Psychopathology Following Traumatic Injury
Logan Pearson, Terri deRoon-Cassini, Mary E “Libby” Schroeder, & Daniel N. Holena
Section Editor: Sydney Timmer-Murillo
In the high-stakes environment of trauma care, the immediate treatment priorities must focus primarily on stabilizing physical injury. This often relegates concern for mental health to the backseat, where it unfortunately remains for much of the early period post-trauma. Despite the critical role that mental health plays in overall recovery and long-term outcomes, current literature suggests a gap in routine mental health assessment and intervention during the early stages of trauma care(deRoon-Cassini et al., 2019). This brief report focuses on the pervasiveness of psychopathology in recovery from traumatic injury via retrospective chart review.
We performed retrospective cohort analysis using a substantial data pool from 76 healthcare organizations on the TriNetX database and investigated the incidence and prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) diagnoses in the year following a traumatic injury, drawing comparisons between injured and non-injured patient cohorts. The findings revealed a notably higher incidence of depression, anxiety, and PTSD among individuals who endured a traumatic injury compared to those who did not. This disparity was particularly stark in the first month post-injury, where the incidence rates for depression, anxiety, and PTSD were 2.0, 2.0, and 1.8 times higher, respectively, among the injured cohort. This trend underscored the urgent need for early mental health assessments and interventions amidst the acute phase of trauma care, aligning with the recent American College of Surgeons Committee on Trauma guidelines that emphasize early identification and intervention for mental health disorders to improve outcomes (American College of Surgeons Trauma Programs, 2022).
Beyond the immediate aftermath, we identified a sustained prevalence of these mental health disorders over the year following the traumatic event. The prevalence among the injured group stood at 26.3% for depression, 28.6% for anxiety, and 7.5% for PTSD, in stark contrast to the 15.3%, 18.6%, and 4.9%, respectively, in the non-injured group. This lingering impact of traumatic injuries on mental health accentuates the necessity for a comprehensive approach towards trauma care that extends well beyond the acute phase.
These disorders significantly impact recovery. Elevated depression scores are linked to higher pain levels at 1-month post-trauma, prolonged hospital stays, and reduced recovery odds at 12 months (Kellezi et al., 2017). PTSD strongly correlates with reduced health-related quality of life post-traumatic injury, while anxiety disorders correlate with increased postoperative mortality (Kiely et al., 2006; Geoffrion et al., 2021). Targeting these conditions in trauma recovery is promising, as multidisciplinary approaches encompassing psychological interventions have shown to lessen procedural complications and enhance patient quality of life both short and long term (Villa et al., 2020).
While our study’s results are compelling, relying on formal diagnoses to identify mental health conditions in a field still standardizing screening can lead to under-diagnosis. Similarly, using retrospective chart review hinges on the accuracy and completeness of pre-existing medical records, which may vary by organization.
Despite this, our comparative analysis highlighted a significant difference in mental health outcomes between injured and non-injured groups, underscoring the urgent need for standardized psychological assessments and interventions in trauma care. As awareness of how psychopathology affects recovery from traumatic injuries grows, it’s crucial to further explore and implement psychological supports to enhance the recovery journey of trauma survivors.
LOGAN PEARSON is a medical student at the Medical College of Wisconsin. His research interests include using innovative research methodologies to come up with creative solutions to community-identified needs. Following medical school, Logan plans to continue engaging in problem-solving endeavors.
TERRI DEROON-CASSINI, PhD, Professor, Division of Trauma & Acute Care Surgery, Dept of Surgery at MCW. She is the Exec Director of the Comprehensive Injury Center, focused on violence, suicide, and non-intentional injury prevention. She co-directs the gun violence prevention program at Froedtert Hospital, is co-Founder of the Milwaukee Trauma Outcomes Project, a research collaborative investigating trauma outcomes. She is a Licensed Psychologist and started the Trauma & Health Psychology Service for the FH/MCW trauma center and member of the multidisciplinary trauma quality of life clinic, providing integrative care for survivors of gun violence.
MARY E “LIBBY” SCHROEDER, MD is an Associate Professor of Surgery in the Division of Trauma and Acute Care Surgery. Her research focuses on social determinants of health post-trauma as well as improving mental health outcomes in the setting of injury.
DANIEL N. HOLENA, MD is a professor of surgery and serves as director of research for the Division of Trauma and Acute care surgery. His research interests include trauma systems, the use of audiovisual recordings to improve processes of care in trauma resuscitation, and the application of the Failure to Rescue (FTR) metric to trauma populations. His research methods primarily focus on the use of large datasets and on abstraction of video recordings in the trauma setting.
Citation: Pearson, L., DeRoon-Cassini, T., Schroeder, S. E., & Holena, D. N. (2023).psychopathology following traumatic injury. Trauma Psychology News, 18(3), 22-24. https://traumapsychnews.com