Emotional distress in critically-injured patients three months after a potentially life-threatening accident

A case-control study was carried out to determine why some critically-injured patients remained emotionally distressed while other critically-injured patients were found to be minimally distressed three months after a potentially life-threatening accidental injury. Cognitive processing and meaning theories suggest that psychological adjustment following a traumatizing event depends on the successful integration of the event into current or modified cognitive schema and the restoration of a sense of meaning in life. These cognitive processes may be facilitated by coping strategies that share concerns, mobilize support and reframe disturbing elements. The Global Severity Index was used to identify critically-injured patients as either emotionally distressed or minimally distressed. Bradburn's Psychological Well-Being Scale, Impact of Events Scale, the Meaning-of-Illness Questionnaire and Family Crisis-Oriented Personal Evaluation Scale were used to collect cross-sectional data from 51 critically-injured patients during face-to-face interviews 8-12 weeks after the accident. Twenty-seven emotionally distressed patients and 24 minimally distressed patients were compared on the variables of psychological well-being, cognitive processing efforts, restoring a sense of meaning in life and use of coping strategies. Descriptive statistics, ANOVA and MANOVA were used to test for significant differences between the two groups. The findings showed that emotionally distressed patients scored significantly higher on efforts to cognitively process what happened, share concerns and mobilize support. They also had difficulty acknowledging the negative effects of the accident on the self and a poorer sense of psychological well-being. In contrast, minimally distressed patients evidenced a significantly greater ability to acknowledge the negative effects on the self and a higher level of psychological well-being. The potential differences between the two groups in the magnitude of the relationships of meaning, cognitive processing and coping strategies on psychological well-being were assessed by hierarchical regression equations. Psychological well-being of minimally distressed patients was characterized by a significantly higher perception of their capabilities and strengths and by an ability to acknowledge a change in their relations with family and friends.