Predicting Postinjury Depression and PTSD Risk
Although injury is unexpected and acute, it can result in long-term health problems and disability. Up to half of all patients experience postinjury depression and posttraumatic stress disorder (PTSD) in the months after injury, increasing suboptimal recovery, disability, and costs for care. For patients like urban black men, some of whom have experienced prior trauma, childhood adversity and neighborhood disadvantage, acute postinjury stress responses are exacerbated.
Addressing the psychological effects of injury can improve health and reduce the negative outcomes of injury. Yet, in a national survey, only seven percent of trauma centers incorporate routine screening for PTSD symptoms.
An original investigation from the University of Pennsylvania School of Nursing (Penn Nursing) explores the risk and protective factors that contribute to postinjury mental health symptoms in urban black men. It finds that those men with violent injuries as compared to non-violent injuries have more severe postinjury mental health symptoms. But importantly it shows the need to take into consideration prior life experiences, such as adverse childhood experiences, neighborhood disadvantage, pre-injury health and psychological resources in addition to acute stress responses to an injury event, in order to identify injured patients at highest risk for poor postinjury mental health outcomes.
“The intersection of prior trauma and adversity, prior exposure to challenging neighborhood disadvantage, and poorer preinjury health and functioning should not be overlooked in the midst of acute injury care when assessing for the risk of postinjury mental health symptoms,” said lead-investigator Therese S. Richmond, PhD, CRNP, FAAN, the Andrea B. Laporte Professor of Nursing, and Associate Dean for Research & Innovation.
Results of the study are set for publication in an upcoming issue of JAMA Surgery in an article titled “Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries.”
The three-and-a-half-year study focused on outcomes in more than 600 urban black men who were hospitalized for serious injury. The researchers followed study participants for three months after hospital discharge to access for depression and PTSD symptoms. Almost one half of study participants met the diagnostic criteria for depression and/or PTSD at follow-up.
“This study takes a life-trajectory approach, helps inform potential points of intervention to improve outcomes, and adds to understanding both risk and protective factors across the life trajectory in an understudied group at high risk for injury,” said Richmond. “We must integrate psychological care into the very essence of trauma care if we are to improve outcomes from serious injuries. Because symptoms develop after hospital discharge, further developing and using screening instruments designed to predict the future development of postinjury mental health problems is warranted to focus services on those patients at highest risk.”
Co-authors of the study include Douglas J. Wiebe, PhD, Patrick M. Reilly, MD, and Justine Shults, PhD, all of the University of Pennsylvania; John Rich, MD, MPH, of Drexel University; and Nancy Kassam-Adams, PhD, of the Children’s Hospital of Philadelphia. This research was supported by the National Institute of Nursing Research of the National Institutes of Health (grant R01NR013503).