Serious injury and depression, anxiety and Post-Traumatic Stress Disorder

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1 Serious injury and depression, anxiety and Post-Traumatic Stress Disorder fact sheet 49 The physical harm and suffering associated with a serious injury can often have an impact on mental health. The emotional trauma of a sudden and severe injury resulting from events such as an assault, car accident or accidental fall can increase the risk of a person developing an anxiety disorder such as Post- Traumatic Stress Disorder (PTSD) or depression. A person s mental health can be further affected when serious injuries result in a loss of skills and opportunities; being unable to participate in everyday activities such as work, study and socialising; worries about finances and the future. However, once recognised, anxiety disorders (including PTSD) and depression can be treated. This fact sheet: looks at some common types of serious injury and how they are linked to a person s mental health gives advice about recognising the early signs of mental health problems and the treatments that can help. WHAT is a SERIOUS INJURy? A serious injury is a sudden trauma to the body that requires immediate treatment at a hospital. Every year, around one in 10 Australians visits the Emergency Department due to a serious injury. 1 A serious injury can occur in a number of ways: From falling Accidental falls are the leading cause of serious injury in Australia. One in three serious injuries happens this way, and elderly people are even more at risk. 2 On roads Around one in seven serious injuries involves road vehicles. Males, and especially young males, 3 are most likely to be injured on the road. 2 From burns Around 10,000 Australians are hospitalised every year with serious burns or scalds. Children aged under four are most vulnerable to this type of injury. 4 Acts of violence Around one in 20 Australians each year is physically assaulted, many of them young people. Also, three in every 1000 experience traumatic sexual assault. 5 At work One in 16 working Australians experiences workrelated injury. This risk is higher for tradespeople, labourers and transport workers. 6 During sports One in 10 serious injuries happens during sport or training. Football-related injuries are the most common. 2 Around one in 10 Australians has a chronic condition caused by a past injury. 7 Fortunately, due to advances in medical science, the majority of those with serious injury recover well. WHAT IS THE LINK BETWEEN SERIOUS INJURY AND MENTAL HEALTH? The majority of people who experience serious injury will recover and have good mental health. For some people, however, a sudden injury can affect their mental health and well-being. The negative effects of serious injuries can make life harder in a number of ways it may be more difficult to get around, stay in or find employment, develop or maintain relationships, or participate in sport or other leisure activities. Even after recovering physically, injured people can still be at risk of serious mental health disorders. 8 Mental health disorders may develop after injury because the injury event is traumatic (leading to Post-Traumatic Stress Disorder) or because people find it difficult to deal with the consequences of the event (leading to difficulties such as depression, travel phobia or other anxiety disorders). Post-Traumatic Stress Disorder (PTSD) Between 10 and 20 per cent of people who experience a serious injury will develop PTSD within 12 months of the traumatic event occurring. 9 Around half of all people with PTSD also have a co-existing disorder such as depression or Generalised Anxiety Disorder. 9 Anxiety and depression Other anxiety disorders and depression can develop following severe injury. Like PTSD, they can occur alone or with another disorder. There is a number of anxiety disorders that can develop after severe injury, including: Generalised Anxiety Disorder Social Phobia Panic Disorder Agoraphobia (abnormal fear of being in crowds, public places or open areas) Specific Phobias (especially travel phobia). Three months after a traumatic injury, around one in three people will experience major depression. 9 For people who have suffered a traumatic brain injury (TBI), the risk of developing depression can be higher. Depression is the most commonly reported consequence of TBI, occurring in 23 to 45 per cent of people with a traumatic brain injury. 10, 11, 12 Short or long-term cognitive impairment may complicate the assessment and management of depression or anxiety disorders in this group. Currently, beyondblue is funding research into TBI and depression. Similarly, people who have had a spinal cord injury (SCI) are also at greater risk of developing depression and anxiety disorders. (TBI is also present in 25 to 50 per cent of SCI cases. 13 ) The effects of SCI can be permanent and potentially devastating for the individual and those around them. It is estimated there are 10,000 Australians living with SCI as a result of a traumatic injury 14 (mainly the result of traffic incidents, falls and water-related accidents 15 ). Up to 40 per cent of people with SCI are at risk of developing PTSD 16, while up to 30 per cent are at risk of experiencing depression. 17,18 Visit Call infoline@beyondblue.org.au 1 of 6

2 Serious injury and depression, anxiety and Post-Traumatic Stress Disorder fact sheet 49 Continuing pain (affecting 65 per cent of people with SCI 19 ) is a strong predictor of depression and distress in this group of people. 20 Remember, if you have recently experienced a serious injury, there is a good chance you will recover without mental health complications. However, it is important to know and recognise the symptoms of PTSD, other anxiety disorders and depression, and to seek help if you think you may be experiencing any of them. WHAT IS POST-TRAUMATIC STRESS DISORDER? Post-Traumatic Stress Disorder (PTSD) is a set of reactions that can develop in people who have experienced a terrifying or life-threatening event. 21 The most common symptoms are re-experiencing the event in nightmares or recurring memories, avoiding things that remind the person of the event, being constantly anxious and alert, feeling emotionally numb and feeling cut off from friends and family members. 9 It is common in the days following injury to experience symptoms like these, but for the majority of people, these symptoms fade over time. If these symptoms continue for more than a month and are very distressing, professional help may be needed. Signs of PTSD The classic symptoms of PTSD are the re-experiencing symptoms where the person feels like he/she is experiencing the traumatic event again. These symptoms include intrusive and distressing memories about the event, and distress when reminded about the event. Other signs of PTSD include: 21 difficulty sleeping vivid nightmares constant alertness (feeling wound-up ) and searching for signs of danger irritability avoiding certain activities, places or people lack of concentration being startled easily sudden panic or extreme fear unexplained sweating or heart palpitations emotional numbness and unresponsiveness detachment from friends and family members loss of interest in previously enjoyable activities. When a person displays some or all of these signs in the months or even years following a serious trauma, they may be experiencing Post-Traumatic Stress Disorder. There is a number of effective treatments for PTSD so it is important to seek help if you think you (or someone you know) may have PTSD. For more information see beyondblue Fact Sheet 31 Post-Traumatic Stress Disorder. WHAT IS DEPRESSION? Depression is more than just sadness or a low mood it s a serious illness that can have severe effects on both physical and mental health. People with depression find it hard to function every day and may be reluctant to participate in activities they once enjoyed. It is important to be aware of the signs of depression, and seek help if you think you need it, as effective treatments are available. Signs of depression A person may be experiencing depression if, for more than two weeks, he/she has been behaving in a way that is out of character. Common behaviour associated with depression includes: moodiness that is out of character increased irritability and frustration finding it hard to accept minor personal criticism spending less time with friends and family members loss of interest in pleasurable activities (such as eating, sex, exercise) being awake throughout the night increased alcohol and/or drug use staying home from work increased physical health complaints like fatigue or pain being reckless or taking unnecessary risks slowing down of thoughts or actions. Everyone experiences some or all of these symptoms from time to time, but when symptoms are lasting and impact on your ability to cope from day to day, it s time to seek help. WHAT IS ANXIETY? Most people feel anxious sometimes, but for some people, anxious feelings are overwhelming and cannot be brought under control easily. An anxiety disorder is a serious condition that makes it hard for the person to cope from day to day. There are many types of anxiety disorders, each with a range of symptoms. Like depression, there are effective treatments available for anxiety disorders. 2 of 6 Visit Call infoline@beyondblue.org.au

3 Signs of anxiety A person may be experiencing an anxiety disorder if for some time, worry and fear have got in the way of other parts of life like how things are at work or in relationships. An anxiety disorder will usually be far more intense than normal anxiety and go on for weeks, months or even longer. An anxiety disorder can be felt in different ways, such as uncontrollable worry, intense fear (phobias or panic attacks), or upsetting dreams. For more information on depression and anxiety disorders, symptom checklists and treatments, visit the beyondblue website or call the info line on WHAT ARE THE TREATMENTS FOR ANXIETY DISORDERS AND DEPRESSION? There are effective treatments for anxiety disorders including PTSD and depression. Common treatments may range from physical exercise for preventing and treating mild depression, through to psychological treatments for depression, anxiety and PTSD, and a combination of psychological and drug treatments for more severe levels of depression, anxiety and PTSD. Whatever the reason for mental health disorders, it is important to seek help as soon as possible. Mental health disorders are both common and treatable and a doctor will be able to help you decide whether treatment is needed and what treatments are suitable. Psychological therapies may not only help with recovery, but can also help to prevent a recurrence of depression or anxiety. These therapies help to build skills in coping with stressful life circumstances. Cognitive Behaviour Therapy (CBT) is one of the most researched psychological therapies and there is a lot of evidence to support its effectiveness in treating people for depression and anxiety disorders. It teaches people to think realistically about common difficulties, helping them to change their thought patterns and the way they react to certain situations. Interpersonal Therapy (IPT) has also been researched and found to be effective for treatment of depression and some anxiety disorders. It helps people find new ways to get along with others and to resolve losses, changes and conflict in relationships. Antidepressant medication is often prescribed, alongside psychological treatments, when a person experiences a moderate to severe episode of depression and/or anxiety. Sometimes antidepressants are also prescribed when other treatments have not been helpful. Some antidepressant medications can be used to treat Post-Traumatic Stress Disorder, but treatment guidelines recommend CBT as the first line treatment for a person with PTSD. Making a decision about which antidepressant is best for a person can be complex. This decision should be made in consultation with a doctor after careful assessment and consideration. The prescribing health professional should discuss differences in effects and possible side-effects of medications. There are many different types of antidepressant medication. The doctor may need to find the medication and dose which is most effective for the person. Keep in mind antidepressants take time before they start to help (at least two weeks). Like any medication, the length of time for which a person takes antidepressants depends on the severity of the illness and how the person responds to treatment. For some people, antidepressants are needed only for a short time (generally six to 12 months) with psychological treatments and self-help techniques being sufficient. For others, antidepressants are needed on an ongoing basis in the same way that someone with asthma would use respiratory medication. Stopping medication should only be done gradually, on a doctor s recommendation and under supervision. The Therapeutic Goods Administration (Australia s regulatory agency for medical drugs) and the manufacturers of antidepressants do not recommend antidepressant use for treating depression in young people under the age of 18. For more information see beyondblue Fact sheet 11 Antidepressant medication. Benzodiazepines are anti-anxiety and sedative drugs that are commonly used to help people cope with anxiety or insomnia. They are, however, addictive and so are only useful for a short period of time (two or three weeks) or if used intermittently. Benzodiazepines are not recommended for PTSD. (For more information on benzodiazepines see beyondblue Fact sheet 44 Benzodiazepines.) It s important that any current prescribed medication or over-thecounter medications including herbal or natural remedies are reviewed by a medical practitioner before starting a course of medication. Most people taking medication will also benefit from psychological therapies, which will reduce the likelihood of relapse after the person has stopped taking the medication. For more information on treatments, see the beyondblue booklets A Guide to What Works for Depression, A Guide to What Works for Anxiety Disorders and A Guide to What Works for Depression in Young People. Booklets and fact sheets can be downloaded or ordered from or by calling the beyondblue info line Visit Call infoline@beyondblue.org.au 3 of 6

4 HELPFUL TIPS FOR MANAGING ANXIETY DISORDERS OR DEPRESSION If you have experienced a serious injury and think you may have PTSD, another anxiety disorder or depression, the following tips may be helpful: Speak to your doctor about your concerns and discuss treatment options. Accept help, support and encouragement from family members and friends. To avoid feeling isolated become involved in support groups and social activities. Acknowledge you have been through a traumatic experience and, when ready, talk about the experience and how you feel. Depending on your physical recovery, try to stay active. (See beyondblue online Fact sheet 8 Keeping active.) Eat healthily and include a wide variety of nutritious foods. (See beyondblue online Fact sheet 30 Healthy eating for people with depression, anxiety and related disorders.) Cut out or limit alcohol intake. (See beyondblue Fact Sheet 9 Reducing alcohol and other drugs.) Get enough sleep. (See beyondblue online Fact Sheet 7 Sleeping well.) Allow yourself time to relax and reduce your stress. (See beyondblue online Fact sheet 6 Reducing stress.) Go to a doctor for regular check-ups. HOW TO GET THE RIGHT TREATMENT Be informed If you have been seriously injured, spend some time learning about the symptoms of depression, anxiety and Post-Traumatic Stress Disorder. Be proactive As with physical health problems, the earlier you get help, the faster you can recover. That s why it s very important to get help at the first sign of any problems. Be direct It s important to give the doctor or mental health professional the full picture. Writing down feelings or questions before your visit can help and makes it less likely you will forget to tell the doctor the important things. It may be useful to take a completed depression or anxiety checklist along. (See Symptom Checklists at Be persistent Finding the right mental health professional is very important. If you don t feel comfortable with a doctor or other health professional, or suspect your mental health isn t being managed effectively, choose another doctor or get a second opinion. Be prepared to follow the treatment plan For some people, it can take a while before they feel well again. It s important for your long-term recovery that you stick with treatment plans and let the doctor know when things aren t working or if you are experiencing side-effects. WHERE TO GET HELP A General Practitioner is a good person with whom to discuss your concerns in the first instance. Your GP will be able to conduct or arrange any necessary medical tests, provide treatment or refer you to a mental health professional. Psychologists can assist people who are having difficulty controlling their emotions, thinking and behaviour. Clinical psychologists are specialists in the assessment, diagnosis and treatment of mental illness such as depression, anxiety and related disorders. Psychiatrists are medical doctors who have undergone specialist training to treat all mental disorders. They can make medical and psychological assessments, conduct medical tests and prescribe medication. Depending on their expertise and type of practice, they can also provide psychological treatments such as Cognitive Behaviour Therapy (CBT) and Interpersonal Therapy (IPT). Some have particular areas of speciality. If you would like a consultation with a psychiatrist, you will need a referral from a GP. Mental health nurses are specially trained to care for people with mental health problems. They work with psychiatrists and General Practitioners to review the state of a person s mental health; they monitor medication and provide information about mental health problems and treatment. Some have training in psychological therapies. If you would like a referral to a mental health nurse who works in a general practice, ask your GP. Social workers in mental health are specially trained to work with people who are experiencing difficulties in life. Social workers can support people with depression, anxiety and related disorders by helping them find ways to manage more effectively some of the situations that trigger these disorders. These may include family issues, financial problems, work stress and living arrangements. Mental health social workers can also provide focused psychological self-help strategies, which include interventions such as relaxation training and skills training (e.g. problem solving and stress management). Occupational therapists in mental health help people who have difficulties functioning because of a mental health problem (such as anxiety or depression) to participate in normal, everyday activities. Mental health occupational therapists can also provide focused psychological self-help strategies. 4 of 6 Visit Call infoline@beyondblue.org.au

5 If a person is referred by a GP or psychiatrist to a clinical psychologist, registered psychologist, social worker or occupational therapist in mental health, a Medicare rebate can be claimed for part of the cost of up to 12 individual consultations and 12 group sessions in a calendar year. If the mental health practitioner bulkbills, there will be no upfront charge. For a list of GPs, psychologists, clinical psychologists, mental health nurses, social workers and occupational therapists with expertise in treating mental health problems, visit and click Find a Doctor or other Mental Health Practitioner or contact the beyondblue info line at infoline@beyondblue.org.au or (local call cost from a landline). HELPFUL STRATEGIES If you have recently experienced a serious injury, take some time to consider how you feel. Think about how you have faced previous stressful situations in your life and what helped you cope (and what didn t). Get support from friends and family and learn as much as you can about the symptoms of Post-Traumatic Stress Disorder, other anxiety disorders and depression and how to recognise and deal with them. Serious injuries can lead to frustration and anger, a sense that the world is unfair ( Why me? ) or that you are particularly unlucky. You may find it helpful to contact other people who have been injured or traumatised and share your experiences through a support group. Your health professional should be able to put you in touch with relevant services. Take a partner, friend or carer with you when you go to the doctor. Not only can they help you to remember what was discussed, ask questions and give you support, but they may benefit from having a better understanding of your condition and its treatments. Remember that, like any other conditions Post-Traumatic Stress Disorder, other anxiety disorders and depression can be treated. The sooner you seek help, the better but it is never too late to treat any of these conditions. REFERENCES 1 Watson WL, Ozanne-Smith J. Injury surveillance in Victoria, Australia: developing comprehensive injury incidence estimates. Accident Analysis and Prevention 2000; 32: Bradley C, Harrison J (2008). Hospital separations due to injury and poisoning, Australia Injury Research and Statistics Series 47: i-iv. 3 Department of Health and Ageing (2004). The National Injury Prevention and Safety Promotion Plan: : Harrison J, Steel D (2006). Burns and scalds. Department of Health and Ageing NISU Briefing 7: Australian Bureau of Statistics (2005a). Crime and Safety, Australia Canberra: ABS. 6 Australian Bureau of Statistics (2005b). Work-Related Injuries, Australia Canberra: ABS. 7 Australian Bureau of Statistics (2005c). Injury in Australia: A Snapshot, Canberra: ABS. 8 Shalev A et al (1998). Prospective Study of Posttraumatic Stress Disorder and Depression Following Trauma. American Journal of Psychiatry 155(5): Bryant RA, O Donnell ML et al (2010). The psychiatric sequelae of traumatic injury. American Journal of Psychiatry 167(3): Busch CR, Alpern HP. (1998). Depression after mild traumatic brain injury: a review of current research. Neuropsychology Review 8(2): Jorge RE, Robinson RG, et al (2004). Major depression following traumatic brain injury. Archives of General Psychiatry 61(1): Kreutzer JS, Seel RT, Gourley E. (2001). The prevalence and symptom rates of depression after traumatic brain injury: a comprehensive examination. Brain Injury:15(7): Davidoff GN, Roth EJ, Richards JS. (1992). Cognitive deficits in spinal cord injury: Epidemiology and outcome. Archives of Physical Medicine and Rehabilitation, 73, O Connor PJ. (2005). Prevalence of spinal cord injury in Australia. Spinal Cord, 43, AIHW: Norton L Spinal cord injury, Australia Injury research and statistics series no.52. Cat. no. INJCAT 128. Canberra: AIHW. 16 Kennedy P, Evans MJ (2001). Evaluation of post traumatic distress in the first 6 months following SCI. Spinal Cord, 39, Craig AR, Hancock KM, Dickson HG (1994). A longitudinal investigation into anxiety and depression in the first 2 years following a spinal cord injury. Paraplegia, 32, Kennedy P, Rogers B. (2000). Anxiety and depression after spinal cord injury: A longitudinal analysis. Archives of Physical Medicine and Rehabilitation, 81, Siddall PJ, Loeser JD. (2001). Pain following spinal cord injury. Spinal Cord, 39, Craig A, Nicholson Perry K (2008). Guide for Health Professionals on the Psychosocial Care of People with a Spinal Cord Injury. Sydney: NSW Health. Available at: 21 Australian Centre for Posttraumatic Mental Health (2008) Posttraumatic Stress Disorder. Visit Call infoline@beyondblue.org.au 5 of 6

6 Serious injury and depression, anxiety and Post-Traumatic Stress Disorder fact sheet 49 MORE INFORMATION beyondblue: the national depression initiative or Information on depression, anxiety and related disorders, available treatments and where to get help Youthbeyondblue beyondblue s website for young people information on depression, anxiety and how to help a friend Lifeline Counselling, information and referral (local call) Australian Centre for Posttraumatic Mental Health (ACPMH) Information on post-traumatic mental health problems and general advice about treatment Suicide Call Back Service or Telephone counselling and online resources for those at risk of suicide, their carers and those bereaved by suicide The Australian Psychological Society or Find a psychologist, information on psychological services and the APS Carers Australia or Family carer support and counselling in each state and territory Brain Injury Australia Information and advocacy for people with an acquired brain injury and their families Spinal Cord Injuries Australia Information, support and advocacy for people with a spinal cord injury and their families Kids Helpline or Counselling for children and young people aged between five and 25 ReachOut.com Information to help young people through tough times headspace Australia s National Youth Mental Health Foundation Information, support and help for young people Multicultural Mental Health Australia Mental health information for people from culturally and linguistically diverse backgrounds MensLine Australia or Counselling, information and referral services for men with family and relationship concerns CRUfAD Information and internet-based education and treatment programs for people with depression and anxiety This fact sheet was developed by beyondblue: the national depression initiative with input from the Australian Centre for Posttraumatic Mental Health (ACPMH). beyondblue: the national depression initiative Info line or infoline@beyondblue.org.au Beyond Blue Ltd BL/ /11 6 of 6 Visit Call infoline@beyondblue.org.au