Dr. David B. Adams – Psychological Blog

Psychology of Illness, Pain, Anxiety and Depression

Injury and Personality Disorders

If your goal needs to be to insure that depression does not interfere with the course of care for the physical injury. For that, you cannot wait.

Depression after serious (and that’s the key word – “serious”) injury is to be expected. It follows a specific path, but that path is not a direct one:

1. The individual is injured, and with few exceptions, the person anticipates immediate and brief treatment.

2. When the nature of the injury does not permit immediate recovery, the individual passively follows the course of care.

3. After a period of several months, when it becomes clear that treatment will span several more months, the patient may become agitated and irritable.

4. If that course of care then leads to multiple therapies, multiple providers and a life scheduled around appointments and medications, a sense of futility and helplessness is often seen.

5. The first annual anniversary of the injury creates a sense of alarm, and the patient feels a sense of despair if not hopelessness, and depression becomes evident.

**This is when a patient should be referred for psychological evaluation**

6. Now irritable, forgetful, often gaining (or losing) substantial weight, sleeping poorly and unable to concentrate, remember or make important decisions, the patient becomes housebound, withdrawn and alienated from family and friends.

**If the patient is not referred at this stage, numerous and substantial problems arise, compliance with care suffers, and there is now a decreased probability of returning to any employment within objective physical limitations**

7. This path will spiral downward if not interrupted, and the case may span years without resolution

8. If care is initiated at the point of early detection of depression, the patient becomes more compliant and begins to make viable future plans…even if such plans involve the acceptance that some complaints will be chronic and a return to work (or to the pre-injury type of work) may no longer be feasible.

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