A conceptual exploration of psychological distress following mild to moderate traumatic upper limb injuries

Psychological distress following severe traumatic hand injuries is common and has a significant influence on enduring disability and pain. In many studies, this distress is measured as symptoms of anxiety disorders such as post-traumatic stress disorder and generalized anxiety disorder. However, the portrayal of psychological distress as a compilation of symptoms of anxiety disorders may not adequately describe the psychological distress experienced by those with less severe injuries. In this thesis, I explore the concept of psychological distress following mild to moderate traumatic upper limb injuries. The research presented in this thesis utilised a mixed methods approach. Study I involved the investigation of three forms of recovery-related anxiety (pain anxiety, state anxiety, and post-injury anxiety) and one form of general anxiety (trait anxiety) in 84 individuals following mild to moderate traumatic upper limb injuries. Recovery-related anxiety was common in this sample. In a multivariate regression model, the four predictor variables (pain anxiety, state anxiety, trait anxiety and post-injury anxiety) accounted for 29% of the between-person variability in disability; however, post-injury anxiety was the only significant independent predictor of disability (19%). Correlational analysis revealed that post-injury anxiety was distinguishable from the other forms of anxiety measured in Study I, and that it most closely resembled the concept of psychological distress in health literature. Studies II and III, therefore, focused on the exploration and development of psychological distress following traumatic upper limb injuries as an independent concept. Study II, an Evolutionary Concept Analysis, explored the portrayal of psychological distress following traumatic upper limb injuries as a concept in its own right within the traumatic upper limb literature. A working definition of psychological distress as a non-pathological emotional reaction to injury was developed and characteristics, related concepts, antecedents, and consequences were defined. Although frequently found in the literature related to traumatic upper limb injuries, psychological distress was rarely used as an independent concept, serving instead as a categorical label to encompass a wide variety of related concepts. In order to be useful as an independent concept in this context, psychological distress requires further development. Initial steps toward this conceptual development were undertaken in Study III. Using semi-structured interviews, the experience of psychological distress following traumatic upper limb injuries was explored with 11 individuals who had recently sustained mild to moderate upper limb injuries. Thematic analysis found that the four sources of psychological distress were: 1) uncertainty about issues such as future function, 2) disruption to daily life and roles, 3) questions relating to legitimacy, and 4) impact on identity. Taken together, the results of the three studies suggested that the prevalence of context-specific psychological distress following traumatic upper limb injuries was high. In addition, this form of psychological distress may be considered a concept distinct from those of general or recovery-related anxiety. Approaching psychological distress as an independent, context-dependent concept may provide insight into the psychological experience of patients following mild to moderate traumatic upper limb injuries that is not made apparent by measuring isolated symptoms of anxiety disorders