PhD Final Report – Emmylou Rahtz

Congratulations to Emmylou who submitted and successfully defended her PhD thesis in May 2015

The trauma of trauma: a prospective study of psychological distress following physical injury

Emmylou Rahtz

Thesis submitted in partial fulfilment of the requirements of the Degree of Doctor of Philosophy
May 2015

Centre for Psychiatry
Wolfson Institute of Preventive Medicine
Barts and The London School of Medicine and Dentistry
Queen Mary University of London

Supervised by Professor Ania Korszun, with Professor Kamaldeep Bhui and Professor Iain Hutchison (Clinical Supervisor)
This PhD was supported by Saving Faces, the Facial Surgery Research Foundation.


People who experience physical trauma face a range of psychosocial outcomes. These may be overlooked by busy clinicians. While some risk factors are understood, our understanding of the psychological effects of violent injury remains limited. Furthermore, there has been little research on the effect of facial trauma. Although changes to appearance can be distressing, the effects of these have not been studied in traumatic injury patients.


To establish the prevalence and persistence of psychological distress and appearance concerns following injury. To compare the psychological outcomes in i) violent and accidental injury and ii) facial and other injury, and iii) to identify explanatory risk factors for psychological distress.


Participants were adults admitted to the Royal London Hospital and being treated for major trauma or oral and maxillofacial trauma. Two hundred and twenty five participants (225) completed baseline questionnaires in hospital. Follow up was at three months (N = 100) and six months (N = 112). Standardised measures were used to assess symptoms of post-traumatic stress (PTSS) (Acute Stress Disorder Scale, PTSD Checklist), depression and anxiety (Hospital Anxiety and Depression Scale), and appearance concern (Derriford Appearance Scale). Explanatory measures were collected, including history of mental health. Data were analysed in logistic and linear regressions, using multilevel models.


PTSS and depressive symptoms affected between a quarter and a third of participants at baseline and at six months. After adjusting for demographic factors, violent injury significantly increased the odds of PTSS, depressive symptoms and appearance concern. A history of mental health problems was associated with increased distress.


There were high levels of psychological distress in this sample. Violent injury was associated with a complex interaction of social and psychological factors. People vulnerable to distress may benefit from psychological support. Hospital admission provides a unique opportunity to engage them in interventions.

Next steps:

After submitting her thesis, Emmylou passed her viva in June 2015 with no corrections. She is now writing further journal articles on the findings from her PhD. Emmylou is currently working at the European Centre for Environment and Human Health at the University of Exeter Medical School. Her research continues to explore the interactions between physical and mental health, and the effect of social and physical environments on health.