Mental Health Symptoms and Engagement in a Stepped-care Mental Health Service Among Patients with a Violent Versus Nonviolent Injury

Overview

Journal J Trauma Acute Care Surg

Specialty Critical Care

Date 2023 Jun 20

PMID 37339343

Authors

Kelly E OConnor

Caroline E Shanholtz

Hannah C Espeleta

Leigh E Ridings

Yulia Gavrilova

Ashley Hink

Kenneth J Ruggiero

Tatiana M Davidson

Affiliations

Soon will be listed here.

Abstract

Background: Few studies have examined mental health symptom trajectories and engagement in mental health follow-up in relation to mechanism of injury. This study examined differences in engagement between survivors of nonviolent and violent injury in the Trauma Resilience and Recovery Program (TRRP), a stepped-care, technology-enhanced model that provides evidence-based mental health screening and treatment to patients admitted to our Level I trauma service.

Methods: This study analyzed data from 2,527 adults enrolled in TRRP at hospital bedside between 2018 and 2022, including 398 patients (16%) with a violent injury and 2,129 patients (84%) with a nonviolent injury. Bivariate and hierarchical logistic regression analyses examined relations between injury type (violent vs. nonviolent) engagement in TRRP and mental health symptoms at 30 day follow-up.

Results: Engagement in services at bedside was similar across survivors of violent and nonviolent traumatic injury. Patients with violent injury had higher levels of posttraumatic stress disorder and depressive symptoms 30 days postinjury but were less likely to engage in mental health screening. Among patients who screened positive for posttraumatic stress disorder and depression, patients with violent injury were more likely to accept treatment referrals.

Conclusion: Patients with a violent traumatic injury have higher levels of mental health needs yet face greater barriers to accessing mental health services following their injury relative to those with a nonviolent injury. Effective strategies are needed to ensure continuity of care and access to mental health care to promote resilience and emotional and functional recovery.

Level Of Evidence: Therapeutic/Care Management; Level IV.

Citing Articles

Mental health sequelae of violent injury in children: a review.

Schuh J, Molitor S, Wilson D, Marik P, Fischer E, Calkins C Pediatr Surg Int. 2025; 41(1):90.

PMID: 40035844 DOI: 10.1007/s00383-025-05991-2.

References

. Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159):1684-1735. PMC: 6227504. DOI: 10.1016/S0140-6736(18)31891-9. View

Tabb L, Rich J, Waite D, Alberto C, Harris E, Gardner J . Examining Associations between Adverse Childhood Experiences and Posttraumatic Stress Disorder Symptoms among Young Survivors of Urban Violence. J Urban Health. 2022; 99(4):669-679. PMC: 9360210. DOI: 10.1007/s11524-022-00628-4. View

Ford K, Hughes K, Cresswell K, Griffith N, Bellis M . Associations between Adverse Childhood Experiences (ACEs) and Lifetime Experience of Car Crashes and Burns: A Cross-Sectional Study. Int J Environ Res Public Health. 2022; 19(23). PMC: 9735663. DOI: 10.3390/ijerph192316036. View

Bernard D, OLoughlin K, Davidson T, Rothbaum A, Anton M, Ridings L . Differences in mental health engagement and follow-up among Black and White patients after traumatic injury. J Trauma Acute Care Surg. 2022; 94(1):117-124. PMC: 9525457. DOI: 10.1097/TA.0000000000003604. View

Blevins C, Weathers F, Davis M, Witte T, Domino J . The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Development and Initial Psychometric Evaluation. J Trauma Stress. 2015; 28(6):489-98. DOI: 10.1002/jts.22059. View

Loberg J, Hayward R, Fessler M, Edhayan E . Associations of race, mechanism of injury, and neighborhood poverty with in-hospital mortality from trauma: A population-based study in the Detroit metropolitan area. Medicine (Baltimore). 2018; 97(39):e12606. PMC: 6181609. DOI: 10.1097/MD.0000000000012606. View

Richmond T, Wiebe D, Reilly P, Rich J, Shults J, Kassam-Adams N . Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries. JAMA Surg. 2019; 154(9):836-843. PMC: 6551579. DOI: 10.1001/jamasurg.2019.1622. View

Penninx B, Benros M, Klein R, Vinkers C . How COVID-19 shaped mental health: from infection to pandemic effects. Nat Med. 2022; 28(10):2027-2037. PMC: 9711928. DOI: 10.1038/s41591-022-02028-2. View

Roberts A, Gilman S, Breslau J, Breslau N, Koenen K . Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med. 2010; 41(1):71-83. PMC: 3097040. DOI: 10.1017/S0033291710000401. View

10.

Smith R, Dobbins S, Evans A, Balhotra K, Dicker R . Hospital-based violence intervention: risk reduction resources that are essential for success. J Trauma Acute Care Surg. 2013; 74(4):976-80. DOI: 10.1097/TA.0b013e31828586c9. View

11.

Chong V, Lee W, Victorino G . Neighborhood socioeconomic status is associated with violent reinjury. J Surg Res. 2015; 199(1):177-82. DOI: 10.1016/j.jss.2015.03.086. View

12.

Ruggiero K, Davidson T, Anton M, Bunnell B, Winkelmann J, Ridings L . Patient Engagement in a Technology-Enhanced, Stepped-Care Intervention to Address the Mental Health Needs of Trauma Center Patients. J Am Coll Surg. 2020; 231(2):223-230. PMC: 7491334. DOI: 10.1016/j.jamcollsurg.2020.03.037. View

13.

Zatzick D, Roy-Byrne P, Russo J, Rivara F, Droesch R, Wagner A . A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. Arch Gen Psychiatry. 2004; 61(5):498-506. DOI: 10.1001/archpsyc.61.5.498. View

14.

Ridings L, Anton M, Winkelmann J, Davidson T, Wray L, Streck C . Trauma Resilience and Recovery Program: Addressing Mental Health in Pediatric Trauma Centers. J Pediatr Psychol. 2019; 44(9):1046-1056. PMC: 9432141. DOI: 10.1093/jpepsy/jsz053. View

15.

Reese C, Pederson T, Avila S, Joseph K, Nagy K, Dennis A . Screening for traumatic stress among survivors of urban trauma. J Trauma Acute Care Surg. 2012; 73(2):462-7. DOI: 10.1097/TA.0b013e31825ff713. View

16.

Moynihan R, Sanders S, Michaleff Z, Scott A, Clark J, To E . Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review. BMJ Open. 2021; 11(3):e045343. PMC: 7969768. DOI: 10.1136/bmjopen-2020-045343. View

17.

Kornfield R, Meyerhoff J, Studd H, Bhattacharjee A, Williams J, Reddy M . Meeting Users Where They Are: User-centered Design of an Automated Text Messaging Tool to Support the Mental Health of Young Adults. Proc SIGCHI Conf Hum Factor Comput Syst. 2022; 2022. PMC: 9098159. DOI: 10.1145/3491102.3502046. View

18.

Johnson S, Bradshaw C, Wright J, Haynie D, Simons-Morton B, Cheng T . Characterizing the teachable moment: is an emergency department visit a teachable moment for intervention among assault-injured youth and their parents?. Pediatr Emerg Care. 2007; 23(8):553-9. DOI: 10.1097/PEC.0b013e31812c6687. View

19.

Jaycox L, Marshall G, Schell T . Use of mental health services by men injured through community violence. Psychiatr Serv. 2004; 55(4):415-20. DOI: 10.1176/appi.ps.55.4.415. View

20.

Bunnell B, Davidson T, Winkelmann J, Maples-Keller J, Ridings L, Dahne J . Implementation and Utility of an Automated Text Messaging System to Facilitate Symptom Self-Monitoring and Identify Risk for Post-Traumatic Stress Disorder and Depression in Trauma Center Patients. Telemed J E Health. 2019; 25(12):1198-1206. PMC: 6918842. DOI: 10.1089/tmj.2018.0170. View