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Beyond the neglect of psychological consequences: post-traumatic stress disorder increases the non-fatal burden of injury by more than 50%
  1. Juanita A Haagsma1,
  2. Suzanne Polinder1,
  3. Hidde Toet2,
  4. Martien Panneman2,
  5. Arie H Havelaar3,
  6. Gouke J Bonsel1,
  7. Ed F van Beeck1
  1. 1Department of Public Health, Erasmus Medical Centre, the Netherlands
  2. 2Consumer Safety Institute, Amsterdam, the Netherlands
  3. 3National Institute of Public Health and the Environment, Bilthoven, the Netherlands
  1. Correspondence to Juanita A Haagsma, Department of Public Health, Erasmus Medical Centre, PO Box 1738, 3000 DR Rotterdam, the Netherlands; j.haagsma{at}


Background Psychological consequences such as post-traumatic stress disorder (PTSD) are currently neglected in burden-of-injury calculations.

Aim To assess the disease burden of PTSD due to unintentional injury and compare this health loss with physical injury consequences.

Methods From literature sources, the prevalence of PTSD at four follow-up periods (<3 months, 3–6 months, 7–12 months and >12 months) was estimated. The uncertainty of the estimated PTSD prevalence was modelled by a Bayesian approach. The prevalence rates were then linked to national data on unintentional injury, disability weights and duration to estimate the incidence and disability-adjusted life years (DALY) resulting from PTSD in addition to physical injury consequences.

Results The data suggest that PTSD prevalence among injury victims decreases over time. The average PTSD prevalence at <3 months follow-up was 21% (90% credibility interval (CI) 17% to 24%) for patients presenting at the emergency department and 30% (90% CI 27% to 33%) for patients who were hospitalised, tapering down after 12 months to 4% (90% CI 3% to 5%) and 6% (90% CI 4% to 10%), respectively. These estimates translate into 191 000 (90% CI 161 000 to 222 000) cases of PTSD per year in the Dutch population (1.2%) due to unintentional injury. Including PTSD increases the non-fatal burden of disease of unintentional injuries by 53% (from 116 000 to 178 000 DALYs (90% CI 150 000 to 217 000)).

Conclusions Ignoring PTSD in burden-of-injury studies results in a considerable underestimation of the burden of injury. This may affect resource allocation and the identification of important prevention priorities.

  • Disability
  • psychological
  • public health
  • sequelae

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  • All authors contributed to the article.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.