kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2016.16.1.67 kjhp-16-67 Original Article Post Traumatic Stress and Related Factors in Some Hand Replantation Patients LeeSan-Hui 1 2 HanMi Ah 3 ParkJong 3 RyuSo Yeon 3 Department of Public Health, Graduate School of Chosun University, Gwangju, Korea Department of Nursing, Gwangju Daejung Hospital, Gwangju, Korea Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea Corresponding author: Mi Ah Han, MD, PhD Department of Preventive Medicine, College of Medicine, Chosun University, 309 Pilmun-daero, Dong-gu, Gwangju 61452, Korea Tel: +82-62-230-6481, Fax: +82-62-225-8293 E-mail: mahan@chosun.ac.kr 01 2016 20 01 2016 16 1 67 75 31082015 06112015 Copyright © 2016 The Korean Society of Health Promotion and Disease Prevention 2016 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background

The risk for a hand injury was increased according to industrial structure and lifestyle change. This study investigated the post traumatic stress (PTS) and related factors in some hand replantation patients.

 Methods

Total 150 hand replantation patients in one hospital were selected using convenience sampling methods. General characteristics of patients, characteristics of injured hand, self-esteem and PTS were collected using self-reported questionnaires. And clinical characteristics of injured hand were obtained from a review of medical records. Descriptive analysis, t-test, ANOVA and multiple regression analysis were performed to determine the associated factors with the score of PTS.

 Results

Among 150 patients, 80% were male and 94% had a job. The mean score of PTS was 22.2±16.9. In simple analysis, PTS score were associated with smoking status, injury day of the week, pain score and self-esteem. Finally, the subjects who injured in weekdays had significantly higher PTS score compared to subjects who injured in weekend (β＝0.185, P＝0.021) and pain score was positively associated with PTS score (β ＝0.181, P＝0.027) in multiple regression analysis.

 Conclusions

Injury day of the week and pain score were associated with PTS score in some hand replantation patients. Considering these results will help to management and improve quality of life of hand replantation patients.

 Amputation Hand injuries Risk factors Stress disorders post-traumatic References Rhee KY Choe SW Kim YS Koo KH The trend of occupational injuries in Korea from 2001 to 2010 Saf Health Work 20134 1 6370 Kim MS Yoon SY So H Changes in pain, mood and post trauma risk level of patients with acute hand microsurgery Korean J Rehabil Nurs 201013 1 4452 Korea Centers for Disease Control and Prevention Korean national hospital discharge in-depth injury survey Osong Korea Centers for Disease Control and Prevention 2012 Hwang MG Kim EJ The effect of subjective quality of life and self-esteem on suicide ideation among the older adults: focused on the mediating effect of depression J Korean Geriatr Soc 200828 4 86585 Ha BY Jung EJ Choi SY Effects of resilience, posttraumatic stress disorder on the quality of life in patients with breast cancer Korean J Women Health Nurs 201420 1 8391 Joo HS A study on the development of a post trauma risk checklist [dissertation] Seoul Ewha Women's University 2008 Korean. Vieweg WV Julius DA Fernandez A Beatty-Brooks M Hettema JM Pandurangi AK Posttraumatic stress disorder: clinical features, pathophysiology, and treatment Am J Med 2006119 5 38390 Kessler RC Sonnega A Bromet E Hughes M Nelson CB Posttraumatic stress disorder in the national comorbidity survey Arch Gen Psychiatry 199552 12 104860 Kwon SC Song J Lee SJ Kim I Koh J Ryou H Kim SH Kim D Posttraumatic stress symptoms and related factors in fire fighters of a firestation Korean J Occup Environ Med 200820 3 193204 Sin SW Levels and countermeasures of PTSD among police officers J Korea Cont Assoc 201111 12 26672 Yoon SC Ham BJ Byun JH Eun HJ Son HG Suh KH Temperament and charcater dimensions of posttraumatic stress disorder in burn patients Korean J Biol Psychiatry 200512 2 15964 Jang SY Jeong HY Go SS A study for cost of road traffic accident taken offender's PTSD in consideration J Korean Soc Transp 201028 5 1729 Yun UC The effect of the stress management program on the stress coping and perceived stress of the patients with finger replantation [dissertation] Jinju Geyong-Sang University 2004 Korean. Lee JY The effect of information offer on compliance with a therapeutic regimen for the patients with hand and arm microsurgery [dissertation] Busan Busan Catholic University 2005 Korean. Yamano Y Replantation of the amputated distal part of the fingers J hand Surg Am 198510 2 2118 Rogenberg M Society and adolescent self-image Princeton Princeton University Press 1965 Jeon BJ Self-esteem: a test of its measurability Yonsei Nonchong 197411 1 10730 Eun HJ Kwon TW Lee SM Kim TH Choi MR Cho SJ A study on reliability and validity of the Korean version of impact of event scale-revised J Korean Neurol Assoc 200544 3 30310 Lee YJ Yun KW Woo HW Kim YC Lim WJ Posttraumatic stress disorder prevalence, symptoms, depressed mood and anxiety according to the presence of consciousness at the time of traumatic accident J Korean Neuropsychiatr Assoc 200241 4 6609 Choi KS Lim CK Choi JW Kang SK Yum YT Posttraumatic stress disorder among occupational accident patients J Korean Neuropsychiatr Assoc 200241 3 46171 Van Loey NE Maas CJ Faber AW Taal LA Predictors of chronic posttraumatic stress symptoms following burn injury: results of a longitudinal study J Trauma Stress 200316 4 3619 Welch AE Jasek JP Caramanica K Chiles MC Johns M Cigarette smoking and 9/11-related post traumatic stress disorder among World Trade Center Health Registry enrollees, 2003–12 Prev Med 201573 4 949 Langdon KJ Leventhal AM Posttraumatic stress symptoms and tobacco abstinence effects in a nonclinical sample: evaluating the mediating role of negative affect reduction smoking expectancies J Psychopharmacol 201428 11 100917 Lee BY Jo HS Kwon MS Survey on quality of life, mental health and subjective health status of community dwelling cancer patients J Korean Public Health Nurs 201024 1 4960 Joo AR A study on the relationship between family stress and health promoting behavior of the dual earner couples Korean J Occup Health Nurs 201120 2 2219 Rusch MD Dzwierzynski WW Sanger JR Pruit NT Siewert AD Return to work outcomes after work-related hand trauma: the role of causal attributions J Hand Surg 200328 4 6737 Opsteegh L Reinders-Messelink HA Groothoff JW Postema K Dijkstra PU van der Sluis CK Symptoms of acute posttraumatic stress disorder in patients with acute hand injuries J Hand Surg 201035 6 9617 Rho IS Won JS The relations of depression, anxiety, posttraumatic stress, self-esteem, and social adjustment among North Korean refugees J Korean Acad Psychiatr Ment Health Nurs 200918 1 6977 Park CH Lee S Kim NH The impact of posttraumatic stress disorder on clinical outcomes in patients with schizophrenia J Korean Neuropsychiatr Assoc 201251 5 24954 S Tables

General characteristics of study subjects (N＝150)

Variable Categories N %
Age, y 20–44 57 38.0
  45–64 81 54.0
  ≥ 65 12 8.0
Gender Male 120 80.0
  Female 30 20.0
Marital status Married 122 81.3
  Unmarried 28 18.7
Education level ≤ Middle school 28 18.7
  High school 77 51.3
  ≥ College 45 30.0
Religion Yes 79 52.7
  No 71 47.3
Job Yes 141 94.0
  No 9 6.0
Hobby Yes 84 56.0
  No 66 44.0
Income, ten thousand won ＜200 34 22.7
  200–399 59 39.3
  ≥ 400 57 38.0
Smoking status Current 23 15.3
  Former 22 14.7
  Never 105 70.0
Drinking frequency None 29 19.3
  1/month 26 17.3
  2–4/month 29 19.3
  2–3/week 45 30.0
  ≥ 4/week 21 14.0
Self-rated health Good 82 54.6
  Fair 55 36.7
  Poor 13 8.7

Characteristics of injured hand

Variable Categories Value
Past experience of hand injury Yes 37 (24.7)
  No 113 (75.3)
Location of injured hand Left 71 (47.3)
  Right 79 (52.7)
Injury day of the week Weekdays 120 (80.0)
  Weekend 30 (20.0)
Injured time zone Night 18 (12.0)
  Morning 54 (36.0)
  Afternoon 78 (52.0)
Places of occurrence Work place 114 (76.0)
  House 26 (17.3)
  Others 10 (6.7)
Type of occurrence Industrial accidents 94 (62.7)
  Others 56 (37.3)
Cause of occurrence Machinery 122 (81.3)
  Others 28 (18.7)
Type of amputation Total 74 (49.3)
  Subtotal 76 (50.7)
The number of injured finger ＜3 134 (89.3)
  ≥ 4 16 (10.7)
Injured fingera Thumb 47 (31.3)
  Index 72 (48.0)
  3rd finger 68 (45.3)
  4th finger 55 (36.7)
  5th finger 31 (20.7)
Injured finger area Zone I 20 (13.3)
  Zone II 79 (52.6)
  Zone III 31 (20.7)
  Zone IV 20 (13.3)
Pain   33.2±33.20
Functional satisfaction   68.8±19.48
Shape satisfaction   60.7±20.63

Values are presented as n (%) or mean ± standard deviation.

Multiple response.

Self-esteem and post-traumatic stress

  Value
Self-esteem 38.49±4.62
Post-traumatic stress 22.2±16.9
PTSD  
Non PTSD (≤ 24) 99 (66.0)
PTSD (≥ 25) 51 (34.0)

Abbreviation: PTSD, post-traumatic stress disorder. Values are presented as mean ± standard deviation or n (%).

Post-traumatic stress score according to general characteristics

Variable　 Categories　 PTS t/F (P)
Age, y 20–44 21.10±17.90 0.564 (0.570)
  45–64 22.33±16.68  
  ≥ 65 26.83±15.02  
Gender Male 21.08±16.44 –1.658 (0.099)
  Female 26.08±18.60  
Marital status Married 23.09±17.10 1.315 (0.191)
  Unmarried 18.42±16.24  
Education level ≤ Middle school 20.53±17.38 0.202 (0.817)
  High school 22.92±17.39  
  ≥ College 22.08±16.33  
Religion Yes 22.22±16.11 0.001 (0.999)
  No 22.22±18.02  
Job Yes 22.63±17.31 2.023 (0.066)
  No 15.88± 8.99  
Hobby Yes 20.10±15.85 –1.735 (0.085)
  No 24.92±18.09  
Income, ten thousand won ＜200 25.29±16.00 2.116 (0.124)
  200–399 18.76±16.16  
  ≥ 400 23.98±18.02  
Smoking status Current 16.56±16.54 3.361 (0.037)
  Former 17.09±13.27  
  Never 24.54±17.37  
Drinking frequency None 24.06±16.11 0.944 (0.440)
  1/month 21.23±15.04  
  2–4/month 20.68±17.01  
  2–3/week 25.00±18.88  
  ≥ 4/month 17.09±16.11  
Self-rated health Good 20.92±16.09 2.001 (0.139)
  Fair 22.09±17.71  
  Poor 31.00±18.10  

Abbreviation: PTS, post-traumatic stress. Values are expressed as mean ± standard deviation.

Post-traumatic stress s core according to characteristics of injured hand

Variable　 Categories　 PTS t/F (P)
Past experience of hand injury Yes 22.67±15.54 0.185 (0.854)
  No 22.07±17.50  
Location of injured hand Left 22.61±18.37 0.268 (0.789)
  Right 21.87±15.75  
Injury day of the week Weekdays 24.09±17.61 3.474 (0.001)　
  Weekend 14.76±11.77  
Injured time zone Night 20.92±16.09 2.001 (0.139)
  Morning 22.09±17.71  
  Afternoon 31.00±18.10  
Places of occurrence Work place 23.32±17.32 1.190 (0.307)
  House 17.65±14.71  
  Others 21.06±18.19  
Type of occurrence Industrial accidents 22.88±17.62 0.612 (0.542)
  Others 21.12±15.95  
Cause of occurrence Machinery 21.27±17.38 0.764 (0.516)
  Others 26.39±14.72  
Type of amputation Total 21.83±17.52 –0.276 (0.783)
  Subtotal 22.60±16.56  
The number of injured finger ≤ 3 21.79±16.87 –0.893 (0.374)
  ≥ 4 25.81±18.08  
Injured finger      
Thumb No 21.16±17.01 –1.134 (0.259)
  Yes 24.55±16.88  
Index No 24.24±18.14 1.530 (0.128)
  Yes 20.04±15.46  
3rd finger No 23.30±17.68 0.853 (0.395)
  Yes 20.92±16.14  
4th finger No 21.09±16.92 –1.073 (0.285)
  Yes 24.18±17.07  
5th finger No 21.47±16.42 –1.068 (0.287)
  Yes 25.12±19.02  
Injured finger area Zone I 23.80±11.61 0.229 (0.876)
  Zone II 21.13±17.45  
  Zone III 23.25±18.26  
  Zone IV 23.35±18.45  

Abbreviation: PTS, post-traumatic stress. Values are expressed as mean ± standard deviation.

Correlation between pain, satisfaction, self esteem and PTS

  PTS
Pain 0.225 (0.006)
Functional satisfaction –0.001 (0.988)
Shape satisfaction –0.129 (0.115)
Self esteem –0.165 (0.043)

Abbreviation: PTS, post-traumatic stress. Values are expressed as correlation coefficients (P-value).

Factors associated with post-traumatic stress score

Characteristics ß SE P-value
Gender (/male)      
Female 0.123 1.500 0.136
Job (/no)      
Yes 0.087 1.090 0.278
Hobby (/yes)      
No 0.134 1.688 0.094
Smoking status (/current smoker)      
Ex-smoker 0.063 0.617 0.538
Nonsmoker 0.136 1.322 0.188
Injury day of the week (/weekend)      
Weekdays 0.185 2.338 0.021
Pain score 0.181 2.236 0.027
Self-esteem –0.114 –1.421 0.158

F＝3.477 (P＝0.001), R

＝16.5%.