“The risk factors for PTSD can be broadly classified as pre-trauma, peritrauma, and posttrauma factors.”
1. Could you briefly introduce yourself and your professional journey in medicine? What inspired you to pursue your current field of practice?
I am Dr. Lakshmipriya, hailing from a small village called Kadalundi in Kozhikode district, Kerala. Ever since childhood I wanted to become a doctor. Looking back, I still cannot point to a specific reason for that. It was simply something I always felt strongly about. I completed my MBBS from Manjeri Medical College. Even during my school days, I used to think a lot about the thought processes of the people around me. Sometimes I would wonder about the lives and thoughts of people I saw while passing by in a bus. This curiosity about people stayed with me through the years. When I entered clinical postings during my MBBS, I was fascinated by many specialties, but psychiatry felt different. It is a field where things are not always clearly defined with specific signs, symptoms, and demarcations. Much of it lies in a grey zone. I found that both tricky and challenging, and that is what drew me towards it. That was when I realized I wanted to pursue psychiatry. I later cleared the NEET postgraduate examination and completed my MD in Psychiatry from Government Medical College, Kozhikode.
2. Can you tell us about your current role at General Hospital Kasaragod and the type of patients you most commonly treat?
For the past couple of months, I have been working as a Casualty Medical Officer in the Emergency Department at General Hospital Kasaragod. In this role, I encounter patients with acute medical and surgical emergencies, where quick assessment and timely intervention are crucial. Kasaragod being a border district, I see patients not only from Kerala but also from neighbouring Karnataka. One interesting aspect of working here is interacting with people who speak different languages such as Tulu, Kannada, Hindi, and Malayalam. Communicating across languages can sometimes be challenging, but it also makes the work environment dynamic and enriching. Although my training is in psychiatry, working in the emergency department has allowed me to encounter patients with a wide range of physical illnesses and acute conditions. It is rewarding to witness the immediate relief patients experience once their acute conditions are addressed.
3. Over the years, what experiences in your clinical practice have shaped your understanding of the connection between physical trauma, emergency surgery, and mental health?
Mind and body are inseparable. Whatever affects our physical health will have an emotional reaction. There is a possibility of cognitive and mental impairments in patients who had experienced physical trauma and emergency surgeries and more so when they had ICU care. The rates of psychiatric comorbidities in patients who underwent emergency surgery are greater than in the general population, particularly depression and anxiety disorders. Screening protocols and timely psychological and pharmacological management of the psychiatric illness will positively reflect on the general outcome of surgery. The only field in medicine where this screening is done routinely is in the postnatal period. There is a higher than expected prevalence of psychiatric illness in those people with end -stage organ disease, and it poses a risk for transplant and adversely influences the outcome. Traumatic physical injuries are a major cause of death and long-term disability. But the impact is not just physical, it can affect a person’s ability to work, their financial stability, and overall quality of life. For many people, the effects go beyond visible injuries. They may struggle with fatigue, difficulty in daily activities, and even changes in personal aspects of life. At the same time, psychological problems like PTSD, depression, and anxiety are quite common after such injuries but often go unnoticed or are not addressed early.
4. Patients who go through traumatic injuries or emergency surgeries often face emotional distress afterwards. In your experience, how common are mental health challenges such as anxiety or PTSD among these patients?
There is a higher prevalence of anxiety symptoms and PTSD in people who have experienced trauma and emergency surgeries. The spectrum may range from minor anxiety symptoms like palpitations, low mood, and sleep disturbances to more distressing PTSD symptoms. Although the prevalence is higher in the immediate period, it tends to diminish with the passage of time. In my experience, patients following physical trauma and emergency surgeries rarely seek help. The symptoms are often neglected. I believe there is a significant treatment gap for these conditions. Traumatic brain injuries predispose individuals to a range of psychiatric symptoms, including anxiety, mood symptoms, cognitive disturbances, and personality changes.
5. Could you share a real-life example or case from your practice that highlights how trauma or emergency surgery affected a patient’s mental well-being?
Once, while I was on consultation liaison work in the orthopedic department, I met a middle-aged man who had met with a severe accident. He had fallen on the railway track and had been hit by a train. He had sustained severe injuries, and a leg amputation had to be done to save his life. After the accident, the man had developed symptoms such as palpitations, anxiety, sleep disorders, and nightmares. He had also been unable to cope with the fact that his limb had been amputated. He had been feeling as if the limb was still there and had even been complaining of pain in the limb, which was a phantom limb phenomenon. However, with regular treatment and support, the man was able to cope better with his condition and move towards a more stable state.
6. What are some of the early psychological signs that healthcare professionals and families should watch for after a patient experiences severe trauma or undergoes emergency surgery?
After severe trauma or emergency surgery, some early psychological signs that we should watch for include increased anxiety, restlessness, irritability, and sleep disturbances. Patients may complain of palpitations, have difficulty relaxing, or appear unusually fearful. Some may have intrusive thoughts or repeated memories about the incident, along with nightmares. Others may try to avoid talking about the event or show emotional withdrawal. Low mood, lack of interest, and reduced interaction with family members can also be early signs. In certain cases, there may be confusion, poor concentration, or changes in behaviour, especially in patients who had head injury or ICU stay. These symptoms are often overlooked in the early phase, but identifying them early can help in timely intervention and better overall recovery.
7. In busy emergency and surgical settings, how can doctors and hospital teams identify patients who may be at higher risk of developing PTSD?
Not all who experience trauma develop PTSD, which has resulted in more attention to risk factors for developing PTSD. The risk factors for PTSD can be broadly classified as pretrauma, peri-trauma, and post-trauma factors. The pre-trauma factors include factors such as age, gender, ethnicity, educational level, prior psychiatric conditions, and neurobiological factors. The peri-trauma factors involve aspects such as the nature of the traumatic event, its severity, and duration, as well as perception of the traumatic event. The post-trauma factors involve support systems, resource availability, coping mechanisms, and physical activity levels.
8. From your experience, what simple steps can hospitals take to support the mental health of trauma patients during their recovery period?
In my experience, hospitals can take some simple but effective steps to support trauma patients’ mental health during recovery. First, there is a need to screen for signs of anxiety, depression, and stress-related symptoms as part of routine care. Basic psychological support, such as listening to the patient’s concerns, providing reassurance, and providing information about the patient’s condition, can greatly help to alleviate anxiety. Crisis intervention is also essential in the early phase, which includes immediate emotional support, safety, and coping with the stress of the traumatic event. The multidisciplinary team approach is essential, with all professionals, including doctors, nurses, and mental health professionals, working together to meet both physical and psychological needs. Family involvement and social support play an important role as well. If required, immediate referral to mental health professionals and providing psychological or pharmacological interventions can make a big difference.
9. How important is communication and emotional support from doctors and nurses in helping patients cope with traumatic medical experiences?
Communication plays a pivotal role in every aspect of medical practice, and every healthcare professional should develop the skills of proper and timely communication. When it comes to patients who have experienced trauma, they are often in a very distressed state—they may be in severe pain, disoriented, and may not even have a clear sense of time. Some may have lost their loved ones, while others may not have anyone around them for support. At such times, healthcare workers often become their primary source of support and reassurance. Compassionate and clear communication can help reduce their fears, provide emotional comfort, and give them the strength to cope and recover.
10. Beyond hospitals, what role can public health systems and community awareness programs play in preventing long-term psychological trauma among patients?
Community health workers can help in early identification of symptoms, ensure timely support, and provide regular followup. Peer support groups and spiritual approaches can also be useful in alleviating symptoms. Proper training in disaster management and community awareness programs should be provided. In the long term, communities can aim at building more resilient generations. It is also important for communities to work on reducing stigma, so that nobody feels hesitant to seek help.
11. What advice would you give to families and caregivers supporting someone who has gone through a traumatic injury or emergency surgery?
Families and caregivers have a very important role in helping someone recover after trauma or emergency surgery. Being there for the person, listening to them, and giving reassurance can make a big difference. It is also important to understand that symptoms like anxiety, poor sleep, or irritability are common after such events. Instead of getting worried, responding with patience and support helps the patient cope better. Encouraging them to seek help when needed and making sure they attend follow-ups is important. At the same time, caregivers should also take care of themselves, as it can be stressful.
12. Looking ahead, what changes or initiatives do you believe are needed in healthcare systems to better address mental health after trauma and prevent PTSD?
Looking ahead, a more defined approach to managing the mental health aspects of trauma and PTSD is required. This is similar to the worldwide emphasis being given to addressing mental health issues during emergencies. Psychological assistance should be incorporated as an integral part of trauma and emergency treatment. AI-based tools will be useful in the early detection of mental health problems. In addition, reducing stigmatization, improving accessibility, and reinforcing government initiatives will be important. Healthcare costs will be lowered.