International Medical Journal Vol. 21, No. 6, pp. 1 - 3 , December 2014 Post traumatic Stress Disorder and Its Associated Risk Factors among Trauma Patients Attending the Orthopaedic Wards and Clinics in Kota Bharu, Kelantan Sharifah Zubaidiah Syed Jaapar, Zarina Zainan Abidin, Zahiruddin Othman ABSTRACT Background: Posttraumatic stress disorder (PTSD) is prevalent among trauma patients seeking treatment. Objectives: This study aimed to evaluate the prevalence and associated risk factors of PTSD using the newly validated Malay Trauma Screening Questionnaire (TSQ-M). Methods: A total of 201 trauma patients attending the orthopaedic wards and clinics, Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II (HRPZII) were recruited and the TSQ-M was administered to all participants. Results: A total of 50 (24.9%) of the trauma patients had PTSD based on TSQ-M using a cut-off score of 5. None of the risk factors were significantly associated with PTSD in this study. Female gender and lower education were, 2.00 and 1.82 times respectively, more likely to experience PTSD. Conclusion: PTSD is common affecting about a quarter of trauma patients attending the orthopaedic services. We need to maintain a high index of suspicion in trauma patients regardless of their socio-demographic and clinical characteristics. KEY WORDS orthopaedic, trauma, risk factor, TSQ, PTSD Received on April 30, 2014 and accepted on August 27, 2014 Department of Psychiatry, School of Medical Sciences, Universiti Sains Malaysia 16150 Kubang Kerian, Kelantan, Malaysia Correspondence to: Sharifah Zubaidiah Syed Jaapar (e-mail: zubaidiah@usm.my) 1 INTRODUCTION Trauma has more than physical effects on the patients. In fact, suf- fering a traumatic injury can have serious and long-lasting implications on patient's mental health with post-traumatic stress disorder (PTSD) and depression affecting 20.7% and 6.6% of injured patients one year after the injury. Both disorders were independently associated with sig- nificant impairments across all functional outcomes. Patients who had one disorder were three times less likely to be working one year after injury, and patients with both disorders were five to six times less likely to have returned to work 1) . PTSD can also accompany chronic painful diseases and as such, PTSD has been observed in more than 50% of fibromyalgia patients with chronic pain 2) . Motor vehicle accidents (MVA) were found to be a leading cause of PTSD preceded only by sexual and physical assaults. MVA alone could account for 28 cases of PTSD for every 1000 adults in the United States 3) . PTSD occurred in about one tenth of MVA survivors. It was associated with having pre-accident psychological or social problems and, in patients with multiple injuries and continuing medical complica- tions 4) . PTSD prevalence rate was higher at 13.3% among motor vehicle accident (MVA) survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi. The risk factor for PTSD include female, age 20-29, being married, post-primary education, experiencing the first motor vehicle accident, and having previous psychiatric illness or other medical illness 5) . In another study conducted in Nigeria, the prevalence of PTSD was 26.7% among MVA survivors compared to 8.0% and 8.7% in the control groups. Female gender and being gainful- ly employed prior to the accident was significantly associated with PTSD 6) . There were few published studies on PTSD in Malaysia. Among the survivors of December 26 th , 2004 Malaysian Tsunami, only 19% of respondents fulfilled the criteria for PTSD. None of the socio-demo- graphic characteristics of the respondent was significantly associated with PTSD. However, there is a significant association with maladaptive coping styles 7) . In a study among help-seeking women experiencing domestic violence in two shelters in Malaysia, 60% had symptoms con- sistent with the diagnosis of PTSD. Negative appraisals about them- selves and self blame for the abusive situations were positively associat- ed with increased tendency to develop PTSD 8) . The purpose of this study was to evaluate PTSD and its associated risk factors among trauma patients attending the orthopaedic wards and clinics, Hospital Universiti Sains Malaysia (HUSM) and Hospital Raja Perempuan Zainab II (HRPZII). We hypothesize that female gender, being married, employed prior to the trauma, and presence of other medical illness would be the risk factors for PTSD. METHODOLOGY Subject The study protocol was approved by the Research and Ethics Committee, Universiti Sains Malaysia and Ministry of Health. Eligible subjects gave their written informed consent after the nature of the cross-sectional study was explained. Subjects age 18-65 with history of trauma at least 1 month prior to the study were recruited from the ortho- paedic wards and clinics, HUSM and HRPZII which are located in Kota Bharu, northeastern part of peninsular Malaysia. They were cooperative, literate and able to understand the Malay language. Those with traumat- C 2014 Japan Health Sciences University & Japan International Cultural Exchange Foundation 541-543