Highlights
- •Although traumatic injury patients often experience psychological difficulties, many do not seek mental health assistance
- •In a controlled trial, patients who were monitored after discharge and referred for specialist help had less disability than usual care
- •Regular monitoring of traumatic injury patients for psychological status after hospital discharge may lead to better outcomes
Abstract
Introduction
Traumatic injuries account for a huge burden of disease. Many patients develop persistent
mental health problems in the months following hospital discharge. This proof-of-concept
trial investigated whether Stepped Care comprising follow-up assessment telephone
calls and appropriate referral information would lead to better mental health and
functioning in traumatic injury patients.
Methods
Patients admitted to the Trauma Service at Royal North Shore Hospital were randomized
to either Stepped Care (n = 84) or and Treatment as Usual (n = 90). All patients were
assessed for anxiety, depression, and posttraumatic stress prior to hospital discharge.
Those in Stepped Care received a telephone call at 1-month and 3-months after hospital
discharge in which they were administered a brief assessment; patients who reported
mental health or pain difficulties were provided with information for local specialists
to address their specific problem. All patients were independently assessed by telephone
interview 9- months after hospital discharge for posttraumatic stress disorder (PTSD)
(primary outcome), as well as for anxiety, depression, disability, and pain.
Results
There were 58 (73%) patients that could be contacted at either the 1-month or 3-month
assessments. Of those contacted, 28 patients (48% of those contacted) were referred
for specialist assistance. There were no differences between treatment arms on PTSD
symptoms at follow-up [F1, 95 = 0.55, p = 0.46]. At the 9-month assessment, patients in the Stepped Care condition reported
significantly less anxiety [F1, 95 = 5.07, p = 0.03] and disability [F1, 95 = 4.37, p = 0.04] relative to those in Treatment as Usual. At 9 months there was no difference
between conditions on depression [F1, 95 = 1.03, p = 0.31]. There were no differences between conditions on self-reported pain difficulties.
Conclusions
This proof-of-concept trial suggests that brief screening assessments of traumatic
injury patients following hospital discharge, combined with appropriate referral information,
may lead to better functional outcomes. Further research is needed with larger sample
sizes and greater verification of referral uptake to validate this finding.
Keywords
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Article info
Publication history
Accepted:
January 1,
2023
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd. All rights reserved.
