Predictors of Post-Traumatic Stress Symptoms after musculoskeletal trauma

Background
Post-traumatic stress symptoms (PTSS) are common following musculoskeletal
trauma and are associated with poorer recovery, disability, and reduced quality of life.
Although psychosocial and injury-related factors have been linked to PTSS, limited
research has examined longitudinal predictors or the relationship between injury
severity and PTSS progression in people hospitalised for musculoskeletal trauma.
Objectives
To identify predictors of PTSS at three and six months following musculoskeletal
trauma and hospitalisation, and to examine the relationship between injury severity
and PTSS severity over time.
Methods
This secondary analysis of a prospective cohort study included 125 adults admitted
to a UK major trauma centre with acute musculoskeletal injuries. PTSS were
assessed using the Impact of Event Scale–Revised (IES-R) at baseline, three, and
six months, with scores ≥22 indicating elevated PTSS. Candidate predictors included
socio-demographic, clinical, and trauma-related variables. Multivariate logistic regression
identified predictors at three and six months. Multicollinearity was assessed
using variance inflation factors and principal component analysis. Injury severity
(mild, moderate, major) was examined using Kruskal-Wallis and Mann-Whitney U
tests. Model discrimination and calibration were evaluated using AUC and
Hosmer-Lemeshow tests.
Results
At baseline, 97.6% of participants met the PTSS threshold, decreasing to 26.4% at three months and 17.6% at six months. This high baseline prevalence likely reflects the early post-injury assessment period and the use of a sensitive screening threshold. At three months, road traffic accidents (OR 3.71, 95% CI 2.60–6.85) and car accidents (OR 2.20, 95% CI 1.68–3.15) significantly increased PTSS risk compared to falls. Higher baseline anxiety (OR 0.53, 95% CI 0.33–0.86) and kinesiophobia (OR 0.58, 95% CI 0.39–0.86) were associated with reduced PTSS odds. At six months, higher chronic pain–related disability independently predicted lower PTSS risk (OR 0.89, 95% CI 0.82–0.97). Injury severity differed significantly at six months (p = 0.022) but not at three months (p = 0.172). The six-month model demonstrated excellent discrimination (AUC = 0.91) and good calibration (p = 0.70).
Conclusions
PTSS following musculoskeletal trauma are influenced by trauma mechanism, psychological factors, and injury severity over time, supporting early risk stratification and targeted psychological intervention.