Factors influencing participation in psychosocial programming among orthopaedic trauma patients with PTSD

Published:September 26, 2022DOI:


      • One third of patients with PTSD participated in trauma recovery services programming.
      • Patients with severe PTSD, higher level of formal education, and commercial insurance were more likely to participate.
      • Participation in TRS may be improved by minimizing the participant commute to the program location and by increasing awareness of patient groups at risk for less engagement.



      Post Traumatic Stress Disorder (PTSD) commonly occurs following acute trauma. Post-injury outcomes are negatively impacted by PTSD. Trauma Recovery Services (TRS) programming was developed at our institution in 2013 to provide psychosocial programming that increases patient satisfaction with care and ability to return to work and decreases PTSD symptoms. We sought to identify factors that influence patients’ decision to participate in programming.


      Over a 3-year period at a single, urban level 1 trauma center, 172 patients over the age of 18 screened positive for PTSD on the validated PTSD checklist for DSM-5 (PCL-5) screening tool. Demographic, socioeconomic, injury, and medical comorbidity information was collected. Variables were initially compared in a univariate manner via Chi-squared, Fisher exact, t-test, or Mann-Whitney U, as appropriate. Variables that had a p-value <0.2 on univariate analysis were entered into a backward stepwise logistic regression model to identify independent predictors of participation in TRS programming.


      Mean age was 37.8 years. 70.1% of patients were male. The most common mechanisms of injury were gunshot wound (33.7%), motor vehicle crash (19.0%), and burn. 33.5% of patients participated in TRS programming. Nine predictors had p<.2 on univariate analysis and were entered into the stepwise regression model. Four predictors remained in the final model. Patients with private insurance (RR=2.2, p=.038), high school diploma or greater (RR=1.53, p=.002; Table 1), and PCL-5 score greater than 50 were more likely to participate in TRS programming (RR=1.42, p=.046). Patients who live 20 or more minutes away by car from TRS were less likely to participate in programming (RR=0.47, p=.065).


      Patients with more severe PTSD, higher levels of education, and private insurance were more likely to participate in TRS programming. Participation in TRS and similar psychosocial programs may be improved by minimizing the participant's potential commute to the program location.
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        • Joseph N.M.
        • Benedick A.
        • Flanagan C.D.
        • Breslin M.A.
        • Simpson M.
        • et al.
        Prevalence of posttraumatic stress disorder in acute trauma patients.
        OTA Int Open Access J Orthop Trauma. 2020; 3: e056
        • Muscatelli S.
        • Spurr H.
        • O'Hara N.N.
        • O'Hara L.M.
        • Sprague S.A.
        • Slobogean G.P
        Prevalence of depression and posttraumatic stress disorder after acute orthopaedic trauma: a systematic review and meta-analysis.
        J Orthop Trauma. 2017; 31: 47-55
        • Shih R.A.
        • Schell T.L.
        • Hambarsoomian K.
        • Belzberg H.
        • Marshall G.N.
        Prevalence of posttraumatic stress disorder and major depression after trauma center hospitalization.
        J Trauma - Inj Infect Crit Care. 2010; 69: 1560-1566
        • Santiago P.N.
        • Ursano R.J.
        • Gray C.L.
        • Pynoos R.S.
        • Spiegel D.
        • et al.
        A systematic review of ptsd prevalence and trajectories in dsm-5 defined trauma exposed populations: intentional and non-intentional traumatic events.
        PLoS ONE. 2013; 8: 1-5
        • McMinn K.R.
        • Thomas E.V.
        • Martin K.R.
        • Khetan J.N.
        • McShan E.E.
        • et al.
        Psychological morbidity and functional impairment following traumatic pelvic injury.
        Injury. 2020; 51: 978-983
        • Giummarra M.J.
        • Casey S.L.
        • Devlin A.
        • Ioannou L.J.
        • Gibson S.J.
        • et al.
        Co-occurrence of posttraumatic stress symptoms, pain, and disability 12 months after traumatic injury.
        Pain Reports. 2017; 2: 1-12
        • Danielsson F.B.
        • Schultz Larsen M.
        • Nørgaard B.
        • Lauritsen J.M.
        Quality of life and level of post-traumatic stress disorder among trauma patients: a comparative study between a regional and a university hospital.
        Scand J Trauma Resusc Emerg Med. 2018; 26: 1-9
        • Walker E.A.
        • Katon W.
        • Russo J.
        • Ciechanowski P.
        • Newman E.
        • Wagner A.W.
        Health care costs associated with posttraumatic stress disorder symptoms in women.
        Arch Gen Psychiatry. 2003; 60: 369-374
        • McGowan Iain W.
        The economic burden of PTSD. A brief review of salient literature.
        Int J Psychiatry Ment Heal. 2019; (Published online): 20-26
        • Early METRC.
        Effects of the trauma collaborative care intervention: results from a prospective multicenter cluster clinical trial.
        J Orthop Trauma. 2019; 33: 538-546
        • Demario B.
        • Kalina M.J.
        • Truong E.
        • Hendrickson S.
        • Tseng E.S.
        • et al.
        Downstream hospital system effects of a comprehensive trauma recovery services program.
        J Trauma Acute Care Surg. 2020; 89: 1177-1182
        • Simske N.M.
        • Benedick A.
        • Rascoe A.S.
        • Hendrickson S.B.
        • Vallier H.A.
        Patient satisfaction is improved with exposure to trauma recovery services.
        J Am Acad Orthop Surg. 2020; 28: 597-605
        • Dilworth S.
        • Higgins I.
        • Parker V.
        • Kelly B.
        • Turner J.
        Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review.
        Psychooncology. 2014; 23: 601-612
        • Castillo R.C.
        • Wegener S.T.
        • Newell M.Z.
        • Carlini A.R.
        • Bradford A.N.
        • et al.
        Improving outcomes at Level I trauma centers: an early evaluation of the trauma survivors network.
        J Trauma Acute Care Surg. 2013; 74: 1534-1540
        • Roy-Byrne P.P.
        • Russo J.
        • Michelson E.
        • Zatzick D.
        • Pitman R.K.
        • Berliner L.
        • et al.
        Risk factors and outcome in ambulatory assault victims presenting to the acute emergency department setting: implications for secondary prevention studies in PTSD.
        Depress Anxiety. 2004; 19: 77-84
        • Weisæth L.
        Acute posttraumatic stress: nonacceptance of early intervention.
        J Clin Psychiatry. 2001; 62: 35-40
        • Corrigan P.W.
        • Druss B.G.
        • Perlick D.A.
        The impact of mental illness stigma on seeking and participating in mental health care.
        Psychol Sci Public Interes Suppl. 2014; 15: 37-70
        • Salerno J.P.
        Effectiveness of universal school-based mental health awareness programs among youth in the United States: a systematic review.
        J Sch Health. 2016; 86: 922-931
        • Kovandžić M.
        • Chew-Graham C.
        • Reeve J.
        • Edwards S.
        • Peters S.
        • et al.
        Access to primary mental health care for hard-to-reach groups: from “silent suffering” to “making it work.
        Soc Sci Med. 2011; 72: 763-772
        • Flanagan C.D.
        • Rascoe A.S.
        • Wang D.M.
        • Vallier H.A.
        Revenue for initial orthopaedic trauma care: effects of patient and injury characteristics.
        J Orthop Trauma. 2018; 32: 433-438
        • Gitajn I.L.
        • Reider L.
        • Scharfstein D.O.
        • et al.
        Variability in discharge disposition across US trauma centers after treatment for high-energy lower extremity injuries.
        J Orthop Trauma. 2020; 34: e78-e85
        • Hendrickson S.B.
        • Simske N.M.
        • DaSilva K.A.
        • Vallier H.A.
        Improvement in outpatient follow-up with a postdischarge phone call intervention.
        J Am Acad Orthop Surg. 2020; 28: e815-e822
        • Truong E.I.
        • DeMario B.S.
        • Hendrickson S.
        • et al.
        Factors influencing nonadherence to recommended postdischarge follow-up after trauma.
        J Surg Res. 2020; 256: 143-148
        • Wegener S.T.
        • Carroll E.A.
        • Gary J.L.
        • McKinley T.O.
        • O'Toole R.V.
        • et al.
        Trauma collaborative care intervention: effect on surgeon confidence in managing psychosocial complications after orthopaedic trauma.
        J Orthop Trauma. 2017; 31: 427-433
        • Simske N.M.
        • Breslin M.A.
        • Hendrickson S.B.
        • et al.
        Implementing recovery resources in trauma care: impact and implications.
        OTA Int. 2019; 2: e045-e051
        • Simske N.M.
        • Rivera T.
        • Breslin M.A.
        • Hendrickson S.B.
        • Simpson M.
        • et al.
        Implementing psychosocial programming at a level 1 trauma center: results from a 5-year period.
        Trauma Surg Acute Care Open. 2020; 5: 1-8
        • Fortney J.C.
        • Pyne J.M.
        • Kimbrell T.A.
        • Hudson T.J.
        • Robinson D.E.
        • et al.
        Telemedicine-based collaborative care for posttraumatic stress disorder: a randomized clinical trial.
        JAMA Psychiatry. 2015; 72: 58-67
        • Portnoy J.
        • Waller M.
        • Elliott T.
        • Portnoy J.
        • Waller M.
        • Elliott T
        Telemedicine in the Era of COVID-19.
        J Allergy Clin Immunol Pract. May 2020; 8 (Epub 2020 Mar 24): 1489-1491
        • Ohannessian R.
        • Duong T.A.
        • Odone A.
        Global telemedicine implementation and integration within health systems to fight the COVID-19 pandemic: a call to action.
        JMIR Public Heal Surveill. 2020; 6
        • Sinkler M.A.
        • Furdock R.J.
        • Vallier H.A.
        Treating trauma more effectively: a review of psychosocial programming.
        Injury. 2022; 53: 1756-1764
        • Stinner D.
        • Hendrickson S.B.
        • Vallier H.A.
        Trauma system support to facilitate recovery.
        J Orthop Trauma. 2022; 36: S6-S9