Submitted:
01 April 2025
Posted:
01 April 2025
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Abstract
Background: Post-traumatic sequelae leave many negative impacts on the health and quality of life of patients, especially for those groups at high risk of exposure to injuries. Therefore, this study was conducted to identify some factors related to post-traumatic sequelae in people in a mountainous province in Northern Vietnam.Materials and Methods: A cross-sectional study was conducted on 228 residents living in two communes, Pom Lot and Thanh Minh, Dien Bien province, who experienced injuries from any cause within one year prior to the study.Result: The rate of post-traumatic sequelae among the study participants was 62.3%. Older age (>40), being of ethnic minority, short treatment duration, and lack of family and social support were factors associated with an increased risk of post-traumatic sequelae. Conclusion: Post-traumatic sequelae are a significant disease burden for residents living in mountainous provinces in Northern Vietnam. High-risk groups for post-traumatic sequelae include the elderly, ethnic minorities, and those with limited family and social support after injury.
Keywords:
Injury
; post-traumatic sequelae
; post-traumatic stress disorder
1. Introduction
Post-traumatic sequelae are a medical term used to describe the long-lasting or delayed consequences of an injury. These consequences can manifest in many forms, including both physical and psychological [1]. Today, the occurrence of numerous adverse events in life has led society to pay more attention to the negative impacts of post-traumatic sequelae on health and quality of life. Especially in Western countries, the prevalence of wars, genocides, natural disasters, human-caused disasters, and terrorist attacks has further increased this concern [1].
As mentioned, post-traumatic sequelae not only relate to the physical limitations that patients experience but also affect mental health. From empirical studies, the close relationship between mental sequelae, specifically post-traumatic stress disorder (PTSD), and physical health issues has been increasingly clarified through patient reports and objective assessments from the healthcare system. This relationship is demonstrated in various aspects, including: healthcare service utilization behavior, patient quality of life, somatization syndrome (psychological problems manifesting as physical symptoms such as headaches and unexplained abdominal pain), acquired pathologies, and early mortality rates. Furthermore, this relationship is more pronounced in men than in women. It can be said that post-traumatic stress plays a significant role in the link between injury and physical health problems [2,3,4].
Factors influencing post-traumatic sequelae are diverse and depend on the type of sequelae left by the injury. For patients with PTSD, the most commonly cited related factors in studies are older age, female gender, severity of the injury, history of depression, and lack of support from family, friends, and society [5,6]. Meanwhile, for injuries that leave physical sequelae, a review study from 10 countries worldwide has shown that factors closely associated with post-traumatic sequelae include older age (>45 years), pre-injury health status, and mental health issues such as PTSD or depression [7].
In the northern mountainous provinces of Vietnam, due to socio-economic and cultural limitations, post-traumatic sequelae from accidents and injuries have become a burden. Identifying factors related to post-traumatic sequelae will provide important scientific evidence, helping policymakers, authorities, and communities to develop practical and effective solutions to protect health and improve the quality of life for people in highland areas. Therefore, we conducted the study “Post-traumatic sequelae and its associated factors: A cross-sectional study in the northern mountainous region of Vietnam” with the aim of: Identifying some factors related to post-traumatic sequelae among residents in the study area.
2. Materials and Methods
2.1. Study Design and Setting
A cross-sectional study was conducted in two communes, Pom Lot and Thanh Minh, Dien Bien province, from June 2024 to August 2024.
2.2. Study Subjects
The study population consisted of residents living in two communes, Pom Lot and Thanh Minh, who had experienced injuries from any cause within one year prior to the study.
✹ Inclusion criteria: People living and working in the two study communes for at least one year; People who had experienced an injury from any cause within one year prior to the study; People without neuropsychiatric problems and capable of answering interview questions; People who agreed to participate in the study.
✹ Exclusion criteria: People who experienced injuries too long ago, making it unsuitable to assess sequelae; People with underlying medical conditions or health issues that could affect post-traumatic sequelae; People unable to comprehend or answer questions.
2.3. Sample Size and Sampling Method
Entire sampling method: All residents living in two communes, Pom Lot and Thanh Minh, who experienced injuries from any cause within one year prior to the study, were selected. In reality, we selected 228 residents who met the inclusion and exclusion criteria to participate in the study.
2.4. Measurements
Injury: In this study, individuals were assessed as having an injury if they met one of the following criteria:
- Lost at least 1 day of work or school.
- Required medical care from a medical facility or healthcare professional.
- Were unable to participate in daily activities such as personal hygiene, bathing, laundry, sweeping, cleaning, etc., for at least 1 day.
Assessment of post-traumatic sequelae: The assessment of whether individuals suffered from post-traumatic sequelae was conducted by medical specialists in the field of trauma, combined with a review of patient medical records at the time of the injury.
2.5. Methods of Data Collection
Data was collected through interviews with residents using a pre-designed questionnaire consisting of two parts: general information about the residents and information about their injury status and any post-traumatic sequelae experienced in the past year.
2.6. Statistical Analysis
Data were cleaned by checking missing data before being entered into the database using Epidata software. The data continued to be cleaned for outliers and illogical data and were converted into SPSS version 27.0 file for analysis. Both descriptive and inferential statistics were used. If data are normally distributed, means and standard deviations ( ± SD) were for continuous variables. Percentages were presented for nominal variables....
2.7. Ethical Consideration
The study was approved by the Ethics Council of Thai Binh University of Medicine and Pharmacy (1624/Ethics Council - TBUMP June, 2024). During the survey, participants were verbally informed about the study, that their participation was voluntary, that they had the right to withdraw at any point, and that data would be confidential. All the respondents were anonymous in the study.
Table 1.
Socio-demographic characteristics of study participants in the northern mountainous region of Vietnam, 2024 (n = 228).
Table 1.
Socio-demographic characteristics of study participants in the northern mountainous region of Vietnam, 2024 (n = 228).
| Characteristics | Frequency | Percentage | |
|---|---|---|---|
| Age groups | ≤40 | 108 | 47.4 |
| >40 | 120 | 52.6 | |
| Sex | Male | 143 | 62.7 |
| Female | 85 | 37.3 | |
| Area | Rural | 121 | 53.1 |
| Urban | 107 | 46.9 | |
| Ethnic groups | Kinh | 56 | 24.6 |
| Minorities* | 172 | 75.4 | |
| Occupation | Manual labor | 181 | 78.4 |
| Mental labor | 18 | 7.9 | |
| Others** | 29 | 12.7 | |
Minorities*: Muong, Thai, H’Mong.; Others**: retired, learners, and children.
3. Results
The data table shows a fairly even distribution of the study sample between the under 40 and over 40 age groups. However, there's a significant gender imbalance. In terms of area, rural areas have a slight majority compared to urban areas. Notably, ethnic minorities represent an overwhelming majority, in contrast to only 24.6% who are Kinh. The predominant occupation is manual labor.
Table 2 shows a difference in the prevalence of post-traumatic sequelae across various characteristic groups. Individuals under 40 years old and females have a higher rate of sequelae. The same applies to people of Kinh ethnicity and those living in rural areas. Manual laborers and individuals with injuries caused by external influences or occurring indoors have a higher risk. Notably, non-drinkers show a higher rate of sequelae than drinkers.
Table 2.
Prevalence of post-traumatic sequelae of study participants in the northern mountainous region of Vietnam, 2024 (n = 228).
Table 2.
Prevalence of post-traumatic sequelae of study participants in the northern mountainous region of Vietnam, 2024 (n = 228).
| Characteristics | Post-traumatic sequelae | ||
|---|---|---|---|
| No | Yes | ||
| n (%) | n (%) | ||
| Age groups | ≤40 | 74 (68.5) | 34 (31.5) |
| >40 | 68 (56.7) | 52 (43.3) | |
| Sex | Male | 84 (58.7) | 59 (41.3) |
| Female | 58 (68.2) | 27 (31.8) | |
| Area | Rural | 79 (65.3) | 42 (34.7) |
| Urban | 63 (58.9) | 44 (41.1) | |
| Ethnic groups | Kinh | 42 (75.0) | 14 (25.0) |
| Minorities* | 100 (58.1) | 72 (41.9) | |
| Occupation | Manual labor | 113 (62.4) | 68 (37.6) |
| Mental labor | 10 (55.6) | 8 (44.4) | |
| Others** | 19 (65.5) | 10 (34.5) | |
| Causal | By yourself | 97 (59.1) | 67 (40.9) |
| External influences | 45 (70.3) | 19 (29.7) | |
| Place of injury | Indoors | 56 (69.1) | 25 (30.9) |
| Outdoors | 86 (58.5) | 61 (41.5) | |
| Drinking | No | 119 (66.1) | 61 (33.9) |
| Yes | 23 (47.9) | 25 (52.1) | |
Minorities*: Muong, Thai, H’Mong.; Others**: retired, student, and children.
Table 3.
Factors associated with post-traumatic sequelae of study participants in the northern mountainous region of Vietnam, 2024 (n = 228).
Table 3.
Factors associated with post-traumatic sequelae of study participants in the northern mountainous region of Vietnam, 2024 (n = 228).
| Variables | Post-traumatic sequelae | ||||
|---|---|---|---|---|---|
| No | Yes | COR | AOR | ||
| n (%) | n (%) | (95% CI) | (95% CI) | ||
| Age groups | ≤40 | 74 (68.5) | 34 (31.5) | 1 | 1 |
| >40 | 68 (56.7) | 52 (43.3) | 1.7 (1.0–2.9)* | 2.6 (1.3–5.3)* | |
| Sex | Male | 84 (58.7) | 59 (41.3) | 1 | 1 |
| Female | 58 (68.2) | 27 (31.8) | 0.7 (0.4–1.2) | 0.6 (0.3–1.5) | |
| Area | Rural | 79 (65.3) | 42 (34.7) | 1 | 1 |
| Urban | 63 (58.9) | 44 (41.1) | 1.3 (0.8–2.2) | 0.6 (0.3–1.5) | |
| Ethnic groups | Kinh | 42 (75.0) | 14 (25.0) | 1 | 1 |
| Minorities* | 100 (58.1) | 72 (41.9) | 2.2 (1.1–4.2)* | 2.5 (1.0–6.0)* | |
| Occupation | Manual labor | 113 (62.4) | 68 (37.6) | 1 | 1 |
| Mental labor | 10 (55.6) | 8 (44.4) | 1.3 (0.5–3.5) | 2.4 (0.6–9.1) | |
| Others** | 19 (65.5) | 10 (34.5) | 0.9 (0.4–2.0) | 0.9 (0.3–2.7) | |
| Causal | By yourself | 97 (59.1) | 67 (40.9) | 1 | 1 |
| External influences | 45 (70.3) | 19 (29.7) | 0.6 (0.3–1.1) | 0.5 (0.2–1.1) | |
| Place of injury | Indoors | 56 (69.1) | 25 (30.9) | 1 | 1 |
| Outdoors | 86 (58.5) | 61 (41.5) | 1.6 (0.9–2.8) | 1.7 (0.7–3.8) | |
| Drinking | No | 119 (66.1) | 61 (33.9) | 1 | 1 |
| Yes | 23 (47.9) | 25 (52.1) | 2.1 (1.1–4.0)* | 1.1 (0.4–2.8) | |
| Type of injury accident | Traffic accident | 34 (54.8) | 28 (45.2) | 1 | 1 |
| Fall | 39 (60.9) | 25 (39.1) | 0.8 (0.4–1.6) | 2.1 (0.8–6.1) | |
| Others*** | 69 (67.6) | 33 (32.4) | 0.6 (0.3–1.1) | 1.1 (0.5–2.9) | |
| Social support | No | 75 (67.0) | 37 (33.0) | 1 | 1 |
| Yes | 67 (57.8) | 49 (42.2) | 1.5 (0.9–2.5) | 1.2 (0.6–2.5) | |
| First aid time | ≤30 | 116 (64.1) | 65 (35.9) | 1 | 1 |
| (minute) | >30 | 26 (55.3) | 21 (44.7) | 1.4 (0.8–2.8) | 1.3 (0.6–3.1) |
| Time of treatment | >1 | 60 (47.6) | 66 (52.4) | 1 | 1 |
| (week) | ≤1 | 82 (80.4) | 20 (19.6) | 4.5 (2.5–8.2)*** | 5.1 (2.2–11.9) *** |
| Need assistance | Yes | 33 (36.7) | 57 (63.3) | 1 | 1 |
| No | 109 (79.0) | 29 (21.0) | 6.5 (3.6–11.7)*** | 5.7 (2.8–11.4)*** | |
Minorities*: Muong, Thai, H’Mong.; Others**: retired, student, and children; Others***: Occupational and social accidents; COR: Crude odd ratio; AOR: Adjusted Odds Ratio; *P < 0.05, **P < 0.01, ***P < 0.001.
This table presents the relationship between sociodemographic characteristics and the prevalence of post-traumatic sequelae. Results show that age over 40, Kinh ethnicity, and treatment duration less than one week are factors that increase the risk of post-traumatic sequelae in the study population.
4. Discussion
Post-traumatic sequelae are a significant public health challenge. The consequences left by post-traumatic sequelae are not only physical impairments but also mental disorders that occur in victims, significantly affecting survivors [8]. Our study, conducted on 228 residents in Dien Bien province – a mountainous region in Northern Vietnam – who had experienced injuries (or trauma) within one year prior to the study, showed that the majority of injury victims (or trauma victims) in the study area were male (62.7%), belonged to ethnic minorities (75.4%), and had primarily manual labor occupations (78.4%). These findings are consistent with previous studies [9,10,11]. This is understandable as males are a group that often engages in activities with high injury risks, such as heavy labor, construction, and transportation. Meanwhile, ethnic minorities may lack awareness of safety in daily life and work, leading to manual labor practices that carry many potential injury risks.
We found that individuals over 40 years old had a higher risk of post-traumatic sequelae compared to those under 40 (AOR = 2.6; 95%CI: 1.3-5.3). This is consistent with the natural aging process of the body, where recovery capacity decreases with age. Tissues, bones, and muscles become weaker and lose elasticity, resulting in longer recovery times after injuries and a higher risk of sequelae. Age is also a related factor reported in Ihori Kobayashi's study (2020) [12].
In addition to age, individuals from ethnic minority groups (Muong, Thai, H’Mong) were also at higher risk of post-traumatic sequelae compared to the Kinh majority (AOR = 2.5; 95%CI: 1.0-6.0). This is mainly due to difficult economic conditions, nutritional deficiencies, and limited access to healthcare services, which reduce the body's recovery ability after injuries and increase the risk of sequelae. Additionally, ethnic minority groups may have traditional living habits that increase the risk of injuries, especially severe injuries with a high rate of sequelae.
Current treatment methods for sequelae emphasize patient perseverance as a way to prevent post-traumatic stress disorder (PTSD) and limit other mental complications, requiring longer actual treatment times, even after patients have stabilized physically [13]. In our study, patients with treatment durations of one week or less had a higher risk of post-traumatic sequelae than those treated for more than one week (AOR = 5.1; 95%CI: 2.2-11.9). Short treatment durations may result in patients not receiving adequate follow-up and rehabilitation after discharge, leading to sequelae that are not detected and treated promptly. Additionally, patients with short treatment durations often return to work too early, before their bodies have fully recovered, increasing the risk of complications and sequelae.
The support factor (both from family and society), with an adjusted OR of 5.7 and a 95% confidence interval ranging from 2.8 to 11.4, shows that this factor is closely associated with post-traumatic sequelae. This result is consistent with findings from previous studies in Ethiopia [11] and the United States [14]. Possible explanations for this association include that family and social support can make patients feel reassured during treatment, motivated to overcome difficulties, and compliant with treatment regimens, thereby reducing the risk of post-traumatic sequelae.
5. Conclusions
Post-traumatic sequelae are a significant disease burden for residents living in the northern mountainous provinces of Vietnam, especially among the elderly, ethnic minorities, and those with limited family and social support after injury. This highlights the need for a shift in focus within injury and trauma-related projects and support policies to specifically target these populations.
Author Contributions
NTD and TTH: Conceptualization and design of the study, Writing original draft, Review & editing the manuscript; TTD: Conceptualization and design of the study, Writing original draft; TTH: Data processing and analysis, Review & editing the manuscript. All authors have read and agreed to the published version of the manuscript.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Institutional Review Board Statement
The research protocol was reviewed and approved by the ethics committees of Thai Binh University of Medicine and Pharmacy. Written informed consent was obtained from each participant. Data is confidential and used for research purposes only. During the survey, participants were informed that their participation was voluntary, they had the right to withdraw at any point, and data would be confidentially managed.
Data Availability Statement
The datasets underlying the results of this study are available from the corresponding author upon reasonable request. Requests to access these datasets should be directed at: diepnguyentheytb@gmail.com.
Acknowledgments
We are extremely grateful to all the participants in the baseline survey of the Study. We would like to thank the Hospital Management, the medical staff who are working in the clinic and the Department of Traumatology. We would also like to thank the principal investigators for their great efforts and contributions to this Study.
Conflicts of Interest
All authors state that they have no conflicts of interest.
Abbreviations
The following abbreviations are used in this manuscript:
| AOR | Adjusted Odds Ratio |
| COR | Crude odd ratio |
| PTSD | Post-traumatic stress disorder |
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