage during the course of the study Compare this to figures from Australian National Survey of Mental Health and Wellbeing: 45% of Australians have a mental disorder during their lifetime 20% experienced a mental disorder in past 12 months

14 14 Size of the mental health issue Point prevalence for each disorder at each wave: 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%

15 15 What about psych history? Of those with no history of mental illness: ~ 50% had a subsequent mental health diagnosis History of mental illness? Wave 1 N = 350 Psych diagnosis present? 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%)

16 16 What about psych history? 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 History of mental illness? Wave 1 N = 350 Psych diagnosis present? Wave 2 N = 317 Wave 3 N = 327 No Yes No Yes No Yes 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%)

17 17 Relationship between mental and physical health Claimants with a psychiatric diagnosis over the course of the study had: Higher disability Lower physical health related quality of life Higher pain Psych diagnosis present? Physical Health Measure Wave 1 Wave 2 Wave 3 No Yes No Yes No Yes Disability *** *** *** Physical quality of life ** *** *** Pain *** ** *** * p <.05, ** p <.01, *** p <.001

18 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 leave Psych 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%)

19 19

20 20 Self-reported disability: Recovery trajectories Predicted WHODAS score Severe (5.9%) Chronic (31.5%) Australian Norm 3.1 (sd=5.3) Recovering (62.5%) 0.00 Months

21 21 Self-reported disability: Recovery trajectories Impact of comorbid PTSD Predicted WHODAS score Severe (5.9%) Chronic (31.5%) Australian Norm 3.1 (sd=5.3) Recovering (62.5%) 0.00 Months

22 22 Self-reported disability: Predictors The following were found to significantly predict higher 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

23 23 Physical health-related quality of life: Recovery Trajectories Australian Norm Mean=49.8 (sd=10.3) Recovering (27.3%) Predicted PCS score Moderate improving (54.7%) Severechronic (17.9%) Months

24 24 Physical health-related quality of life: Recovery Trajectories Australian Norm Mean=49.8 (sd=10.3) Impact of comorbid PTSD Recovering (27.3%) Predicted PCS score Moderate improving (54.7%) Severechronic (17.9%) Months

25 25 Physical health-related quality of life: Predictors The following were found to significantly predict lower physical health-related quality of life: expectation to return to work expectation to recover pain age perceived threat to life PTSD diagnosis present

26 26 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 Pre-RTC Work Status Wave 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%)

27 27 Return to Work: Predictors At 6 months, the following were found to significantly predict 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

28 28

29 29 Conclusions The presence of a mental illness predicts poorer physical health 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

30 30 Questions? Justin Kenardy Professor Centre of National Research on Disability and Rehabilitation Medicine (CONROD) Health and Behavioural Sciences Faculty The University of Queensland

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