Skip to main content
Download PDF

Acute stress disorder and associated factors among adult trauma patients in Ethiopia: a multi-institutional study

BMC Psychiatry volume 24, Article number: 418 (2024) Cite this article

Abstract

Introduction

Acute stress disorder (ASD) is a mental disorder that happens after someone experienced traumatic event within duration of less than a month. Other studies conducted in different countries revealed that adults with a trauma had experienced acute stress disorder. This results in substantial distress and interferes with social and day to day activities. Despite the high burden of this problem, very little is known about the prevalence and risk factors for acute stress disorder in adults with traumatic injuries in Ethiopia.

Objective

This study was aimed to assess the prevalence of acute stress disorder and associated factors among adult trauma patients attending in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia 2022.

Methods

An institutional based cross-sectional study design was employed among 422 adult trauma patients from May– June 2022. Systematic sampling technique was applied to recruit study participants. Data were collected through interviewer administered questionnaires using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, acute stress disorder measurement tools. Then, it was entered into Epi-Data version 4 and exported to STATA version 14 for analysis. Bivariate and multivariable binary logistic regressions model were carried out to identify factors significantly associated acute stress disorder.

Result

The prevalence of acute stress disorder among adult trauma patients in northwest Amhara comprehensive specialized hospitals was found to be 44.15% (95% CI: 39.4%, 49.0%) with 99% of response rate. In multivariate logistic analysis younger age (21–29) (AOR = 0.33 95% CI: 0.14–0.77), (30–39) (AOR = 0.35 95% CI: 0.15–0.85), (40–49) (AOR = 0.28 95% CI: 0.10–0.76) respectively, presence of complication (AOR = 2.22 95% CI: 1.36–3.60), prolonged length of hospital stay (AOR = 1.89 95% CI: 1.21–2.95) and having low (AOR = 3.21, 95% CI: 1.66–6.19) and moderate (AOR = 1.99, 95%, CI: 1.14–3.48) social support were factors significantly associated with acute stress disorder.

Conclusion and recommendation

This study showed that the prevalence of acute stress disorder among the adult study participants who experienced traumatic events was high as compared to other literatures. Age, complication, prolonged hospital stay and social support were factors significantly associated with ASD at p-value < 0.05. This indicates the need for early identification and interventions or ASD care services from health workers of psychiatric ward.

Peer Review reports

Introduction

Acute stress disorder (ASD) is a mental disorder that commonly occur after someone experienced trauma either in the form of direct exposure or witness to the traumatic event or being confronted with events involving actual or threatened death, physical injury, or other threats to the physical integrity of the self or others. Moreover it also includes intense fear, helplessness, or horror responses with the traumatic event within short duration of time [1].

About 20–90% of the general population is exposed to one or more extreme stressful events in their life which causes fear related ASD [2, 3]. Stress diagnoses are drawing attention because of recent increases in traumatic events that occur suddenly such as traffic road accidents, violent,personal assault (like, sexual assault, and physical attack), torture, conflict, terrorism, and natural disaster which may causes Acute stress disorder (ASD). It is characterized by experiencing and avoiding reminders of the traumatic event over time and recurrent, involuntary, and intrusive distressing memories of the traumatic event and dissociative reactions that are higher in traumatic events compared to non-traumatic events [4, 5].

Among traumatic events that are commonly occurred, around 50% of adults will experience a traumatic event in their lifetime and generally prevalence of acute stress disorder among peoples who have experienced trauma ranges from 6–33% [6,7,8,9]. Between 21% and 23.6% of adults develop ASD after experiencing a traumatic event [4, 10].

Globally, a systematic review of ASD among traumatized adults showed that the world wide prevalence of ASD in < 1 week post-injury and 1–2 weeks post-injury was: 24.0–24.6% and 11.7–40.6% respectively [11].

According WHO, from 2000–2020 road traffic related deaths would increase with 80% in low and middle income nations, of 32% accounted in sub-Saharan Africa in 2015 [12, 13]. In east Africa including Ethiopia, especially in Sudan and Tanzania in 2014 and 2005 respectively indicates a significant increment of traffic events burden [14,15,16].

Trauma has numerous negative and psychological impacts on individuals who experienced actual and unexpected serious injury or death [17, 18]. It is also a leading cause of death and disability especially among young adults under 45 years of age and most of them left with serious psychological problems. Individuals who experienced trauma are not exposed only for physical injury it may be causes social, economic, occupational and psychological impact. This results in prolong hospital stay, delay recovery time, increase the cost of care and decrease productivity of the individual following serious injury and unexpected death on the survivors [18,19,20,21].

ASD is a hidden problem throughout the world, particularly in countries with a high rate of accident and traumatic event. Ethiopia has a relatively high rate of road traffic accidents when compared to other African countries. According to the Ethiopian National Road Safety Coordination Office, there are 114 road crash fatalities per 10,000 vehicles per year. As a result, early detection is mandatory for better management [22]. However to the researcher knowledge there are insufficient studies available in prevalence of ASD and associated factors in adult age group. Because of inadequate evidence towards ASD,it is difficult to diagnose or treat ASD among adults accurately, compared to other mental disorder (depression or PTSD) [1, 23]. This results in substantial distress, prolonged hospital length of stay and interferes with sleep, social, day to day activities and almost half of the individuals with ASD develop PTSD [24]. This may be because of lack of information and awareness towards ASD especially in low-income developing countries.

Adults are more vulnerable to various traumatic events nowadays, and they should receive early screening, immediate intervention, and ongoing monitoring for ASD to reduce the occurrence of PSTD and suicide. Because evidences showed that patients with ASD are twenty-four times more likely to die by suicide and have a two-fold increased risk of all-cause mortality when compared to the general population.

Understanding the problem could help local decision makers as it helps to design a comprehensive strategy to tackle the problem as early as possible. In addition, for clinicians, it might be helpful to detect and give timely management by identifying the prevalence and factors that are associated with ASD. Furthermore, because there is insufficient research in the study area, this finding provides a baseline for future research on ASD.

Therefore this study aims to assess prevalence of ASD and associated factors among Adults who experienced trauma which is an essential first step toward the plan of early management for clinicians and provides scientific evidence for policy makers, programmers and service planners to make an informed decision that could address the best interests of the patient with ASD which leading to better health and quality of life.

Methods

Study design, area and population

An institutional-based cross-sectional quantitative study design was conducted from May– June 2022.The study was carried out in Amhara Comprehensive specialized Hospitals (CSH). According to the 2007 Central Statistical Agency of Ethiopia, Amhara regional state has a total population of 17,221,976 of whom 8,641,580 are male and 8,580,396 females. The Region has eleven administrative zones. There are a total of sixty-seven public hospitals in the region of which eight; Debre Birhan, Debre Markos, Felege Hiwot, Tibebe Geon, University of Gondar, Deretabor, Woldyia and Dessie Hospitals are CSH. Each CSHs serves for 3.5–5 million people [25]. From the eight CSHs the five (Debre Markos, Felege Hiwot, Tibebe Gion, University of Gondar, and Deretabor) are found in northwest of Amhara.

All Adult trauma patients admitted to orthopedic and surgical wards was taken as a source population. All adult trauma patients admitted to orthopedics and surgical ward with trauma of three days and less than one month available during data collection was considered as a study population.

Variables of the study

The outcome variable of this study was acute stress disorder. The explanatory variables included in our study were socio-demographic factors (age, educational status, marital status, gender, occupation), clinical factors (psychiatric history, ICU admission history, prolonged hospital length of stay, co-morbidity, complications), trauma related factors (causality of family members, property loss, extremity involvement, injury type, pain, previous disaster history, disaster exposure, presence of amputation) and psychosocial support (social support) (Fig. 1).

Fig. 1
figure 1

A conceptual framework for factor association with acute stress disorder among Adult trauma patients developed from a review of different literatures [4, 26,27,28,29,30,31]; CSH-Comprehensive Specialized Hospital

Full size image

Inclusion and exclusion criteria

Inclusion criteria

  • All Adult trauma patients admitted to adult surgical and orthopedic wards due to trauma of three days and less than one month was included in the study.

Exclusion criteria

  • Individuals who have been seriously ill and are unable to respond properly to the questions, as well as those who have been diagnosed with ASD/PTSD prior to trauma with chart review, was excluded.

Sample size determination

The sample size was determined by using single population proportion formula considering the following assumptions (Cochran’s formula).

$$\text{mi}=\frac{{\left({\text{Z}}_{\text{a}/2}\right)}^{2}\text{ X P}\left(1-\text{P}\right)}{{\text{D}}^{2}}$$

Where

n = sample size required for the study

Z = standard normal distribution (z = 1.96) with confidence interval of 95% and

D = 0.05

P = the prevalence of acute stress disorder in physically traumatized adults is unknown in our country, hence = 50% (0.5)

D = absolute precision tolerable margin of error (D) = 5% = 0.05

$$n=\frac{{\left(1.96\right)}^{2} X 0.5\left(1-0.5\right)=384}{{\left(0.05\right)}^{2}}$$

Considering 10% non-response rate, nf = 384 + 38 = 422.

Sampling techniques and procedure

To select sample of 422 patients from the five referral hospitals, each hospitals was listed down with their respective number of patients, and then the number of patients per month in each hospital was proportionally allocated to sample size; and finally the study subjects of each hospital was selected by using systematic random sampling technique. Based on proportional allocation formula the total sample sizes (422) was allocated to the five public hospitals.

$$\text{nj }= \frac{\text{n XNj}}{\text{N}}$$

Where;

Nj = the sample size of the jth hospital

Nj = population size of the jth hospital

n = n1 + n2 + n3 + n4 + n5 is the total sample size (422)

N = N1 + N2 + N3 + N4 + N5 is total population size of hospitals (850)

Gondar university comprehensive specialized hospital = 422*250/850 = 124

Tibebe Geon comprehensive specialized hospital = 422*200/850 = 99

Felege Hiwot comprehensive specialized hospital = 422*200/850 = 99

D/Tabor comprehensive specialized hospital = 422*100/850 = 50

D/Markos comprehensive specialized hospital = 422*100/850 = 50 (Fig. 2).

Fig. 2
figure 2

Schematic representation of sampling procedure for prevalence and associated factors of acute stress disorder among adult patients with trauma

Full size image

Systematic random sampling technique was applied to select samples from each hospital with the K value determined as follows.

$$k=N/n=850/422=2$$

Operational definition

Trauma (physical injury) can be explained as a trauma that causes a body wound produced by sudden physical injury from Road traffic accident, Bullet/blast and Blow/assault, and Fall &Crush by a heavy object [7].

Acute stress disorder by using DSM-5 those who scored > 9 on the combined re-experiencing(intrusive), dissociative, negative mood, avoidance, and arousal cluster scores, indicates the presence of clinically significant levels of acute stress disorder [32, 33].

Social support: According to Multidimensional Scale of Perceived Social Support (MSPSS), participants with mean scale score ranging from 1 to 2.9, 3 to 5, and 5.1 to 7 was considered as having low support; moderate support; and high support, respectively [34].

Pain: Operationalized by the 0-to-10 Numerical Rating Scale (NRS) with the values on the pain scale correspond to pain levels as 1–3 = mild pain, 4–6 = moderate pain, and 7–10 = severe pain [35].

Prolonged hospital length of stay: a traumatic patient stays in the hospital for ≥ 21 days [36].

Property loss and causality of family members; Subjects were asked to self-rate the degree of loss and injury they had experienced in the accident on two 5-point scales. Loss was rated as: 1 = none; 2 = material loss (such as damage to a vehicle or loss of wages); 3 = death of someone unknown; 4 = death of someone known; 5 = death of a relative [4].

Data collection tool and procedure

A semi-structured pretested questionnaire was used to collect the data. The questionnaire which originally developed in English was translated into the local language (Amharic) by experts and translated back to English to check the consistency. The patients background variables like socio demographic characteristics (such as; age, gender, educational status, marital status and occupation), clinical factors (e.g. Depression) and social support are incorporated in the questionnaire. The questionnaire regarding the trauma related factors, clinical factors and socio demographic characteristics was adapted from different literature’s [4, 29].

Acute stress disorder was measured by using items from DSM-5 diagnostic criteria. The ASD symptom items are listed as “Yes” or “No “questions. The total value with “Yes” on the combined Intrusive, Negative Mood, Dissociative, avoidance, and arousal cluster scores indicates the presence of clinically significant levels of acute stress disorder. In sum, the DSM-5 diagnostic criteria is a valid and reliable self-report instrument for assessing DSM-5 ASD diagnosis for Adults.

Social support was measured by the Multidimensional Scale of Perceived Social Support (MSPSS). Accordingly, participants with mean scale score ranging from 1 to 2.9, 3 to 5, and 5.1 to 7 could be considered as having low support; moderate support; and high support, respectively [34].Its structure and reliability was checked by Cronbach’s alpha (ASD-0.7878, Social support-0.9191).

Data quality assurance

To maintain the quality of data, data collectors was trained for half day about techniques of interviewing and filling of the check list. In order to measure the validity of check list Pretest was conducted in Dessie comprehensive specialized hospital at April 2022, before the main data collection and which is not included in the final analysis, by taking 5% of trauma patients in a hospital which is out of the study area. The questionnaire was translated from English to Amharic by experts and back to English to assure same meaning is conveyed. Two trained Psychiatry nurses was assigned to collect data through face to face interview for each hospital and 2 Psychiatry nursing professional supervisors was made onsite supervision during data collection period and review all filled checklist during the evening of each data collection day so as to isolate incomplete and incoherent data. In each day evening all filled questionnaire was reviewed and after reviewing incomplete and incoherent questionnaires was isolated.

Data processing and analysis

Data was checked for completeness and its consistency. Then it was coded and entered into EPI-DATA version 4 and exported into a STATA version 14 for further analysis. Descriptive statistics was computed to describe the frequency, percentages, and distributions of the sample and the result was presented using tables, cross tabulations and charts. The association between dependent and independent variables was assessed by using a binary logistic regression analysis, to estimate the strength of association using Odds Ratios (OR). Multivariable logistic regression was conducted to determine independent predictors of ASD after controlling confounders. All variables associated with ASD with a p-value less than 0.2 in the bivariate logistic regression, was further analyzed using a multivariable logistic regression analyses to control potential confounding factors. Variables with a p-value less than 0.05 was declared as factors associated with ASD.

Result

Socio-demographic status of adult trauma patients in Northwest Amhara comprehensive specialized hospitals, Ethiopia, 2022

A total of (n = 422) patients with physical trauma have completed the study with a response rate of 99%. The median age of participants was 28 with age ranging from 18 to 76 years. Out of the study participants, 333 (79.47%) were males, and more than half of participants 210(50.12%) were married. About 170(40.57%) of the participants were farmers and around (32.22% %) of participants were unable to read and write (Table 1).

Table 1 Socio-demographic status of adult trauma patients in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022
Full size table

Clinical factors of adult trauma patients in Northwest Amhara comprehensive specialized hospitals, Ethiopia, 2022

Among the study participants about 47(11.22%) had previous psychiatric history in which more than half 25(52.08%) of them accounts for depression, while 148(35.32%) of the respondents had family psychiatric history. Of the participants 86(20.53%) had co-morbidity in which 20(23.26%) and 20(23.26%) were accounts for hypertension and DM respectively. About 33(7.88%) had ICU admission history (Table 2).

Table 2 Clinical factors of adult trauma patients in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022
Full size table

Trauma related factors of adult trauma patients in Northwest Amhara comprehensive specialized hospitals, Ethiopia, 2022

Among the participants, about 77 (18.38%) had disaster exposure history and more than half 52 (67.53%) was war exposure. For more than half 223 (53.22%) of the respondents, bullet/blast injury was the major cause of trauma. About 329 (78.52%) of them had experienced fracture which accounts 188 (44.87%) on their lower extremity. On the other hand, 50 (62.50%) of the participants had lower extremity amputation and about 140 (38.78%) had moderate level of pain. Among the participants who develop complication 159(37.95%), about 106 (66.25%) were accounts for infection and 201 (47.97%) of them had prolonged hospital stay (Table 3).

Table 3 Trauma related factors of adult trauma patients in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022
Full size table

Social support of adult trauma patients in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022

Out of 422 respondents more than half 236(56.32%) of them had moderate social support.

Prevalence of acute stress disorder among adult trauma patients in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022

Among 422 study participants the prevalence of ASD among adult trauma patients in Northwest Amhara comprehensive specialized hospitals was found to be 44.15% (95% CI: 39.4%, 49.0%).

Factors associated with acute stress disorder among adult trauma patients in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022

To determine the association of independent variables with ASD, bivariate and multivariable binary logistic regression analysis were carried out. In the bivariate analysis factors such as age, affected body part, complication, amputation, pain, prolonged hospital stay and social support were the factors associated with ASD which satisfies a preliminary assumptions (P < 0.2 in bivariate logistic regression) to be analyze further in multivariable analysis in order to control potential confounding factors.

Finally, after the variables that passed bivariate analysis were taken in to multivariable logistic regressions for further analysis age, complication, prolonged hospital stay and social support were the factors significantly associated with ASD at p-value < 0.05. As a result a respondents age ranging from 21–29 years 77% (AOR = 0.33 95% CI: 0.14–0.77), 30–39 years 75% (AOR = 0.35 95% CI: 0.15–0.85) and 40–49 years were 72% (AOR = 0.28 95% CI: 0.10–0.76) less likely to develop ASD compared to older age group respectively.

Likewise, the odds of presenting ASD among participants who has complication were 2.22 times more likely higher as compared to participants who didn’t have complication (AOR = 2.22 95% CI: 1.36–3.60). Moreover the likelihood of developing ASD was 1.89 times more likely higher among participants with prolonged hospital stay as compared to their counter-part (AOR = 1.89 95% CI: 1.21–2.95).

On the other way, participants who had poor and moderate social support were 3.21 and 1.99 times more likely to develop ASD when compared to participants having good social support(AOR = 3.21, 95% CI: 1.66–6.19) and (AOR = 1.99, 95%, CI: 1.14–3.48), respectively(Table 4).

Table 4 Bivariable and multivariable logistic regression of factors associated with acute stress disorder among adult trauma patients in northwest Amhara Comprehensive Specialized Hospitals, Ethiopia, 2022
Full size table

Discussion

The prevalence of ASD and associated factors among adult patients with physical trauma in Northwest Amhara comprehensive specialized hospitals were investigated in this study. As a result, it revealed that the prevalence of acute stress disorder among adult patients with physical trauma was found to be 44.15%, which implies it is still the hidden and common community concern that needs early identification and management. The finding of this study is in line with a studies conducted in united Kingdom,south Africa and Ethiopia with 40.6% [37], 40.9% [37] and 45% [38] respectively. This may be related to measurement tools used (DSM-5 criteria).

However, it is significantly lower than a study conducted in Barcelona (Spain) 66.6% [30],New Orleans 62% [39] and Australia 60% [40]. This variation might be due to the differences in instruments, the type of the accident, sample size used and religious adherence to cope from the stress. In Barcelona,Spain it may be due to difference in sample size for only 156 women exposed to a recent sexual assault, in instrument it was DSM-4 and DSM-5 criteria [30]. Similarly in West mead hospital, Australia, the difference may be related to sample size which was for only 51 motor vehicle accident participants using DSM-4 criteria [40]. On the other hand in New Orleans study the difference may be related to sampling method (convenience sampling) among 175 study participants with duration of 2 and 28 days after trauma and study setting which was community-based survey that may increase prevalence cases because of inadequate early treatment and availability of special care with health professions and it was a natural disaster related trauma (flooding) using DSM-4 criteria [39]. Beside to the trauma, in the current study for the increment of prevalence of ASD in Amhara (Ethiopia) may be related to the current crises such as war, conflicts and inadequate human right protection that increases stress.

Conversely, this study is far higher than a studies conducted in united airline(UK), New York, England, two study in China, Brazil and Netherlands that was 25.6%, 24.0%, 21%, 12.59% and 15%, 6.85%, 21.7% respectively [4, 26,27,28, 41, 42]. Similarly higher than a study done in United Kingdom, John Hopkins burn center, England, Canada with 23.6%, 19%, 14.2% (at week 2) and 3.6% respectively [29, 43,44,45] and also a study conducted in Belgium and Turkey with 14% and 5(22.7%) respectively [46, 47]. This discrepancy may be related to differences in data collection method, procedures, result scoring method, sample size, type of accident, study setting, measurement tools, socio-cultural, economic difference, poor access to psychiatric counseling, cultural behaviors and inadequate awareness towards acute stress disorder and its treatment between Ethiopia and other countries. In United Kingdom the procedure were involves those participants with road traffic accident who can understand and write English who scored > 35 on the community and in China it was clustered sampling method on disaster exposed participants using DSM-4 criteria. In New York the sample size was 307 using self-administered data collection method and in Brazil the sample size were 146. In addition the sample size in Netherland were 267and in Turk 79 participants with motor vehicle accident using DSM-4.On the other way from the rest of Ethiopian region Amhara regional state were exposed for different forms of traumatic events related to either the geographical area or conflicts in and around the region that results in physical and psychological trauma. Additionally, even though there is good social relationship and religious adherence to cope from the stress, inadequate awareness towards acute stress disorder and its treatment may be contributes for the increment of ASD in the present study.

Regarding age, being a younger age (21–29), (30–39) and (40–49) are less likely to develop ASD compared to older age group (> 50). This was contrary to the previous studies [27, 48, 49].This may be population, nature of the trauma, sample size difference and inadequate researches on older age. Moreover, the difference may be lies on stress management, this might be implies younger people are physically sound to deal with different physical or mental problems. In addition older adults have greater immunological impairment to stress than younger adults, their natural ability to fight back stress gradually decline, increment of chronic illness contracting and developing and delay in wound healing process might be contributes for the development of ASD as their age goes up [50].

In the current study, participants with prolonged hospital length of stay are more prone to develop ASD compared to the counter-part. This is consistent with the study conducted in New York [51]. This may be due to the measurement tool used which was DSM-5. Additionally, these patients represent a significant economic problem on public health systems, their families and the participant also perceive that their discharge delay because of worsening of their case which increases the risk of ASD development.

Likewise participants with complications are significantly associated with ASD than those without complications since it affects them in economy, delays wound healing process and reduce their quality of life which contributes for the outcome occurrence.

Moreover, participants who had low and moderate social support experienced ASD than participants who have high social support. This was affirmed with a study conducted in Denmark and in Ethiopia [38, 52]. This might be related to sample size, instrument such as in Ethiopia it was done among 422 participants using DSM-5 criteria. Moreover even though there is good social relationship and religious adherence to cope from the stress, it might be related to inadequate awareness towards acute stress disorder and its treatment. Likewise those participants with lack of help to compensate for physical incapacity, emotional support and someone to reassure them are might be less likely to cope from trauma related stress which contributes for the development of ASD.

Conclusion and Recommendation

This study showed that the prevalence of acute stress disorder among the adult study participants who experienced traumatic events was high as compared to other literatures. Age, complication, prolonged hospital stay and social support were the factors significantly associated with ASD at p-value < 0.05. The study findings indicated the need for early identification and interventions or ASD care services from health workers of psychiatric ward. Efforts should focus on improving patients' perceptions about waiting in the surgical and orthopedic wards to get adequate care in coordination with psychiatric department. A feasible approach to provide emotional and social support for those who are experiencing prolonged hospital stays.

Availability of data and materials

All relevant data are available within the manuscript.

Abbreviations

AOR:

Adjusted Odds Ratio

ASD:

Acute Stress Disorder

CI:

Confidence Interval

COR:

Crude Odds Ratio

CSH:

Comprehensive Specialized Hospital

DSM:

Diagnostic and Statistical Manual of Mental Disorder

ETB:

Ethiopian Birr

ICU:

Intensive Care Unit

MSPSS:

Multidimensional Scale of Perceived Social Support

OR:

Odds Ratio

PTSD:

Post-Traumatic Stress Disorder

WHO:

World Health Organization

References

  1. Kassam-Adams N, Winston FK. Predicting child PTSD: the relationship between acute stress disorder and PTSD in injured children. J Am Acad Child Adolesc Psychiatry. 2004;43(4):403–11.

    Article  PubMed  Google Scholar 

  2. Perrin M, Vandeleur CL, Castelao E, Rothen S, Glaus J, Vollenweider P, et al. Determinants of the development of post-traumatic stress disorder, in the general population. Soc Psychiatry Psychiatr Epidemiol. 2014;49(3):447–57.

    Article  PubMed  Google Scholar 

  3. Johnson LR, McGuire J, Lazarus R, Palmer AA. Pavlovian fear memory circuits and phenotype models of PTSD. Neuropharmacology. 2012;62(2):638–46.

    Article  CAS  PubMed  Google Scholar 

  4. Holeva V, Tarrier N, Wells A. Prevalence and predictors of acute stress disorder and PTSD following road traffic accidents: Thought control strategies and social support. Behav Ther. 2001;32(1):65–83.

    Article  Google Scholar 

  5. Gradus JL. Prevalence and prognosis of stress disorders: a review of the epidemiologic literature. Clin Epidemiol. 2017;9:251–60.

    Article  PubMed  PubMed Central  Google Scholar 

  6. B R. Acute stress disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, and diagnosis. 2022.

  7. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–60.

    Article  CAS  PubMed  Google Scholar 

  8. Juel K, Sørensen J, Brønnum-Hansen H. Risk factors and public health in Denmark: summary report: Syddansk Universitet. Statens Institut for Folkesundhed; 2007.

  9. Schütt NM, Frederiksen ML, Helweg-Larsen K. Dating violence in Denmark. English Summary A nation wide survey of prevalence, character and consequences of exposure to violence among. 2008:16–24.

  10. Bryant RA, Harvey AG. Gender differences in the relationship between acute stress disorder and posttraumatic stress disorder following motor vehicle accidents. Aust N Z J Psychiatry. 2003;37(2):226–9.

    Article  PubMed  Google Scholar 

  11. Ophuis RH, Olij BF, Polinder S, Haagsma JA. Prevalence of post-traumatic stress disorder, acute stress disorder and depression following violence related injury treated at the emergency department: a systematic review. BMC Psychiatry. 2018;18(1):311.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Peden M, Scurfield R, Sleet D, Mathers C, Jarawan E, Hyder A, et al. World report on road traffic injury prevention. Jeneva: World Health Organization; 2004.

  13. Bashah DT, Dachew BA, Tiruneh BT. Prevalence of injury and associated factors among patients visiting the Emergency Departments of Amhara Regional State Referral Hospitals, Ethiopia: a cross-sectional study. BMC Emerg Med. 2015;15(1):1–7.

    Article  Google Scholar 

  14. Moshiro C, Heuch I, Åstrøm AN, Setel P, Hemed Y, Kvåle G. Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey. BMC Public Health. 2005;5(1):1–10.

    Article  Google Scholar 

  15. Tayeb SE, Abdalla S, Mørkve O, Heuch I, Van den Bergh G. Injuries in Khartoum state, the Sudan: a household survey of incidence and risk factors. Int J Inj Contr Saf Promot. 2014;21(2):144–53.

    Article  PubMed  Google Scholar 

  16. Tsegaye F, Abdella K, Ahmed E, Tadesse T, Bartolomeos K. Pattern of fatal injuries in Addis Ababa, Ethiopia: a one-year audit. East Central Afr J Surg. 2010;15(2):10–7.

    Google Scholar 

  17. Rapsang AG, Shyam DC. Scoring systems of severity in patients with multiple trauma. Cirugía Española (English Edition). 2015;93(4):213–21.

    Article  Google Scholar 

  18. Karakaya I, Çolak B. Çocuk ve ergenlerde travma sonrası stres bozukluğu ve adli tıbbi değerlendirme. Adli Tıp Bülteni. 2007;12(2):82–7.

    Google Scholar 

  19. Bryant RA, Harvey AG. The influence of traumatic brain injury on acute stress disorder and post-traumatic stress disorder following motor vehicle accidents. Brain Inj. 1999;13(1):15–22.

    Article  CAS  PubMed  Google Scholar 

  20. Frommberger UH, Stieglitz R-D, Nyberg E, Schlickewei W, Kuner E, Berger M. Prediction of posttraumatic stress disorder by immediate reactions to trauma: a prospective study in road traffic accident victims. Eur Arch Psychiatry Clin Neurosci. 1998;248(6):316–21.

    Article  CAS  PubMed  Google Scholar 

  21. Tsay SL, Halstead MT, McCrone S. Predictors of coping efficacy, negative moods and post-traumatic stress syndrome following major trauma. Int J Nurs Pract. 2001;7(2):74–83.

    Article  CAS  PubMed  Google Scholar 

  22. Hailemichael F, Suleiman M, Pauolos W. Magnitude and outcomes of road traffic accidents at Hospitals in Wolaita Zone, SNNPR, Ethiopia. BMC Res Notes. 2015;8(1):1–5.

    Article  Google Scholar 

  23. Fanai M, Khan MAB. Acute Stress Disorder. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2021, StatPearls Publishing LLC; 2021.

    Google Scholar 

  24. Bryant RA, Friedman MJ, Spiegel D, Ursano R, Strain J. A review of acute stress disorder in DSM-5. Depress Anxiety. 2011;28(9):802–17.

    Article  PubMed  Google Scholar 

  25. Alebachew A, Waddington C. Improving health system efficiency: Ethiopia: human resources for health reforms. Ethiopia: World Health Organization; 2015.

  26. Zhao G, Wang YG, Wang Y, Fu S-F, Cao R, Ma N, et al. Prevalence and predictors of acute stress disorder after earthquake: findings from Wenchuan earthquake in China. Zhonghua yu Fang yi xue za zhi [Chinese Journal of Preventive Medicine]. 2008;42(11):802–5.

    PubMed  Google Scholar 

  27. Fullerton CS, Ursano RJ, Wang L. Acute stress disorder, posttraumatic stress disorder, and depression in disaster or rescue workers. Am J Psychiatry. 2004;161(8):1370–6.

    Article  PubMed  Google Scholar 

  28. Nosanov LB, Prindeze NJ, Schneider DM, Clemente LE, Parrish KR, Travis TE, et al. Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury. Am J Surg. 2022;223(1):151–6.

  29. Roberge M-A, Dupuis G, Marchand A. Acute stress disorder after myocardial infarction: prevalence and associated factors. Psychosom Med. 2008;70(9):1028–34.

    Article  CAS  PubMed  Google Scholar 

  30. Garcia-Esteve L, Torres-Gimenez A, Canto M, Roca A, Roda E, Velasco E, et al. Prevalence and risk factors for acute stress disorder in female victims of sexual assault. Psychiatry Res. 2021;306:114240.

    Article  PubMed  Google Scholar 

  31. Tamayo-Gómez A, Velásquez-Suárez J, Páramo-Duque L, Ortiz-Carmona D, Escobar-Gómez L, Cortés-López V, et al. Epidemiology and factors associated with acute stress disorder in burned patients: a case-control study. Burns. 2021.

  32. Bryant RA. Acute stress disorder: What it is and how to treat it: Guilford Publications; 2016.

  33. Bryant RA. The current evidence for acute stress disorder. Curr Psychiatry Rep. 2018;20(12):1–8.

    Article  Google Scholar 

  34. Bruwer B, Emsley R, Kidd M, Lochner C. Seedat SJCp Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth. Compr Psychiatry. 2008;49(2):195–201.

    Article  PubMed  Google Scholar 

  35. Castarlenas E, Jensen MP, von Baeyer CL, Miró J. Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents. Clin J Pain. 2017;33(4):376–83.

    Article  PubMed  Google Scholar 

  36. Toh HJ, Lim ZY, Yap P, Tang T. Factors associated with prolonged length of stay in older patients. Singapore Med J. 2017;58(3):134–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Ophuis RH, Olij BF, Polinder S, Haagsma JA. Prevalence of post-traumatic stress disorder, acute stress disorder and depression following violence related injury treated at the emergency department: a systematic review. BMC Psychiatry. 2018;18(1):1–9.

    Article  Google Scholar 

  38. Worku A, Tesfaw G, Getnet B. Acute stress disorder and the associated factors among traumatized patients admitted at Felege-Hiwot and the University of Gondar comprehensive specialized hospitals in Northwest Ethiopia. BMC Psychiatry. 2022;22(1):1–12.

    Article  Google Scholar 

  39. Mills MA, Edmondson D, Park CL. Trauma and stress response among Hurricane Katrina evacuees. Am J Public Health. 2007;97(Supplement_1):S116–23.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bryant RA, Panasetis P. Panic symptoms during trauma and acute stress disorder. Behav Res Ther. 2001;39(8):961–6.

    Article  CAS  PubMed  Google Scholar 

  41. Santana MRM, Zatti C, Spader ML, Malgarim BG, Salle E, Piltcher R, et al. Acute stress disorder and defense mechanisms: a study of physical trauma patients admitted to an emergency hospital. Trends Psychiatry Psychother. 2017;39(4):247–56.

    Article  PubMed  Google Scholar 

  42. Visser E, Den Oudsten BL. Psychological risk factors that characterize acute stress disorder and trajectories of posttraumatic stress disorder after injury: a study using latent class analysis. 2022;13(1):2006502

  43. Meiser-Stedman R, McKinnon A, Dixon C, Boyle A, Smith P, Dalgleish T. Acute stress disorder and the transition to posttraumatic stress disorder in children and adolescents: prevalence, course, prognosis, diagnostic suitability, and risk markers. Depress Anxiety. 2017;34(4):348–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Brewin CR, Andrews B, Rose S, Kirk M. Acute stress disorder and posttraumatic stress disorder in victims of violent crime. Am J Psychiatry. 1999;156(3):360–6.

    Article  CAS  PubMed  Google Scholar 

  45. McKibben JB, Bresnick MG, Wiechman Askay SA, Fauerbach JA. Acute stress disorder and posttraumatic stress disorder: a prospective study of prevalence, course, and predictors in a sample with major burn injuries. J Burn Care Res. 2008;29(1):22–35.

    Article  PubMed  Google Scholar 

  46. Harvey AG, Bryant RA. Two-year prospective evaluation of the relationship between acute stress disorder and posttraumatic stress disorder following mild traumatic brain injury. Am J Psychiatry. 2000;157(4):626–8.

    Article  CAS  PubMed  Google Scholar 

  47. Copuroglu C, Ozcan M, Yilmaz B, Gorgulu Y, Abay E, Yalniz E. Acute stress disorder and post-traumatic stress disorder following traumatic amputation. Acta Orthop Belg. 2010;76(1):90–3.

    PubMed  Google Scholar 

  48. Visser E, Gosens T, Den Oudsten BL, De Vries J. The course, prediction, and treatment of acute and posttraumatic stress in trauma patients: a systematic review. J Trauma Acute Care Surg. 2017;82(6):1158–83.

    Article  PubMed  Google Scholar 

  49. Kim SY, Yang K. Incidence and direct medical cost of acute stress disorder and post-traumatic stress disorder in Korea: Based on National Health Insurance Service Claims Data from. J Korean Med Sci. 2021;36(18):e125.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Graham JE, Christian LM, Kiecolt-Glaser JK. Stress, age, and immune function: toward a lifespan approach. J Behav Med. 2006;29(4):389–400.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Nosanov LB, Prindeze NJ, Schneider DM, Clemente LE, Parrish KR, Travis TE, et al. Prevalence and risk factors for acute stress disorder and posttraumatic stress disorder after burn injury. Am J Surg. 2022;223(1):151–6.

    Article  PubMed  Google Scholar 

  52. Cook JD, Bickman L. Social support and psychological symptomatology following a natural disaster. J Trauma Stress. 1990;3(4):541–56.

    Article  Google Scholar 

Download references

Acknowledgements

The authors appreciate the data collectors and study participants; moreover, our gratitude also goes to all selected comprehensive specialized hospital health care workers for giving us the information that we need to conduct this study.

Funding

University of Gondar.

Author information

Authors and Affiliations

  1. Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Tewodros Guay Hagos, Belayneh Shetie Workneh & Nega Nigussie Abrha

  2. Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Tadesse Tarik Tamir

  3. Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Negesu Gizaw Demissie

  4. Department of Psychiatry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

    Daniel Ayelegne Gebeyehu

Authors
  1. Tewodros Guay Hagos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tadesse Tarik Tamir
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Belayneh Shetie Workneh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nega Nigussie Abrha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Negesu Gizaw Demissie
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Ayelegne Gebeyehu
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

TG conceived the idea and wrote the proposal, analyze data, and draft the paper. All the authors approved the proposal with some revisions, participated in data analysis, review and approval of the final draft of the manuscript.

Corresponding author

Correspondence to Tewodros Guay Hagos.

Ethics declarations

Ethics approval and consent to participate

Ethical clearance was obtained from research and ethical committee of school of nursing college of medicine and health science on behalf of research and ethical review board committee of University of Gondar and written permission letter was obtained from hospital managers. Informed consent was obtained from study participants before the beginning of data collection. Confidentiality was kept by using codes rather than stating their names. Initially, they were informed about their right to withdraw from the study at any time of the interview process. When they were informed about their right to withdraw they agreed to leave the study whenever they are not feeling comfortable. For illiterate participants of the study informed consent was obtained from a parent and/or legal guardian. At the end of the interview, patients positive for ASD symptoms were linked to the psychiatry clinic. All methods of our study were performed in accordance with the relevant guidelines and regulation.

Consent to publish

Not applicable.

Competing interests

The authors have declared that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hagos, T.G., Tamir, T.T., Workneh, B.S. et al. Acute stress disorder and associated factors among adult trauma patients in Ethiopia: a multi-institutional study. BMC Psychiatry 24, 418 (2024). https://doi.org/10.1186/s12888-024-05861-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12888-024-05861-6

Keywords

BMC Psychiatry

ISSN: 1471-244X

Contact us