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Giummarra MJ, Reeder S, Williams S, Devlin A, Knol R, Ponsford J, Arnold CA, Konstantatos A, Gabbe BJ, Clarke H, Katz J, Mitchell F, Robinson E, Zatzick D. Stepped collaborative care for pain and posttraumatic stress disorder after major trauma: a randomized controlled feasibility trial. Disabil Rehabil 2024; 46:3643-3659. [PMID: 37706486 PMCID: PMC10937328 DOI: 10.1080/09638288.2023.2254235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 06/29/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023]
Abstract
PURPOSE To examine feasibility and acceptability of providing stepped collaborative care case management targeting posttraumatic stress disorder (PTSD) and pain symptoms after major traumatic injury. MATERIALS AND METHODS Participants were major trauma survivors in Victoria, Australia, at risk of persistent pain or PTSD with high baseline symptoms. Participants were block-randomized, stratified by compensation-status, to the usual care (n = 15) or intervention (n = 17) group (46% of eligible patients). The intervention was adapted from existing stepped collaborative care interventions with input from interdisciplinary experts and people with lived experience in trauma and disability. The proactive case management intervention targeted PTSD and pain management for 6-months using motivational interviewing, cognitive behavioral therapy strategies, and collaborative care. Qualitative interviews explored intervention acceptability. RESULTS Intervention participants received a median of 7 h case manager contact and reported that they valued the supportive and non-judgmental listening, and timely access to effective strategies, resources, and treatments post-injury from the case manager. Participants reported few disadvantages from participation, and positive impacts on symptoms and recovery outcomes consistent with the reduction in PTSD and pain symptoms measured at 1-, 3- and 6-months. CONCLUSIONS Stepped collaborative care was low-cost, feasible, and acceptable to people at risk of PTSD or pain after major trauma.IMPLICATIONS FOR REHABILITATIONAfter hospitalization for injury, people can experience difficulty accessing timely support to manage posttraumatic stress, pain and other concerns.Stepped case management-based interventions that provide individualized support and collaborative care have reduced posttraumatic stress symptom severity for patients admitted to American trauma centers.We showed that this model of care could be adapted to target pain and mental health in the trauma system in Victoria, Australia.The intervention was low cost, acceptable and highly valued by most participants who perceived that it helped them use strategies to better manage post-traumatic symptoms, and to access clinicians and treatments relevant to their needs.
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Affiliation(s)
- Melita J. Giummarra
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Sandra Reeder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Scott Williams
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Australia
| | - Anna Devlin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Rose Knol
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Social Work, Alfred Health, Melbourne, Australia
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Clayton, Australia
- Monash-Epworth Rehabilitation Research Centre, Epworth Hospital, Richmond, Australia
| | - Carolyn A. Arnold
- Caulfield Pain Management and Research Centre, Caulfield Hospital, Alfred Health, Caulfield, Australia
- Academic Board of Anaesthesia & Perioperative Medicine, School of Medicine Nursing & Health Sciences, Monash University, Clayton, Australia
| | - Alex Konstantatos
- Department of Anaesthesia, The Alfred Hospital, Melbourne, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea University, Swansea, UK
| | - Hance Clarke
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Canada
| | - Joel Katz
- Department of Anaesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Anaesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
| | - Fiona Mitchell
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Patient and Carer Coinvestigators with Lived Experience of Trauma, Australia
| | - Elizabeth Robinson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Patient and Carer Coinvestigators with Lived Experience of Trauma, Australia
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of WA School of Medicine, Seattle, WA, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA, USA
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Conrad EJ, Rajo EM, Barker C, Beiter K, Hughes JB, Stuart S. The Trauma Recovery Clinic: A Stepped Collaborative Care Model for Trauma Surgery Patients to Address Health Disparities. Am Surg 2024:31348241262431. [PMID: 38889953 DOI: 10.1177/00031348241262431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Background: The Trauma Recovery Clinic (TRC) was developed to meet the psychiatric, psychological, and psychosocial needs of traumatically injured patients following discharge from a level-I trauma center. The objective of this study is to demonstrate the efficacy of the TRC as an application of the stepped collaborative care model in order to address health disparities.Methods: Patients with a history of inpatient treatment for a physically traumatic injury at this level-I trauma center were approached and enrolled at initial TRC outpatient appointments. Data was collected, including the PTSD Checklist-Civilian Version (PCL-C), the Patient Health Questionnaire (PHQ-9), the Attitudes towards Guns scale, and the Youth Behavior Risk Survey (questions about weapon carrying practices).Results: A total of 80 patients were included in this study. Patients expressed several social determinants of health risk factors, with 60% of the sample reporting witnessing someone being wounded or killed. Results demonstrated a significant decrease in trauma symptoms (T24 = 3.33; P = .001, d = 0.67) and depressive symptoms (T24 = 2.23, P = .02, d = 0.45) by their 6th clinic visit. Additionally, patients reported significant improvements in role limitations due to emotional problems (T25 = 1.74; P = .04; d = 0.34) and social functioning (T25 = 2.23; P = .02; d = 0.43). Interestingly, patients who reported carrying a weapon in the last 30 days reported significantly higher trauma symptoms (T64 = 3.21, P = .002) and depressive symptoms (T64 = 2.77, P = .007).Discussion: This evaluation of services at the recently implemented Trauma Recovery Clinic demonstrated that the clinic is successfully treating individuals who have experienced traumatic injuries. More specifically, the clinic services are effectively engaging a vulnerable, hard-to-reach patient population.
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Affiliation(s)
- Erich J Conrad
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Erika M Rajo
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Chikira Barker
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kaylin Beiter
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Jennifer B Hughes
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Sarah Stuart
- Department of Psychiatry, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Reed DE, Engel CC, DeFaccio R, Gaj L, Douglas JH, Williams RM, Etingen B, Kroenke K, Bokhour BG, Zeliadt SB. Examining the Veterans Health Administration whole health model of care within the context of posttraumatic stress disorder. Psychol Serv 2024; 21:224-234. [PMID: 38079475 PMCID: PMC11139595 DOI: 10.1037/ser0000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
The Veterans Health Administration's Whole Health system of care focuses on offering veterans holistic health approaches and tailoring health care to individual's goals and preferences. The present study assessed factors associated with Whole Health use and its potential benefits among veterans with posttraumatic stress disorder (PTSD) receiving Veterans Health Administration care. This cohort study used retrospective electronic health records combined with survey data (baseline, 6 months) from 18 Veterans Affairs Whole Health pilot implementation sites and compared patient-reported outcomes between veterans who used Whole Health services versus those who did not, among veterans with (n = 1,326) and without (n = 3,243) PTSD. Patient-reported outcomes assessed were pain (PEG), patient-reported outcomes measurement information system physical and mental health functioning, and a one-item global meaning and purpose assessment. Veterans with PTSD were more likely to have used Whole Health (38% vs. 21%) than those without PTSD. Veterans with PTSD who used Whole Health services experienced small improvements over 6 months in physical (Cohen's d = .12) and mental (Cohen's d = .15) health functioning. Veterans without PTSD who used Whole Health services experienced small improvements in physical health (Cohen's d = .09) but not mental health (Cohen's d = .04). Veterans with PTSD were frequently connected with Whole Health services even though implementation efforts were not explicitly focused on reaching this population. Results suggest Whole Health may play an important role in how veterans with PTSD engage with health care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- David E Reed
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care
| | - Charles C Engel
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care
| | - Rian DeFaccio
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care
| | - Lauren Gaj
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System
| | - Jamie H Douglas
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care
| | | | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. Veterans Affairs Hospital
| | | | - Barbara G Bokhour
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System
| | - Steven B Zeliadt
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research and Development, VA Puget Sound Health Care
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Shoyer J, Ruggiero KJ, Abu K, Birk N, Conde C, Ryan P, Knutzen T, Engstrom A, Russo J, Wang J, Zatzick DF. Engaging and following physical injury survivors at risk for developing posttraumatic stress disorder symptoms: A 25 site US national study. Injury 2024; 55:111426. [PMID: 38423897 PMCID: PMC11023765 DOI: 10.1016/j.injury.2024.111426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/12/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Early intervention for patients at risk for Posttraumatic Stress Disorder (PTSD) relies upon the ability to engage and follow trauma-exposed patients. Recent requirements by the American College of Surgeons Committee on Trauma (College) have mandated screening and referral for patients with high levels of risk for the development of PTSD or depression. Investigations that assess factors associated with engaging and following physically injured patients may be essential in assessing outcomes related to screening, intervention, and referral. METHODS This investigation was a secondary analysis of data collected as part of a United States level I trauma center site randomized clinical trial. All 635 patients were ages ≥18 and had high PTSD symptom levels (i.e., DSM-IV PTSD Checklist score ≥35) at the time of the baseline trauma center admission. Baseline technology use, demographic, and injury characteristics were collected for patients who were followed up with over the course of the year after physical injury. Regression analyses were used to assess the associations between technology use, demographic and injury characteristics, and the attainment of follow-up outcome assessments. RESULTS Thirty-one percent of participants were missing one or more 3-, 6- or 12-month follow-up outcome assessments. Increased risk of missing one or more outcome assessments was associated with younger age (18-30 versus ≥55 Relative Risks [RR] = 1.78, 95 % Confidence Interval [CI] = 1.09, 2.91), lack of cell phone (RR = 1.32, 95 % CI = 1.01, 1.72), no internet access (RR = 1.47, 95 % CI = 1.01, 2.16), public versus private insurance (RR = 1.47, 95 % CI = 1.12, 1.92), having no chronic medical comorbidities (≥4 versus none, RR = 0.28, 95 % CI = 0.20, 0.39), and worse pre-injury mental health function (RR = 0.99, 95 % CI = 0.98, 0.99). CONCLUSIONS This multisite investigation suggests that younger and publicly insured and/or uninsured patients with barriers to cell phone and internet access may be particularly vulnerable to lapses in trauma center follow-up. Clinical research informing trauma center-based screening, intervention, and referral procedures could productively explore strategies for patients at risk for not engaging and adhering to follow-up care and outcome assessments.
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Affiliation(s)
- Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kenneth J Ruggiero
- Departments of Nursing and Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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Li G, Shi W, Gao X, Shi X, Feng X, Liang D, Li C, Phillips MR, Hall BJ. Mental health and psychosocial interventions to limit the adverse psychological effects of disasters and emergencies in China: a scoping review. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 45:100580. [PMID: 38699294 PMCID: PMC11064723 DOI: 10.1016/j.lanwpc.2022.100580] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Exposure to disasters and public health emergencies negatively affects mental health. Research documenting the psychosocial responses to these calamities in China increased dramatically after the 2008 Wenchuan earthquake. However, there is no comprehensive assessment of the available literature on China's mental health and psychosocial support (MHPSS) responses to these events. This scoping review systematically maps existing published research and grey literature sources regarding MHPSS to disasters and emergencies in China. We examined relevant literature in English and Chinese from six databases and official websites from Jan 1, 2000, to Aug 13, 2021, and included 77 full-text records in this review. The main types of interventions reported included a) stepped care intervention models, b) individual structured psychotherapy and pharmacotherapy, c) mental health education, d) psychological counselling, and e) government-based policy interventions. Most interventions were evaluated using quantitative methods that assessed the treatment of common mental disorders. The review found that rapid national mobilization, emphasis on resilience-strengthening interventions, and the widespread use of step-care models were essential components of reducing the adverse psychosocial effects of disasters. The review also identified remaining gaps, including a) a lack of integration of disaster-related services with the pre-existing health care system, b) inadequate supervision of MHPSS providers, and c) limited monitoring and evaluation of the services provided. These results show where additional research is needed in China to improve mental health services. It also provides a framework that other countries can adapt when developing and evaluating MHPSS policies and plans in response to disasters.
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Affiliation(s)
- Gen Li
- Center for Global Health Equity, New York University Shanghai, 1555 Century Avenue, Shanghai, China
| | - Wei Shi
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Xing Gao
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Xinyi Shi
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Xiaoyu Feng
- The Institute for Disaster Management and Reconstruction, Sichuan University, No.24 South Section 1, Yihuan Road, Chengdu, China
| | - Di Liang
- School of Public Health, Fudan University, 220 Handan Rd., Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wanping Nan Rd., Shanghai, China
- Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, 1954 Huashan Road, Shanghai, China
| | - Michael R. Phillips
- Suicide Research and Prevention Center, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wanping Nan Rd., Shanghai, China
- Departments of Psychiatry and Epidemiology, Columbia University, New York, NY, USA
| | - Brian J. Hall
- Center for Global Health Equity, New York University Shanghai, 1555 Century Avenue, Shanghai, China
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Birk N, Russo J, Heagerty P, Parker L, Moloney K, Bulger E, Whiteside L, Moodliar R, Engstrom A, Wang J, Palinkas L, Abu K, Zatzick D. Can Baseline Patient Clinical and Demographic Characteristics Predict Response to Early Posttraumatic Stress Disorder Interventions After Physical Injury? Psychiatry 2024; 87:134-148. [PMID: 38497603 PMCID: PMC11116057 DOI: 10.1080/00332747.2024.2323367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
OBJECTIVE A growing evidence base supports stepped care interventions for the early treatment of posttraumatic stress disorder (PTSD) after physical injury. Few investigations have examined the characteristics of patients who do and do not respond to these interventions. METHOD This investigation was a secondary analysis that used previously collected data from three randomized clinical trials of stepped care interventions (patient N = 498). The study hypothesized that a subgroup of patients would manifest persistent PTSD symptoms regardless of randomization to intervention or control conditions, and that characteristics present at the time of baseline injury hospitalization could distinguish patients who would develop persistent symptoms from potential treatment responders. Regression analyses identified baseline patient clinical and demographic characteristics that were associated with persistent PTSD symptoms over the 6-months post-injury. Additional analyses identified treatment attributes of intervention patients who were and were not likely to demonstrate persistent symptoms. RESULTS A substantial subgroup of patients (n = 222, 44.6%) demonstrated persistent PTSD symptoms over time. Greater numbers of pre-injury trauma, pre-injury PTSD symptoms, elevated early post-injury PTSD symptoms, unemployment, and non-White race identified patients with persistent symptoms. Patients with ≥3 of these baseline risk characteristics demonstrated diminished treatment responses when compared to patients with <3 characteristics. Intervention patients with ≥3 risk characteristics were less likely to engage in treatment and required greater amounts of interventionist time. CONCLUSIONS Injured trauma survivors have readily identifiable characteristics at the time of hospitalization that can distinguish responders to PTSD stepped care interventions versus patients who may be treatment refractory.
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Affiliation(s)
- Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Patrick Heagerty
- Department of Biostatistics University of Washington School of Medicine, Seattle, Washington, USA
| | - Lea Parker
- Department of Psychology Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lawrence Palinkas
- Department of Public Health and Longevity Science, University of California, San Diego, California, USA
| | - Khadijah Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Abu K, Bedard-Gilligan M, Moodliar R, Bulger EM, Hernandez A, Knutzen T, Shoyer J, Birk N, Conde C, Engstrom A, Ryan P, Wang J, Russo J, Zatzick DF. Can stepped collaborative care interventions improve post-traumatic stress disorder symptoms for racial and ethnic minority injury survivors? Trauma Surg Acute Care Open 2024; 9:e001232. [PMID: 38287923 PMCID: PMC10824071 DOI: 10.1136/tsaco-2023-001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/07/2024] [Indexed: 01/31/2024] Open
Abstract
Objectives No large-scale randomized clinical trial investigations have evaluated the potential differential effectiveness of early interventions for post-traumatic stress disorder (PTSD) among injured patients from racial and ethnic minority backgrounds. The current investigation assessed whether a stepped collaborative care intervention trial conducted at 25 level I trauma centers differentially improved PTSD symptoms for racial and ethnic minority injury survivors. Methods The investigation was a secondary analysis of a stepped wedge cluster randomized clinical trial. Patients endorsing high levels of distress on the PTSD Checklist (PCL-C) were randomized to enhanced usual care control or intervention conditions. Three hundred and fifty patients of the 635 randomized (55%) were from non-white and/or Hispanic backgrounds. The intervention included care management, cognitive behavioral therapy elements and, psychopharmacology addressing PTSD symptoms. The primary study outcome was PTSD symptoms assessed with the PCL-C at 3, 6, and 12 months postinjury. Mixed model regression analyses compared treatment effects for intervention and control group patients from non-white/Hispanic versus white/non-Hispanic backgrounds. Results The investigation attained between 75% and 80% 3-month to 12-month follow-up. The intervention, on average, required 122 min (SD=132 min). Mixed model regression analyses revealed significant changes in PCL-C scores for non-white/Hispanic intervention patients at 6 months (adjusted difference -3.72 (95% CI -7.33 to -0.10) Effect Size =0.25, p<0.05) after the injury event. No significant differences were observed for white/non-Hispanic patients at the 6-month time point (adjusted difference -1.29 (95% CI -4.89 to 2.31) ES=0.10, p=ns). Conclusion In this secondary analysis, a brief stepped collaborative care intervention was associated with greater 6-month reductions in PTSD symptoms for non-white/Hispanic patients when compared with white/non-Hispanic patients. If replicated, these findings could serve to inform future American College of Surgeon Committee on Trauma requirements for screening, intervention, and referral for PTSD and comorbidities. Level of evidence Level II, secondary analysis of randomized clinical trial data reporting a significant difference. Trial registration number NCT02655354.
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Affiliation(s)
- Khadija Abu
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Michelle Bedard-Gilligan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rddhi Moodliar
- Department of Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Tanya Knutzen
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jake Shoyer
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Navneet Birk
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Cristina Conde
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Allison Engstrom
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Paige Ryan
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jin Wang
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Prater L, Bulger E, Maier RV, Goldstein E, Thomas P, Russo J, Wang J, Engstrom A, Abu K, Whiteside L, Knutzen T, Iles-Shih M, Heagerty P, Zatzick D. Emergency Department and Inpatient Utilization Reductions and Cost Savings Associated With Trauma Center Mental Health Intervention: Results From a 5-year Longitudinal Randomized Clinical Trial Analysis. Ann Surg 2024; 279:17-23. [PMID: 37747970 PMCID: PMC10843150 DOI: 10.1097/sla.0000000000006102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
OBJECTIVE To identify and refer patients at high risk for the psychological sequelae of traumatic injury, the American College of Surgeons Committee on Trauma now requires that trauma centers have in-place protocols. No investigations have documented reductions in utilization and associated potential cost savings associated with trauma center mental health interventions. BACKGROUND The investigation was a randomized clinical trial analysis that incorporated novel 5-year emergency department (ED)/inpatient health service utilization follow-up data. METHODS Patients were randomized to a mental health intervention, targeting the psychological sequelae of traumatic injury (n = 85) versus enhanced usual care control (n = 86) conditions. The intervention included case management that coordinated trauma center-to-community care linkages, psychotropic medication consultation, and psychotherapy elements. Mixed model regression was used to assess intervention and control group utilization differences over time. An economic analysis was also conducted. RESULTS Over the course of the 5-year intervention, patients demonstrated significant reductions in ED/inpatient utilization when compared with control patients [ F (19,3210) = 2.23, P = 0.009]. Intervention utilization reductions were greatest at 3 to 6 months (intervention 15.5% vs control 26.7%, relative risk = 0.58, 95% CI: 0.34, 1.00) and 12 to 15 months (intervention 16.5% vs control 30.6%, relative risk = 0.54, 95% CI: 0.32, 0.91) postinjury time points. The economic analysis suggested potential intervention cost savings. CONCLUSIONS Mental health intervention is associated with significant reductions in ED and inpatient utilization, as well as potential cost savings. These findings could be productively integrated into future American College of Surgeons Committee on Trauma policy discussions.
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Affiliation(s)
- Laura Prater
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Firearm Injury and Policy Research Program, University of Washington, Seattle, WA
| | - Eileen Bulger
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Surgery, University of Washington, Seattle, WA
| | - Ronald V. Maier
- Department of Surgery, University of Washington, Seattle, WA
| | - Evan Goldstein
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT
| | | | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | | | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Lauren Whiteside
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Emergency Medicine, University of Washington, Seattle, WA
| | - Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Doug Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
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Knutzen T, Bulger E, Iles-Shih M, Hernandez A, Engstrom A, Whiteside L, Birk N, Abu K, Shoyer J, Conde C, Ryan P, Wang J, Russo J, Heagerty P, Palinkas L, Zatzick D. Stepped collaborative care versus American College of Surgeons Committee on Trauma required screening and referral for posttraumatic stress disorder: Clinical trial protocol. Contemp Clin Trials 2024; 136:107380. [PMID: 37952714 PMCID: PMC11025340 DOI: 10.1016/j.cct.2023.107380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/13/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Each year in the US, approximately 1.5-2.5 million individuals are so severely injured that they require inpatient hospital admissions. The American College of Surgeons Committee on Trauma (College) now requires that trauma centers have in place protocols to identify and refer hospitalized patients at risk injury psychological sequelae. Literature review revealed no investigations that have identified optimal screening, intervention, and referral procedures in the wake of the College requirement. METHODS The single-site pragmatic trial investigation will individually randomize 424 patients (212 intervention and 212 control) to a brief stepped care intervention versus College required mental health screening and referral control conditions. Blinded follow-up interviews at 1-, 3-, 6-, and 12-months post-injury will assess the symptoms of PTSD and related comorbidity for all patients. The emergency department information exchange (EDIE) will be used to capture population-level automated emergency department and inpatient utilization data for the intent-to-treat sample. The investigation aims to test the primary hypotheses that intervention patients will demonstrate significant reductions in PTSD symptoms and emergency department/inpatient utilization when compared to control patients. The study incorporates a Rapid Assessment Procedure-Informed Clinical Ethnography (RAPICE) implementation process assessment. CONCLUSIONS The overarching goal of the investigation is to advance the sustainable delivery of high-quality trauma center mental health screening, intervention, and referral procedures for diverse injury survivors. An end-of-study policy summit will harness pragmatic trial data to inform the capacity for US trauma centers to implement high-quality acute care mental health screening, intervention and referral services for diverse injured patient populations. TRIAL REGISTRATION Clinicaltrials.govNCT05632770.
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Affiliation(s)
- Tanya Knutzen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Matt Iles-Shih
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Alexandra Hernandez
- Department of Surgery, University of Washington School of Medicine, Seattle, USA.
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
| | - Navneet Birk
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Khadija Abu
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jake Shoyer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Cristina Conde
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Paige Ryan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle, USA.
| | - Larry Palinkas
- Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, USA.
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA.
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10
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Rivara FP, Hink AB, Kuhls D, Banks S, Agoubi LL, Kirkendoll S, Winchester A, Hoeft C, Patel B, Nathens A. Firearm injuries in Missouri. PLoS One 2023; 18:e0294737. [PMID: 37992058 PMCID: PMC10664957 DOI: 10.1371/journal.pone.0294737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/05/2023] [Indexed: 11/24/2023] Open
Abstract
Firearm deaths continue to be a major public health problem, but the number of non-fatal firearm injuries and the characteristics of patients and injuries is not well known. The American College of Surgeons Committee on Trauma, with support from the National Collaborative on Gun Violence Research, leveraged an existing data system to capture lethal and non-lethal injuries, including patients treated and discharged from the emergency department and collect additional data on firearm injuries that present to trauma centers. In 2020, Missouri had the 4th highest firearm mortality rate in the country at 23.75/100,000 population compared to 13.58/100,000 for the US overall. We examined the characteristics of patients from Missouri with firearm injuries in this cross-sectional study. Of the overall 17,395 patients, 1,336 (7.7%) were treated at one of the 11 participating trauma centers in Missouri during the 12-month study period. Patients were mostly male and much more likely to be Black and uninsured than residents in the state as a whole. Nearly three-fourths of the injuries were due to assaults, and overall 7.7% died. Few patients received post-discharge services.
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Affiliation(s)
- Frederick P. Rivara
- Departments of Pediatrics and Epidemiology and the Firearm Injury and Policy Research Program, University of Washington, Seattle, Washington, United States of America
| | - Ashley B. Hink
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, United States of America
| | - Deborah Kuhls
- Department of Surgery, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, Nevada, United States of America
| | - Samantha Banks
- Firearm Injury and Policy Research Program, University of Washington, Seattle, Washington, United States of America
| | - Lauren L. Agoubi
- Harborview Injury Prevention and Research Center and the Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | - Shelbie Kirkendoll
- Department of Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Alex Winchester
- American College of Surgeons, Chicago, Illinois, United States of America
| | - Christopher Hoeft
- American College of Surgeons, Chicago, Illinois, United States of America
| | - Bhavin Patel
- American College of Surgeons, Chicago, Illinois, United States of America
| | - Avery Nathens
- Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
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11
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Ridings LE, Espeleta HC, Litvitskiy N, Higgins K, Bravoco O, Davidson TM, Streck CJ, Kassam-Adams N, Ruggiero KJ. Behavioral Health Screening and Follow-Up Services in Pediatric Trauma Centers Across the United States. J Pediatr Psychol 2023; 48:960-969. [PMID: 37794767 PMCID: PMC10653355 DOI: 10.1093/jpepsy/jsad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/14/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Over 120,000 U.S. children are hospitalized for traumatic injury annually, a major risk factor for behavioral health problems such as acute/posttraumatic stress disorder (PTSD) and depression. Pediatric trauma centers (PTCs) are well positioned to address the recent mandate by the American College of Surgeons Committee on Trauma to screen and refer for behavioral health symptoms. However, most PTCs do not provide screening or intervention, or use varying approaches. The objective of this mixed-methods study was to assess PTCs' availability of behavioral health resources and identify barriers and facilitators to service implementation following pediatric traumatic injury (PTI). METHODS Survey data were collected from 83 Level I (75%) and Level II (25%) PTC program managers and coordinators across 36 states. Semistructured, qualitative interviews with participants (N = 24) assessed the feasibility of implementing behavioral health education, screening, and treatment for PTI patients and caregivers. RESULTS Roughly half of centers provide behavioral health screening, predominantly administered by nurses for acute stress/PTSD. Themes from qualitative interviews suggest that (1) service provision varies by behavioral health condition, resource, delivery method, and provider; (2) centers are enthusiastic about service implementation including screening, inpatient brief interventions, and follow-up assessment; but (3) require training and lack staff, time, and funding to implement services. CONCLUSIONS Sustainable, scalable, evidence-based service models are needed to assess behavioral health symptoms after PTI. Leadership investment is needed for successful implementation. Technology-enhanced, stepped-care approaches seem feasible and acceptable to PTCs to ensure the availability of personalized care while addressing barriers to sustainability.
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Affiliation(s)
- Leigh E Ridings
- College of Nursing, Medical University of South Carolina, USA
| | | | | | - Kristen Higgins
- College of Nursing, Medical University of South Carolina, USA
| | - Olivia Bravoco
- College of Nursing, Medical University of South Carolina, USA
| | | | - Christian J Streck
- Department of Surgery, College of Medicine, Medical University of South Carolina, USA
| | - Nancy Kassam-Adams
- Center for Injury Research & Prevention, Children’s Hospital of Philadelphia, USA
- University of Pennsylvania Perelman School of Medicine, USA
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12
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Kaufman EJ, Whitehorn G, Orji W, Chreiman K, Jackson S, Holena D, Lane-Fall M, Jacoby SF. Patient Experiences of Acute and Postacute Care After Trauma. J Surg Res 2023; 291:303-312. [PMID: 37506429 DOI: 10.1016/j.jss.2023.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/13/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Traumatic injury can transform a healthy, independent individual into a patient with complex health needs. Little is known about how injured patients understand their health and healthcare needs during postacute recovery, limiting our ability to optimize care. This multiple-methods study explored injured patients' experiences of care up to 30 days after discharge. METHODS Injured adults admitted to an urban, Level I trauma center August 1, 2019-November 30, 2020 were sampled purposively to balance blunt and penetrating injuries. Patient experience and health status were assessed at baseline and 30 days postdischarge using the Quality of Trauma Care Patient-Reported Experience Measure. Fifteen qualitative interviews were conducted with a purposive subset and analyzed using qualitative content analysis. RESULTS Of 67 participants (76% male, 73% Black, 51% penetrating, median age 34 years), 37 completed follow-up surveys. Quality of acute care was rated 9-10/10 by 81% of the sample for acute and 65% for postacute care (P = 0.09). Thirty percent described fair or poor mental health, but only mental health concerns were addressed for only 2/3. Pain control was inadequate in 31% at baseline and for 46% at follow-up (P = 0.09). Qualitative analysis revealed general satisfaction with acute care but challenges in recovery with unmet needs for communication and care coordination. CONCLUSIONS Trauma patients appreciated the quality of their acute care experiences but identified opportunities for improvement in prognostic communication, pain management, and mental health support. Unmet mental and physical care needs persist at least 1 month after hospital discharge and reinforce the need for interventions that optimize postacute trauma care.
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Affiliation(s)
- Elinore J Kaufman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Gregory Whitehorn
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Whitney Orji
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Kristen Chreiman
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sunny Jackson
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Daniel Holena
- Division of Traumatology, Surgical Critical Care, and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Meghan Lane-Fall
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Sara F Jacoby
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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13
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Fuchita M, Perkins A, Holler E, Glober N, Lasiter S, Mohanty S, Ortiz D, Gao S, French DD, Boustani M, Zarzaur BL. Utility of the Healthy Aging Brain Care Monitor as a Patient-Reported Symptom Monitoring Tool in Older Injury Survivors. J Surg Res 2023; 290:83-91. [PMID: 37224608 PMCID: PMC10330368 DOI: 10.1016/j.jss.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 03/21/2023] [Accepted: 04/15/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION The objective of this study was to evaluate the performance of the Healthy Aging Brain Care Monitor (HABC-M) as a patient-reported outcome tool to measure cognitive, functional, and psychological symptoms among older adults who sustained non-neurologic injuries requiring hospital admission. METHODS We used data from a multicenter randomized controlled trial to evaluate the utility of the HABC-M Self-Report version in older patients recovering from traumatic injuries. A total of 143 patients without cognitive impairment were included in the analysis. Cronbach's alpha was used to measure the internal consistency, and Spearman's rank correlation test was used to evaluate the relationship of the HABC-M with standard measures of cognitive, functional, and psychological outcomes. RESULTS The HABC-M subscales and the total scale showed satisfactory internal consistency (Cronbach's alpha = 0.64 to 0.77). The HABC-M cognitive subscale did not correlate with the Mini-Mental State Examination. The HABC-M functional and psychological subscales correlated with corresponding standard reference measures (|rs| = 0.24-0.59). CONCLUSIONS The HABC-M Self-Report version is a practical alternative to administering multiple surveys to monitor functional and psychological sequelae in older patients recovering from recent non-neurologic injuries. Its clinical application may facilitate personalized, multidisciplinary care coordination among older trauma survivors without cognitive impairment.
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Affiliation(s)
- Mikita Fuchita
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
| | - Anthony Perkins
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana
| | - Nancy Glober
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Indiana University Health Physicians, Indianapolis, Indiana
| | - Sue Lasiter
- School of Nursing and Health Studies, Health Sciences District, University of Missouri, Kansas City, Missouri
| | - Sanjay Mohanty
- Indiana University Health Physicians, Indianapolis, Indiana; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Damaris Ortiz
- Indiana University Health Physicians, Indianapolis, Indiana; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana; Eskenazi Health, Indianapolis, Indiana
| | - Sujuan Gao
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Dustin D French
- Departments of Ophthalmology and Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Malaz Boustani
- Indiana University Health Physicians, Indianapolis, Indiana; Eskenazi Health, Indianapolis, Indiana; Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Center for Health Innovation and Implementation Science, Indiana University School of Medicine, Indianapolis, Indiana
| | - Ben L Zarzaur
- Division of Acute Care and Regional General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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14
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Espeleta HC, Litvitskiy NS, Higgins K, Ridings LE, Bravoco O, Jones S, Ruggiero KJ, Davidson T. Implementation of a stepped care program to address posttraumatic stress disorder and depression in a Level II trauma center. Injury 2023; 54:110922. [PMID: 37422365 PMCID: PMC10528678 DOI: 10.1016/j.injury.2023.110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/12/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND The Trauma Resilience and Recovery Program (TRRP) is a technology enhanced model of care that includes education, screening, and service referrals to address posttraumatic stress disorder and depression following traumatic injury. TRRP has shown high rates of engagement at a Level I trauma center, but Level II centers have fewer resources and face more challenges to addressing patients' mental health needs. METHODS We utilized clinical administrative data to examine engagement in TRRP in a Level II trauma center with 816 adult trauma activation patients. RESULTS Most patients (86%) enrolled in TRRP, but only 30% completed screens during a 30-day follow-up call. Three-quarters of patients who endorsed clinically significant symptoms accepted treatment recommendations/referrals. CONCLUSIONS Engagement at each step of the model was lower than previously reported in a Level I center. Differences likely correspond to lower rates of mental health symptoms in the trauma patients at this setting. We discuss program adaptations that may be needed to improve patient engagement.
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Affiliation(s)
- Hannah C Espeleta
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA.
| | - Nicole S Litvitskiy
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Kristen Higgins
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Leigh E Ridings
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Olivia Bravoco
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Seon Jones
- Trident Medical Center, 9291 Medical Plaza Dr. Suite B, Charleston, SC 29406, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
| | - Tatiana Davidson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street Charleston, SC 29425, USA
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15
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Hullenaar KL, Rivara FP, Wang J, Zatzick DF. Exploring Collaborative Care Effects on the Mental and Physical Health of Patients With and Without Violent Victimization Histories. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6865-6887. [PMID: 36458828 DOI: 10.1177/08862605221138655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Collaborative care is a multicomponent intervention delivered by frontline social work, nursing, and physician providers to address patients' physical, emotional, and social needs. We argued that collaborative care may particularly benefit patients with a violent victimization history because it practices three principles of trauma-informed care: patient-provider collaboration, preventing repeat trauma in clinical and community settings, and delivering comprehensive mental and physical healthcare. We conducted an exploratory secondary data analysis of a collaborative care randomized clinical trial involving patients who presented with traumatic physical injury at a Level I trauma center in Washington state between 2006 and 2009. We used random-effect linear regression models to estimate how histories of multiple violent traumas moderated the effects of the collaborative care intervention on Short Form-36 Mental Component Summary (MCS) and Physical Component Summary (PCS) T-scores over time. Collaborative care significantly improved follow-up MCS scores among patients who experienced three to four types of violent victimization in their lifetime. Additionally, intervention effects on MCS scores at the 3- and 6-month follow-up were clinically stronger for patients who reported three to four types of violent victimization (3-month = 7.5, 95% confidence level [CI] = 5.1 to 18.7; 6-month = 11.9, 95% CI = 5.1 to 18.7) than those without a history of violent victimization (3-month = 0.8, 95% CI = -5.1, 6.6; 6-month = 5.6, -2.4 to 13.5). We did not find that intervention effects on PCS scores differed between these groups at any wave. Collaborative care may be a promising approach to delivering trauma-informed mental healthcare to patients with histories of multiple types of violent victimization.
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Affiliation(s)
| | | | - Jin Wang
- University of Washington, Seattle, USA
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16
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Hruska B, Patterson PD, Doshi AA, Guyette MK, Wong AH, Chang BP, Suffoletto BP, Pacella-LaBarbara ML. Examining the prevalence and health impairment associated with subthreshold PTSD symptoms (PTSS) among frontline healthcare workers during the COVID-19 pandemic. J Psychiatr Res 2023; 158:202-208. [PMID: 36592534 PMCID: PMC9796598 DOI: 10.1016/j.jpsychires.2022.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 12/29/2022]
Abstract
The COVID-19 pandemic has increased healthcare workers' (HCWs) risk for posttraumatic stress disorder (PTSD). Although subthreshold PTSD symptoms (PTSS) are common and increase vulnerability for health impairments, they have received little attention. We examined the prevalence of subthreshold PTSS and their relationship to physical health symptoms and sleep problems among HCWs during the pandemic's second wave (01/21-02/21). Participants (N = 852; 63.1% male; Mage = 38.34) completed the Short-Form PTSD Checklist (SF-PCL), the Cohen-Hoberman Inventory of Physical Symptoms, and the PROMIS Sleep-Related Impairment-Short-Form 4a. We created three groups with the SF-PCL: scores ≥11 = probable PTSD (5.5%); scores between 1 and 10 = subthreshold PTSS (55.3%); scores of 0 = no PTSS (39.2%). After controlling for demographics, occupational characteristics, and COVID-19 status, HCWs with subthreshold PTSS experienced greater physical health symptoms and sleep problems than HCWs with no PTSS. While HCWs with PTSD reported the greatest health impairment, HCWs with subthreshold PTSS reported 88% more physical health symptoms and 36% more sleep problems than HCWs with no PTSS. Subthreshold PTSS are common and increase risk for health impairment. Interventions addressing HCWs' mental health in response to the COVID-19 pandemic must include subthreshold PTSS to ensure their effectiveness.
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Affiliation(s)
- Bryce Hruska
- Department of Public Health, Syracuse University, Syracuse, NY, USA
| | - P Daniel Patterson
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ankur A Doshi
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Ambrose H Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bernard P Chang
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
| | - Brian P Suffoletto
- Department of Emergency Medicine, Stanford University, Palo Alto, CA, USA
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Joseph AP, Wallman M, Scott E, Ilchef R, Harris N, Jackson A, Bryant RA. A proof-of-concept randomized controlled trial of follow-up mental health care for traumatic injury patients following hospital discharge. Injury 2023; 54:1362-1368. [PMID: 36858896 DOI: 10.1016/j.injury.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 12/14/2022] [Accepted: 01/01/2023] [Indexed: 01/07/2023]
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 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.
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Affiliation(s)
- Anthony P Joseph
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
| | - Matthew Wallman
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Elliot Scott
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Ralf Ilchef
- Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Newman Harris
- Department of Pain Management, Royal North Shore Hospital, St Leonards, NSW 2065
| | - Alicia Jackson
- Trauma Service, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia
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18
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Systematic Review and Meta-Analysis of Stepped Care Psychological Prevention and Treatment Approaches for Posttraumatic Stress Disorder. Behav Ther 2022; 54:476-495. [PMID: 37088505 DOI: 10.1016/j.beth.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/07/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Stepped care approaches have been developed to increase treatment accessibility for individuals with posttraumatic stress disorder (PTSD). However, despite guidelines recommending stepped care, it is currently unclear how the approach compares to other treatments for PTSD in terms of symptom reduction, cost, and client-rated acceptability. We conducted a systematic review and meta-analysis of randomized controlled and open trials evaluating stepped care prevention (i.e., targeting those with recent trauma exposure at risk of developing PTSD) and treatment approaches for adults and adolescents/children with PTSD. Eight prevention and four treatment studies were included. There was considerable variation in the sample types, stepped approaches, and control conditions. Most studies found no significant differences between stepped care (both prevention and treatment) and control (active and usual care) in terms of PTSD severity, loss of PTSD diagnosis, depression severity, and quality of life at the final follow-up. There was some evidence to suggest that stepped care was more cost-effective, and as acceptable or more acceptable compared to controls. Interpretations were tempered by high statistical heterogeneity, risk of bias, and lack of recommended evidence-based treatments. Stepped care can make PTSD treatment more accessible; however, more high-quality research is needed comparing stepped care to active controls.
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Ortiz D, Perkins AJ, Fuchita M, Gao S, Holler E, Meagher AD, Mohanty S, French DD, Lasiter S, Khan B, Boustani M, Zarzaur B. Pre-Existing Anxiety and Depression in Injured Older Adults: An Under-Recognized Comorbidity With Major Health Implications. ANNALS OF SURGERY OPEN 2022; 3:e217. [PMID: 36590891 PMCID: PMC9780044 DOI: 10.1097/as9.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/25/2022] [Indexed: 01/03/2023] Open
Abstract
To compare differences in baseline depression and anxiety screenings between older injured patients with pre-existing diagnoses and those without. Background Little is known about the prevalence and impact of psychiatric comorbidities on early postinjury depression and anxiety in nonneurologically injured older adults. Methods This was a retrospective post-hoc analysis of data from the Trauma Medical Home, a multicenter randomized controlled trial (R01AG052493-01A1) that explored the effect of a collaborative care model on postinjury recovery for older adults compared to usual care. Results Nearly half of the patients screened positive for at least mild depressive symptoms as measured by the Patient Health Questionnaire-9. Forty-one percent of the patients screened positive for at least mild anxiety symptoms as measured by the Generalized Anxiety Disorder Scale. Female patients with a history of concurrent anxiety and depression, greater injury severity scores, and higher Charlson scores were more likely to have mild anxiety at baseline assessment. Patients with a history of depression only, a prior history of depression and concurrent anxiety, and higher Charlson scores (greater medical comorbidity) had greater odds of at least mild depression at the time of hospital discharge after traumatic injury. Conclusions Anxiety and depression are prevalent in the older adult trauma population, and affect women disproportionately. A dual diagnosis of depression and anxiety is particularly morbid. Mental illness must be considered and addressed with the same importance as other medical diagnoses in patients with injuries.
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Affiliation(s)
- Damaris Ortiz
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Sidney and Lois Eskenazi Hospital Smith Level One Trauma Center, Indianapolis, IN
| | - Anthony J Perkins
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Mikita Fuchita
- Division of Critical Care, Department of Anesthesiology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO
| | - Sujuan Gao
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN
| | - Emma Holler
- Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN
| | - Ashley D Meagher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Indiana University Health, Methodist Hospital Level One Trauma Center, Indianapolis, IN
| | - Sanjay Mohanty
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
- Indiana University Health, Methodist Hospital Level One Trauma Center, Indianapolis, IN
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Veterans Affairs Health Services Research and Development Service, Chicago, IL
| | - Sue Lasiter
- School of Nursing and Health Studies, Health Sciences District, University of Missouri, Kansas City, MO
| | - Babar Khan
- Sidney and Lois Eskenazi Hospital Smith Level One Trauma Center, Indianapolis, IN
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Malaz Boustani
- Center of Health Innovation and Implementation Science, Center for Translational Science and Innovation, Indianapolis, IN
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Ben Zarzaur
- Department of Surgery, University of Wisconsin School of Medicine, Madison, WI
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20
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The 12-Month Effects of the Trauma Collaborative Care Intervention: A Nonrandomized Controlled Trial. J Bone Joint Surg Am 2022; 104:1796-1804. [PMID: 36000769 DOI: 10.2106/jbjs.22.00475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Studies have suggested that patient-centered collaborative care in the early phases of recovery may assist providers and patients in managing the multifactorial consequences of injury and may lead to better outcomes. This cluster-controlled trial, conducted at 12 U.S. Level-I trauma centers, was designed to evaluate the impact of the Trauma Collaborative Care (TCC) program on 1-year outcomes following severe musculoskeletal injury. METHODS Patients with high-energy orthopaedic trauma requiring surgical fixation were prospectively enrolled. Six sites implemented the TCC intervention as well as the Trauma Survivors Network (TSN), and the other 6 sites provided the standard of care. Participants were followed for 1 year, and a composite primary outcome measure composed of the Short Musculoskeletal Function Assessment (SMFA) Dysfunction Index, Patient Health Questionnaire-9 (PHQ-9), and Posttraumatic Stress Disorder Checklist (PCL) was assessed. A 2-stage, Bayesian hierarchical statistical procedure was used to characterize treatment effects. Sensitivity analyses were conducted to account for an error in the delivery of the intervention. RESULTS There were 378 patients enrolled at 6 trauma centers implementing the TCC program, and 344 patients enrolled at 6 trauma centers providing usual care. Patient utilization of treatment components varied across the intervention sites: 29% of patients in the intervention group received all 5 key components (TSN handbook education, peer visits, recovery assessment, and calls before and after recovery assessment). Posterior estimates of the intention-to-treat effect suggested that the intervention did not have an appreciable effect: the odds of the composite outcome for the TCC group increased by 5% (95% credible interval, -40% to 63%). The estimates of the effect of receiving all 5 key intervention components were similar. CONCLUSIONS Despite prior work showing early positive effects, this analysis suggests that the TCC program as delivered did not have positive effects on patient outcomes at 1 year. It is not known whether programs that improve compliance or target specific subgroups would better meet the psychosocial needs of trauma survivors. LEVEL OF EVIDENCE Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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21
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Ridings LE, Davidson TM, Walker J, Winkelmann J, Anton MT, Espeleta HC, Nemeth LS, Streck CJ, Ruggiero KJ. Caregivers' and Young Children's Emotional Health Needs After Pediatric Traumatic Injury. Clin Pediatr (Phila) 2022; 61:560-569. [PMID: 35581720 PMCID: PMC9329229 DOI: 10.1177/00099228221097498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pediatric traumatic injury (PTI) is associated with emotional health difficulties, but most US trauma centers do not adequately address emotional recovery needs. This study aimed to assess families' emotional health needs following PTI and determine how technology could be used to inform early interventions. Individual semi-structured, qualitative interviews were conducted with caregivers of children admitted to a Level I trauma center in the Southeastern United States to understand families' experiences in-hospital and post-discharge. Participants included 20 caregivers of PTI patients under age 12 (M = 6.4 years; 70% male, 45% motor vehicle collision). Thematic analysis was used to analyze data from interviews that were conducted until saturation. Caregivers reported varying emotional needs in hospital and difficulties adjusting after discharge. Families responded enthusiastically to the potential of a technology-enhanced resource for families affected by PTI. A cost-effective, scalable intervention is needed to promote recovery and has potential for widespread pediatric hospital uptake.
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Affiliation(s)
- Leigh E. Ridings
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M. Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | | | - Jennifer Winkelmann
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Margaret T. Anton
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Hannah C. Espeleta
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Lynne S. Nemeth
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Christian J. Streck
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kenneth J. Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
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22
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Abdalla SM, Cohen GH, Tamrakar S, Sampson L, Moreland A, Kilpatrick DG, Galea S. Mitigating the mental health consequences of mass shootings: An in-silico experiment. EClinicalMedicine 2022; 51:101555. [PMID: 35898317 PMCID: PMC9310116 DOI: 10.1016/j.eclinm.2022.101555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 06/16/2022] [Accepted: 06/22/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND There is emerging evidence that mass shootings are associated with adverse mental health outcomes at the community level. Data from other mass-traumatic events examined the effectiveness of usual care (UC), (i.e., psychological first aid approaches without triage), and stepped care (SC) approaches, with triage, in reducing the burden of post-traumatic stress disorder (PTSD) in a community. METHODS We built an agent-based model of 118,000 people that was demographically comparable to the population of Parkland and Coral Springs, Florida, US. We parametrized the model with data from other traumatic events. Using simulations, we then estimated the community prevalence of PTSD one month following the Stoneman Douglas High School (Florida, US) shooting and reported the potential reach, effectiveness, and cost effectiveness of different what-if treatment scenarios (SC or UC) over a two-year period. FINDINGS One month following the mass shooting, PTSD prevalence in the community was 11.3% (95% CI: 11.1-11.5%). The reach of SC was 3461 (95% CI: 3573-3736) per 10,000 and the reach of UC was 2457 (95% CI: 2401-2510) per 10,000. SC was superior to UC in reducing PTSD prevalence, yielding, after two years, a risk difference of -0.044 (95% CI, -0.046 to -0.042) and a risk ratio of 0.452 (95% CI, 0.437-0.468). SC was also superior to UC in reducing the persistence of PTSD, yielding, after two years, a risk difference of -0.39 (95% CI, -0.401 to -0.379) and a risk ratio of 0.452 (95% CI, 0.439-0.465). The incremental cost-effectiveness of SC compared to UC was $2718.49 per DALYs saved, and $0.47 per PTSD-free day. INTERPRETATION This simulation demonstrated the potential benefits of different community-level approaches in mitigating the burden of PTSD following a mass shooting. These results warrant further research on community-based interventions to mitigate the mental health consequences of mass shootings. FUNDING None.
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Affiliation(s)
- Salma M. Abdalla
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
- Corresponding author at: Epidemiology Department, School of Public Health, Boston University, 715 Albany Street - Talbot 510E, Boston, MA 02118.
| | - Gregory H. Cohen
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
| | - Shailesh Tamrakar
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
| | - Laura Sampson
- Epidemiology Department, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Angela Moreland
- Medical University of South Carolina, South Carolina, United States
| | | | - Sandro Galea
- Epidemiology Department, School of Public Health, Boston University, Boston, United States
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23
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Nguyen J, Whiteside LK, Bulger EM, Veach L, Moloney K, Russo J, Nehra D, Wang J, Zatzick DF. Post-traumatic stress disorder (PTSD) symptoms and alcohol and drug use comorbidity at 25 US level I trauma centers. Trauma Surg Acute Care Open 2022; 7:e000913. [PMID: 35979039 PMCID: PMC9358953 DOI: 10.1136/tsaco-2022-000913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background Questions regarding the extent to which post-traumatic stress disorder (PTSD) is comorbid with alcohol and drug use are particularly germane in an era when the American College of Surgeons Committee on Trauma (ACS-COT) is considering policy requiring screening, intervention and/or referral services for patients presenting with psychological sequalae of traumatic injury. Literature review revealed few multisite trauma-center-based investigations that have assessed the association between PTSD symptoms and alcohol and drug use comorbidities in injured patients. Methods This investigation was a secondary analysis of baseline data collected prior to randomization in a 25-site trauma center pragmatic clinical trial. All 635 patients included in the investigation had elevated PTSD symptom levels at the time of trauma center admission. Self-report questionnaire screening, laboratory toxicology results, and electronic health record data were combined to assess the frequencies of alcohol, stimulant (i.e., amphetamine and cocaine), opioid and marijuana use comorbidities for injured patients. Logistic regression was used to assess the associations between demographic and injury characteristics and alcohol and drug use comorbidity. Results The frequency of patients with one or more alcohol or substance use comorbidity was between 62% and 79%. Over 50% of patients were positive for one or more alcohol or cannabis comorbidity. Approximately 26% of patients were positive for stimulants and 10% for opioid comorbidity. Discussion This multisite investigation suggests that between 62% and 79% of hospitalized injury survivors with elevated PTSD symptoms have one or more alcohol or drug use comorbidity. Orchestrated ACS-COT policy and trauma center service delivery development should incorporate the key finding that a substantial majority of patients with high levels of psychological distress (eg, elevated PTSD symptoms) may have alcohol and drug use comorbidities. Level of evidence Level II (epidemiological investigation of untreated controls from a multisite randomized clinical trial) Trial registration number NCT02655354.
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Affiliation(s)
- Jefferson Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Laura Veach
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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24
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McBain SA, Stoycos S, Doenges T. Breaking Silos to Address Medical Trauma: The Need for Integration of Trauma and Health Psychology Training. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09897-2. [PMID: 35841442 DOI: 10.1007/s10880-022-09897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) following a traumatic injury is a significant public health concern impacting approximately a third of traumatically injured patients. In 2018, the American College of Surgeons (ACS) Committee on Trauma recommended implementation of PTSD screening and brief intervention in level 1 trauma centers to meet the mental health needs of this underserved population. In March 2022, ACS revised its standards to include a requirement for mental health screening and referral process in level 1 and level 2 trauma centers. However, implementation of these programs has been limited. One barrier to implementation has been the lack of cross-trained trauma and health psychologists to support the development and implementation of trauma-focused programs in acute and critical care settings. This paper is a call to action to bring together experts in the fields of trauma and health psychology to effectively address training gaps in post-injury PTSD and medical traumatic stress. Through development of trauma and health psychology cross-training models, the field of psychology can collaborate to meet the increasing demand for trauma-focused psychologists in acute and critical care settings.
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Affiliation(s)
- Sacha A McBain
- Departments of Psychiatry & Surgery, College of Medicine, University of Arkansas for Medical Sciences, 4301 W Markham Street, Little Rock, AR, 72205, USA.
| | - Sarah Stoycos
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
| | - Tim Doenges
- Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, CO, USA
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25
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Menear M, Girard A, Dugas M, Gervais M, Gilbert M, Gagnon MP. Personalized care planning and shared decision making in collaborative care programs for depression and anxiety disorders: A systematic review. PLoS One 2022; 17:e0268649. [PMID: 35687610 PMCID: PMC9187074 DOI: 10.1371/journal.pone.0268649] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/04/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies-personalized care planning and shared decision making-within collaborative care programs for depression and anxiety disorders in primary care. METHODS We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. RESULTS In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. CONCLUSION This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.
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Affiliation(s)
- Matthew Menear
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Ariane Girard
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Michèle Dugas
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
| | - Michel Gervais
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Michel Gilbert
- Centre National d’Excellence en Santé Mentale, Quebec, Quebec, Canada
| | - Marie-Pierre Gagnon
- VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada
- Faculty of Nursing, Université Laval, Quebec, Quebec, Canada
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26
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Sinkler MA, Furdock RJ, Vallier HA. Treating trauma more effectively: A review of psychosocial programming. Injury 2022; 53:1756-1764. [PMID: 35491278 DOI: 10.1016/j.injury.2022.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 02/02/2023]
Abstract
IMPORTANCE Traumatic events are the leading cause of life-altering disability in adults of working age. The management of patients with traumatic injury has substantially improved due to development of sophisticated trauma centers increasing survival after injury. Unlike the adoption of the trauma system framework, the same has not occurred with specialized trauma recovery services to include mental and social health needs. This literature review will discuss unique issues facing trauma survivors, some current recovery programs available, outcomes and benefits of these programs, and barriers that impair widespread incorporation. OBSERVATIONS Studies have shown that patients with traumatic injury experience reduction in quality of life and concurrent threats to mental health, including post-traumatic stress disorder (PTSD), alcohol use disorder, and recreational substance abuse. Patients with traumatic injury also have high recidivism rates, low pain management satisfaction, and poor engagement in care following injury. Screening efforts for PTSD, mental illness, and alcohol and substance abuse are more widely available interventions. Early coordinated efforts included dedicated multidisciplinary recovery teams. Recently, more methodical and organized programs, such as the Trauma Survivors Network, trauma collaborative care, Trauma Recovery Services, and Center of Trauma Survivorship, have been implemented. CONCLUSIONS AND RELEVANCE The enrollment of patients with traumatic injury in novel programs to enhance recovery has led to heightened self-efficacy, better coping mechanisms, and increased use of mental health services. Additionally, trauma recovery services have been shown to reduce recidivism and have generated cost savings for hospital systems. While positive outcomes have been demonstrated, they are not consistently predictable. Barriers for widespread implementation include limitations of time, funding, and institutional support. This article describes models of successful programs initiated within some trauma centers, which may be duplicated to serve future trauma survivors.
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Affiliation(s)
- Margaret A Sinkler
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ryan J Furdock
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, OH.
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27
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Al Jowf GI, Ahmed ZT, An N, Reijnders RA, Ambrosino E, Rutten BPF, de Nijs L, Eijssen LMT. A Public Health Perspective of Post-Traumatic Stress Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6474. [PMID: 35682057 PMCID: PMC9180718 DOI: 10.3390/ijerph19116474] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 11/25/2022]
Abstract
Trauma exposure is one of the most important and prevalent risk factors for mental and physical ill-health. Prolonged or excessive stress exposure increases the risk of a wide variety of mental and physical symptoms, resulting in a condition known as post-traumatic stress disorder (PTSD). The diagnosis might be challenging due to the complex pathophysiology and co-existence with other mental disorders. The prime factor for PTSD development is exposure to a stressor, which variably, along with peritraumatic conditions, affects disease progression and severity. Additionally, many factors are thought to influence the response to the stressor, and hence reshape the natural history and course of the disease. With sufficient knowledge about the disease, preventive and intervenient methods can be implemented to improve the quality of life of the patients and to limit both the medical and economic burden of the disease. This literature review provides a highlight of up-to-date literature on traumatic stress, with a focus on causes or triggers of stress, factors that influence response to stress, disease burden, and the application of the social-ecological public health model of disease prevention. In addition, it addresses therapeutic aspects, ethnic differences in traumatic stress, and future perspectives, including potential biomarkers.
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Affiliation(s)
- Ghazi I. Al Jowf
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- Department of Public Health, College of Applied Medical Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Ziyad T. Ahmed
- College of Medicine, Sulaiman Al Rajhi University, Al-Bukairyah 52726, Saudi Arabia;
| | - Ning An
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Rick A. Reijnders
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Elena Ambrosino
- Institute for Public Health Genomics, Department of Genetics and Cell Biology, Research School GROW (School for Oncology and Reproduction), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands;
| | - Bart P. F. Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Laurence de Nijs
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
| | - Lars M. T. Eijssen
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Faculty of Health, Medicine and Life Sciences, Maastricht University Medical Centre, 6200 MD Maastricht, The Netherlands; (N.A.); (R.A.R.); (B.P.F.R.); (L.d.N.)
- European Graduate School of Neuroscience, Maastricht University, 6200 MD Maastricht, The Netherlands
- Department of Bioinformatics—BiGCaT, School of Nutrition and Translational Research in Metabolism (NUTRIM), Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
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28
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Whiteside LK, Huynh L, Morse S, Hall J, Meurer W, Banta-Green CJ, Scheuer H, Cunningham R, McGovern M, Zatzick DF. The Emergency Department Longitudinal Integrated Care (ED-LINC) intervention targeting opioid use disorder: A pilot randomized clinical trial. J Subst Abuse Treat 2022; 136:108666. [PMID: 34952745 PMCID: PMC9056018 DOI: 10.1016/j.jsat.2021.108666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/09/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Opioid use disorder (OUD) and related comorbid conditions are highly prevalent among patients presenting to emergency department (ED) settings. Research has developed few comprehensive disease management strategies for at-risk patients presenting to the ED that both decrease illicit opioid use and improve initiation and retention in medication treatment for OUD (MOUD). METHODS The research team conducted a pilot pragmatic clinical trial that randomized 40 patients presenting to a single ED to a collaborative care intervention (n = 20) versus usual care control (n = 20) conditions. Interviewers blinded to patient intervention and control group status followed-up with participants at 1, 3, and 6 months after presentation to the ED. The 3-month Emergency Department Longitudinal Integrated Care (ED-LINC) collaborative care intervention for patients at risk for OUD included: 1) a Brief Negotiated Interview at bedside, 2) overdose education and facilitation of MOUD, 3) longitudinal proactive care management, 4) utilization of the statewide health information exchange platform for 24/7 tracking of recurrent ED utilization, and 5) weekly caseload supervision that incorporated measurement-based care treatment assessment with stepped-up care for patients with recalcitrant symptoms. RESULTS Overall, the ED-LINC intervention was feasibly delivered and acceptable to patients. The pilot study achieved >80% follow-up rates at 1, 3, and 6 months. In adjusted longitudinal mixed model regression analyses, no statistically significant differences existed in days of opioid use over the past 30 days for ED-LINC intervention patients when compared to patients receiving usual care (incidence-rate ratio (IRR) 1.50, 95% CI 0.54-4.16). The unadjusted mean number of days of illicit opioid use decreased at the 1-month and 3-month follow-up time points for both groups. ED-LINC intervention patients had increased rates of MOUD initiation compared to control patients (50% versus 30%); intervention versus control comparisons did not achieve statistical significance, although power to detect significant differences in the pilot was limited. CONCLUSIONS The ED-LINC intervention for patients with OUD can be feasibly implemented and warrants testing in larger scale, adequately powered randomized pragmatic clinical trial investigations. CLINICALTRIALS gov NCT03699085.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Ly Huynh
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Sophie Morse
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Jane Hall
- Department of Emergency Medicine, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - William Meurer
- Department of Emergency Medicine, University of Michigan Medical School, 1500 E Medical Center Drive, Ann Arbor, MI 48109-5303, United States of America.
| | - Caleb J Banta-Green
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Hannah Scheuer
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
| | - Rebecca Cunningham
- Department of Emergency Medicine, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Rd Bldg. 10-G080, Ann Arbor, MI 48109-2800, United States of America.
| | - Mark McGovern
- Department of Psychiatry & Behavioral Sciences and Department of Medicine, Stanford University School of Medicine, 1520 Page Mill Road Suite 158, MC 5721, Stanford, CA 94305, United States of America.
| | - Douglas F Zatzick
- Department of Psychiatry & Behavioral Sciences & Harborview Injury Prevention and Research Center, University of Washington School of Medicine, 325 9th Ave., Seattle, WA 98104-2499, United States of America.
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Hink AB, Killings X, Bhatt A, Ridings LE, Andrews AL. Adolescent Suicide—Understanding Unique Risks and Opportunities for Trauma Centers to Recognize, Intervene, and Prevent a Leading Cause of Death. CURRENT TRAUMA REPORTS 2022; 8:41-53. [PMID: 35399601 PMCID: PMC8976221 DOI: 10.1007/s40719-022-00223-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 11/21/2022]
Abstract
Purpose of Review This provides up-to-date epidemiology of adolescent suicide and risk factors for suicide and highlights the overlap of risks for suicide and injury. It reviews signs and symptoms, and the up-to-date evidence on screening for depression, post-traumatic stress disorder (PTSD), suicide, substance abuse, and lethal means, and offers strategies of implementation in trauma centers. Recent Findings The incidence of adolescent suicide has continued to rise in the USA to 6.5 per 100,000, with notable racial disparities. The risk factors are complex, but many pre-existing risk factors and sequela after injury such as exposures to violence, suicidal behaviors, substance abuse, depression and post-traumatic stress disorder, and specific injuries including traumatic brain injury and spinal cord injury have further emerged as risks. Studies show rates of suicidality as high as 30% in the acute care setting. There are short screening instruments that can be used to universally screen for depression and suicidality in adolescent trauma patients. Step-up models of care for PTSD are promising to increase screening and services after injury. Lethal means counseling, secure firearm storage practices, and firearm safety policies can reduce the risk of suicide. Summary Suicide is the second leading cause of death in US adolescents, and trauma patients have significant risk factors for mental illness and suicidality before and after injury. Trauma centers should strongly consider screening adolescents, establish strategies for mental health support and referrals, and provide lethal means counseling to help prevent suicide.
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Berger M, Fernando S, Churchill A, Cornish P, Henderson J, Shah J, Tee K, Salmon A. Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults. Early Interv Psychiatry 2022; 16:327-341. [PMID: 34018335 PMCID: PMC9292436 DOI: 10.1111/eip.13180] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 11/28/2022]
Abstract
AIMS Many young people with mental health and/or substance use concerns do not have access to timely, appropriate, and effective services. Within this context, stepped care models (SCMs) have emerged as a guiding framework for care delivery, inspiring service innovations across the globe. However, substantial gaps remain in the evidence for SCMs as a strategy to address the current systemic challenges in delivering services for young people. This scoping review aims to identify where these gaps in evidence exist, and the next steps for addressing them. METHODS A scoping review was conducted involving both peer-reviewed and grey literature. Eligible studies explored SCMs implemented in the various health care settings accessed by young people aged 12-24 seeking treatment for mental health and substance use challenges. After screening titles and abstracts, two reviewers examined full-text articles and extracted data to create a descriptive summary of the models. RESULTS Of the 656 studies that were retrieved, 51 studies were included and grouped by study team for a final yield of 43 studies. Almost half of the studies were focused on the adult population (i.e., 18 and over), and most did not specify interventions for young people. Among the SCMs, substantial variability was found in almost every aspect of the models. CONCLUSIONS Considering the current body of evidence, there is an urgent need for a consensus position on the definition, implementation, and outcome measures required for rigorously assessing the utility of SCMs for young people.
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Affiliation(s)
- Mai Berger
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saranee Fernando
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - AnnMarie Churchill
- Student Wellness and Counseling Centre, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Cornish
- Director of Counseling and Psychological Services, University of California, Berkeley, Berkeley, California, USA.,Honorary Research Professor, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Joanna Henderson
- Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Jai Shah
- Prevention and Early Intervention Program for Psychosis (PEPP-Montreal), Douglas Mental Health University Institute, Montreal, Quebec, Canada.,ACCESS Open Minds, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Karen Tee
- Foundry, Vancouver, British Columbia, Canada
| | - Amy Salmon
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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31
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Kettlewell J, Radford K, Kendrick D, Patel P, Bridger K, Kellezi B, Das Nair R, Jones T, Timmons S. Qualitative study exploring factors affecting the implementation of a vocational rehabilitation intervention in the UK major trauma pathway. BMJ Open 2022; 12:e060294. [PMID: 35361654 PMCID: PMC8971801 DOI: 10.1136/bmjopen-2021-060294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/02/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This study aimed to: (1) understand the context for delivering a trauma vocational rehabilitation (VR) intervention; (2) identify potential barriers and enablers to the implementation of a VR intervention post-trauma. DESIGN Qualitative study. Data were collected in person or via phone using different methods: 38 semistructured interviews, 11 informal 'walk-through care pathways' interviews, 5 focus groups (n=25), 5 codesign workshops (n=43). Data were thematically analysed using the framework approach, informed by the Consolidated Framework for Implementation Research. SETTING Stakeholders recruited across five UK major trauma networks. PARTICIPANTS A variety of stakeholders were recruited (n=117) including trauma survivors, rehabilitation physicians, therapists, psychologists, trauma coordinators and general practitioners. We recruited 32 service users (trauma survivors or carers) and 85 service providers. RESULTS There were several issues associated with implementing a trauma VR intervention including: culture within healthcare/employing organisations; extent to which healthcare systems were networked with other organisations; poor transition between different organisations; failure to recognise VR as a priority; external policies and funding. Some barriers were typical implementation issues (eg, funding, policies, openness to change). This study further highlighted the challenges associated with implementing a complex intervention like VR (eg, inadequate networking/communication, poor service provision, perceived VR priority). Our intervention was developed to overcome these barriers through adapting a therapist training package, and by providing early contact with patient/employer, a psychological component alongside occupational therapy, case coordination/central point of contact, and support crossing sector boundaries (eg, between health/employment/welfare). CONCLUSIONS Findings informed the implementation of our VR intervention within the complex trauma pathway. Although we understand how to embed it within this context, the success of its implementation needs to be measured as part of a process evaluation in a future trial.
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Affiliation(s)
- Jade Kettlewell
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Kate Radford
- Centre for Rehabilitation & Ageing Research, University of Nottingham School of Medicine, Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Priya Patel
- Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Kay Bridger
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Blerina Kellezi
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
- Department of Psychology, Nottingham Trent University, Nottingham, UK
| | - Roshan Das Nair
- Institute of Mental Health, University of Nottingham School of Medicine, Nottingham, UK
| | - Trevor Jones
- Centre for Academic Primary Care, University of Nottingham School of Medicine, Nottingham, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership & Learning, Nottingham University Business School, University of Nottingham, Nottingham, UK
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Bulger E, Johnson P, Parker L, Moloney KE, Roberts MK, Vaziri N, Seo S, Nehra D, Thomas P, Zatzick D. Nationwide Survey of Trauma Center Screening and Intervention Practices for Posttraumatic Stress Disorder, Firearm Violence, Mental Health, and Substance Use Disorders. J Am Coll Surg 2022; 234:274-287. [PMID: 35213489 PMCID: PMC10234338 DOI: 10.1097/xcs.0000000000000064] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) symptoms, firearm violence events, alcohol and drug use problems, and major depression and suicidal ideation are endemic among patients admitted to US trauma centers. Despite increasing policy importance, the current availability of screening and intervention services for this constellation of conditions in US trauma centers is unknown. STUDY DESIGN Trauma program staff at all Level I and Level II trauma centers in the US. (N = 627) were contacted to complete a survey describing screening and intervention procedures for alcohol and drug use problems, PTSD symptoms, depression and suicidality, and firearm violence. Additional questions asked trauma centers about the delivery of peer interventions and information technology capacity for screening and intervention procedures. RESULTS Fifty-one percent of trauma centers (n = 322) responded to the survey. More than 95% of responding sites endorsed routinely screening and/or intervening for alcohol use problems. Routine services addressing PTSD were less common, with 28% of centers reporting routine screening. More than 50% of sites that screened for PTSD used previously established trauma center alcohol use services. Programmatic screening and intervention for firearm injury sequelae was occurring at 30% of sites. CONCLUSION Alcohol screening and intervention is occurring frequently at US trauma centers and appears to be responsive to American College of Surgeons Committee on Trauma verification requirements. Routine screening and intervention services for PTSD and firearm injury were occurring less frequently. Regular national surveys may be a key element of tracking progress in national mental health and substance use screening, intervention, and referral policy.
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Affiliation(s)
- Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Peyton Johnson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, PA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Michelle K Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
- Department of Anthropology, University of Kentucky College of Arts and Sciences, Lexington, KY
| | - Natalie Vaziri
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Sara Seo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Peter Thomas
- Powers Pyles Sutter & Verville PC, Washington, DC
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, WA
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33
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Wright HM, Fuessel-Hermann D, Pazdera M, Lee S, Ridge B, Kim JU, Konopacki K, Hilton L, Greensides M, Langenecker SA, Smith AJ. Preventative Care in First Responder Mental Health: Focusing on Access and Utilization via Stepped Telehealth Care. FRONTIERS IN HEALTH SERVICES 2022; 2:848138. [PMID: 36925868 PMCID: PMC10012773 DOI: 10.3389/frhs.2022.848138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022]
Abstract
First responders are at high risk for disorders that arise from repeat exposure to stress and trauma (Post Traumatic Stress Disorder, depression, and problematic alcohol use). Although mental health treatments are available, first responders often do not access them, anchored by barriers that include: lack of knowledge, stigma, negative experience with mental health providers, and time-based burdens. In this study, we designed an intervention to address these barriers, extending a Planned-Action framework. Step 1 involved self-report screening for four mental health risks (PTSD, depression, anxiety, and alcohol use risk), delivered to all personnel electronically, who were free to either consent and participate or opt-out. The detection of risk(s) in Step 1 led to scheduling a Step 2 telehealth appointment with a trained clinician. We report descriptive statistics for participation/attrition/utilization in Steps 1 and 2, rates of risk on four mental health variables, and rate of adherence to follow-up treatment recommendations. Step 1: In total, 53.3% of personnel [229 of 429 full-time employees (221 males; eight females; 95% White; 48% paramedic or Emergency Medical Technician; 25% captain; 19% engineer; 7% other)] initially opted-in by consenting and completing the brief remote screening survey. Among those who opted-in and completed (n = 229), 43% screened positive for one or more of the following mental health risks: PTSD (7.9%); depression (9.6%); anxiety (13.5%); alcohol use (36.7%). Step 2: A maximum of three attempts were made to schedule "at risk" individuals into Step 2 (n = 99). Among the 99 who demonstrated a need for mental health treatment (by screening positive for one or more risk), 56 (56.6%) engaged in the telehealth appointment. Of the 56 who participated in Step 2 clinical appointments, 38 were recommended for further intervention (16.6% of full-time personnel who participated). Among the 38 firefighters who were recommended to seek further mental health services, 29 were adherent/followed through (76.3% of those who received recommendations for further services). Taken together, evidence-based, culturally conscious, stepped care models delivered via the virtual/telehealth medium can promote access, utilization, and cost-effective mental health services for first responders. Implications are for informing larger, more rigorous dissemination and implementation efforts.
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Affiliation(s)
- Hannah M Wright
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | | | - Myah Pazdera
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Somi Lee
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Brook Ridge
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Joseph U Kim
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Salt Lake City Veterans Affairs (VA) Medical Center, Salt Lake City, UT, United States
| | - Kelly Konopacki
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Layne Hilton
- United Fire Authority, Salt Lake City, UT, United States
| | | | - Scott A Langenecker
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States
| | - Andrew J Smith
- Department of Psychiatry, University of Utah School of Medicine, Huntsman Mental Health Institute, Salt Lake City, UT, United States.,Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO, United States
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34
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Ruggiero KJ, Anton MT, Davidson TM, deRoon-Cassini TA, Hink AB. It is time to prioritize complete trauma care. J Trauma Acute Care Surg 2022; 92:e18-e21. [PMID: 34591038 DOI: 10.1097/ta.0000000000003423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Kenneth J Ruggiero
- From the Departments of Nursing and Psychiatry and Behavioral Sciences, College of Nursing (K.J.R., T.M.D.), College of Nursing (M.T.A.), Medical University of South Carolina, Charleston, South Carolina; Departments of Surgery, Psychiatry, and Institute for Health and Equity (T.A.dR.-C.), Medical College of Wisconsin, Milwaukee, Wisconsin; and Department of Surgery (A.B.H.), College of Medicine, Medical University of South Carolina, Charleston, South Carolina
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35
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Engstrom A, Moloney K, Nguyen J, Parker L, Roberts M, Moodliar R, Russo J, Wang J, Scheuer H, Zatzick D. A Pragmatic Clinical Trial Approach to Assessing and Monitoring Suicidal Ideation: Results from A National US Trauma Care System Study. Psychiatry 2021; 85:13-29. [PMID: 34932440 PMCID: PMC8916972 DOI: 10.1080/00332747.2021.1991200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Few investigations have comprehensively described methods for assessing and monitoring suicidal ideation in pragmatic clinical trials of mental health services interventions. This investigation's goal was to assess a collaborative care intervention's effectiveness in reducing suicidal ideation and describe suicide monitoring implementation in a nationwide protocol. METHOD The investigation was a secondary analysis of a stepped wedge cluster randomized trial at 25-Level I trauma centers. Injury survivors (N = 635) were randomized to control (n = 370) and intervention (n = 265) conditions and assessed at baseline hospitalization and follow-up at 3-, 6- and 12-months post-injury. The Patient Health Questionnaire (PHQ-9) item-9 was used to evaluate patients for suicidal ideation. Mixed model regression was used to assess intervention versus control group changes in PHQ-9 item-9 scores over time and associations between baseline characteristics and development of suicidal ideation longitudinally. As part of the study implementation process assessment, suicide outreach call logs were also reviewed. RESULTS Over 50% of patients endorsed suicidal ideation at ≥1 assessment. Intervention patients relative to control patients demonstrated reductions in endorsements of suicidal ideation that did not achieve statistical significance (F[3,1461] = 0.74, P = .53). The study team completed outreach phone calls, texts or voice messages to 268 patients with PHQ-9 item-9 scores ≥1 (n = 161 control, n = 107 intervention). CONCLUSIONS Suicide assessment and monitoring can be feasibly implemented in large-scale pragmatic clinical trials. Intervention patients demonstrated less suicidal ideation over time; however, these comparisons did not achieve statistical significance. Intensive pragmatic trial monitoring may mask treatment effects by providing control patients a supportive intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jefferson Nguyen
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, US
| | - Michelle Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, USA
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Department of Psychology, University of California, Los Angeles, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Hannah Scheuer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- School of Social Work, University of Washington, Seattle, USA
| | - Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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36
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Zhao Q, Small DS, Ertefaie A. Selective inference for effect modification via the lasso. J R Stat Soc Series B Stat Methodol 2021; 84:382-413. [DOI: 10.1111/rssb.12483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Qingyuan Zhao
- Department of Pure Mathematics and Mathematical Statistics University of Cambridge Cambridge UK
| | - Dylan S. Small
- Department of Statistics and Data Science University of Pennsylvania Philadelphia Pennsylvania USA
| | - Ashkan Ertefaie
- Department of Biostatistics and Computational Biology University of Rochester Rochester New York USA
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37
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Nehra D, Bulger EM, Maier RV, Moloney KE, Russo J, Wang J, Anderson K, Zatzick DF. A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms. Ann Surg 2021; 274:e364-e369. [PMID: 34225296 PMCID: PMC8434993 DOI: 10.1097/sla.0000000000005043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. SUMMARY AND BACKGROUND DATA Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. METHODS We conducted a secondary analysis of a pragmatic 25-trauma center randomized trial (N = 635). Baseline characteristics of firearm-injured patients (N = 128) were compared with other trauma patients. Mixed model regression was used to identify risk factors for postinjury firearm weapon carriage and PTSD symptoms. RESULTS Firearm injury patients were younger and more likely to be black, male and of lower socioeconomic status, and more likely to carry a firearm in the year before injury. Relative to preinjury, there was a significant drop in firearm weapon carriage at 3- and 6-months postinjury, followed by a return to preinjury levels at 12-months. Firearm injury was significantly and independently associated with an increased risk of postinjury firearm weapon carriage [relative risk = 2.08, 95% confidence interval (1.34, 3.22), P < 0.01] and higher PTSD symptom levels [Beta = 3.82, 95% confidence interval (1.29, 6.35), P < 0.01]. CONCLUSIONS Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels postinjury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months postinjury suggests that there is an important postinjury "teachable moment" that should be targeted with preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
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Affiliation(s)
- Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Ronald V Maier
- Department of Surgery, University of Washington School of Medicine, Seattle, USA
| | - Kathleen E Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
| | - Kristina Anderson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- The Koshka Foundation, Seattle, USA
| | - Douglas F Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, USA
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, USA
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38
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Lotzin A, Hinrichsen I, Kenntemich L, Freyberg RC, Lau W, Gibson K, O’Donnell M. [Skills fOr Life Adjustment and Resilience Program]. PSYCHOTHERAPEUT 2021; 66:533-542. [PMID: 34539085 PMCID: PMC8442514 DOI: 10.1007/s00278-021-00535-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/26/2022]
Abstract
Hintergrund Nach Katastrophen, Traumata und anderen schweren Belastungen entwickelt ein Teil der Betroffenen eine psychische Erkrankung, während ein weiterer Teil anhaltende subklinische Belastungen zeigt, die das psychosoziale Funktionsniveau einschränken. Anhaltend subklinisch belastete Menschen erhalten jedoch selten psychosoziale Unterstützungsangebote. Ziel der Arbeit Vorgestellt wird das Programm „Skills fOr Life Adjustment and Resilience“ (SOLAR), eine Kurzintervention für Menschen mit anhaltender subklinischer Belastung nach Katastrophen und anderen schweren Belastungen. Erste Ergebnisse einer Pilotstudie zur Zufriedenheit mit dem Programm bei Betroffenen werden berichtet. Methoden Das SOLAR-Programm wurde von einem internationalen Konsortium, zusammengesetzt aus Katastrophen- und Traumaexperten, entwickelt. Es beinhaltet 5 wöchentliche Gruppensitzungen, in denen verhaltenstherapeutische Elemente vermittelt werden. Im Rahmen der Pilotstudie nahmen 15 Teilnehmende im Präsenzformat und 15 Teilnehmende mithilfe einer Videokonferenzschaltung während der „Coronavirus Disease 2019“ (COVID-19) Pandemie am SOLAR Programm teil. Nach Abschluss beantworteten die Teilnehmenden den Fragebogen zur Messung der Patientenzufriedenheit (ZUF-8). Ergebnisse Die Teilnehmenden waren „weitgehend“ bis „sehr zufrieden“. In der Präsenzgruppe war die Zufriedenheit über alle Aspekte hinweg geringfügig stärker ausgeprägt als in der Onlinegruppe. Die TrainerInnen bewerteten das Programm als gut durchführbar. Schlussfolgerung Das SOLAR-Programm ist eine vielversprechende Kurzintervention bei anhaltender subklinischer Belastung nach schweren Belastungen, die im Präsenz- oder im videogestützten Format weiter auf seine Wirksamkeit erprobt werden sollte. Im Beitrag werden Praxisempfehlungen zur Durchführung gegeben.
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Affiliation(s)
- Annett Lotzin
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
- Martinistr. 52, 20246 Hamburg, Deutschland
| | - Imke Hinrichsen
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Laura Kenntemich
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Renée-Christin Freyberg
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Winnie Lau
- Phoenix Centre for Posttraumatic Mental Health, The University of Melbourne, Melbourne, Australien
| | - Kari Gibson
- Phoenix Centre for Posttraumatic Mental Health, The University of Melbourne, Melbourne, Australien
| | - Meaghan O’Donnell
- Phoenix Centre for Posttraumatic Mental Health, The University of Melbourne, Melbourne, Australien
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Zatzick D, Moloney K, Palinkas L, Thomas P, Anderson K, Whiteside L, Nehra D, Bulger E. Catalyzing the Translation of Patient-Centered Research Into United States Trauma Care Systems: A Case Example. Med Care 2021; 59:S379-S386. [PMID: 34228020 PMCID: PMC8263139 DOI: 10.1097/mlr.0000000000001564] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The expedient translation of research findings into sustainable intervention procedures is a longstanding health care system priority. The Patient-Centered Outcomes Research Institute (PCORI) has facilitated the development of "research done differently," with a central tenet that key stakeholders can be productively engaged throughout the research process. Literature review revealed few examples of whether, as originally posited, PCORI's innovative stakeholder-driven approach could catalyze the expedient translation of research results into practice. OBJECTIVES This narrative review traces the historical development of an American College of Surgeons Committee on Trauma (ACS/COT) policy guidance, facilitated by evidence supplied by the PCORI-funded studies evaluating the delivery of patient-centered care transitions. Key elements catalyzing the guidance are reviewed, including the sustained engagement of ACS/COT policy stakeholders who have the capacity to invoke system-level implementation strategies, such as regulatory mandates linked to verification site visits. Other key elements, including the encouragement of patient stakeholder voice in policy decisions and the incorporation of end-of-study policy summits in pragmatic comparative effectiveness trial design, are discussed. CONCLUSIONS Informed by comparative effectiveness trials, ACS/COT policy has expedited introduction of the patient-centered care construct into US trauma care systems. A comparative health care systems conceptual framework for transitional care which incorporates Research Lifecycle, pragmatic clinical trial and implementation science models is articulated. When combined with Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE), employed as a targeted implementation strategy, this approach may accelerate the sustainable delivery of high-quality patient-centered care transitions for US trauma care systems.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA
| | - Lawrence Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, CA
| | - Peter Thomas
- Powers Pyles Sutter and Verville PC, Washington, DC
| | - Kristina Anderson
- The Koshka Foundation and Department of Psychiatry and Behavioral Sciences
| | | | - Deepika Nehra
- Surgery, University of Washington School of Medicine, Seattle, WA
| | - Eileen Bulger
- Surgery, University of Washington School of Medicine, Seattle, WA
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Health Professionals' Perspectives on the Efficacy of Using Comprehensive Care to Improve Outcomes in Patients With Traumatic Injury. J Nurs Res 2021; 28:e126. [PMID: 32604337 PMCID: PMC7664980 DOI: 10.1097/jnr.0000000000000396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Barriers related to comprehensive posttrauma care and health outcome monitoring exist. The insights and perspectives of health professionals on this issue may help integrate care experiences to provide continuous care to patients with traumatic injury. Purpose The purpose of this study was to explore the perspectives of health professionals with regard to comprehensive care to improve the outcomes of patients with traumatic injury. Methods Data were collected at two teaching hospitals in Taiwan. In total, 28 health professionals across various disciplines were interviewed in five focus groups. Results Six themes were delineated, including “wound care is a primary concern for patients,” “ineffective health education during the hospital stay,” “patients and families worry about postinjury conditions,” “current continuity of care is not effective,” “lack of standards for discharge planning,” and “incorporation of interdisciplinary care to improve patient outcomes.” Conclusions The experiences of health professionals are useful to the establishment of a foundation for trauma case management and interdisciplinary care for hospitals.
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Fann WC, Hung CC, Chaboyer W, Lee BO. Effectiveness of a Nurse-Delivered Intervention on Illness Perceptions and Quality of Life in Patients With Injury. J Nurs Res 2021; 29:e163. [PMID: 34091568 DOI: 10.1097/jnr.0000000000000439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Research has shown that nursing interventions are able to affect short-term outcomes in patients with injury. However, evidence based on a comprehensive nurse-led intervention may be beneficial for trauma care. PURPOSE This study was designed to assess the effect of a nursing intervention on the illness perceptions and quality of life of patients with injury. METHODS A two-group experimental design and a follow-up period of 12 months were used. Ninety-four patients were randomly assigned to either the experimental group or the control group. A nurse-led cognitive behavioral therapy intervention was used to improve outcomes. RESULTS The illness perception variables of "personal control" and "treatment control" were found to be significantly improved in the experimental group at 3 months after discharge, whereas "emotional perception" was significantly improved at 6 months after discharge. The intervention was also shown to improve "social quality of life" at 6 and 12 months after injury. CONCLUSIONS This study adds new knowledge related to nursing interventions for patients with injury in terms of the intervention achieving longer-term effects than the interventions examined in previous studies. The results highlight the importance of providing interprofessional collaborative care. However, the intervention protocol should be tested further in future studies.
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Affiliation(s)
- Wen-Chih Fann
- MSc, MD, Attending Physician, Department of Emergency Medicine, Chia-Yi Chang Gung Memorial Hospital, Taiwan
| | - Chang-Chiao Hung
- PhD, RN, Associate Professor, Department of Nursing, Chang Gung University of Science and Technology, and Associate Research Fellow, Department of Nursing, Chia-Yi Chang Gung Memorial Hospital, Taiwan
| | - Wendy Chaboyer
- PhD, RN, Professor, School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Queensland, Australia
| | - Bih-O Lee
- PhD, RN, Professor, College of Nursing, Kaohsiung Medical University, Taiwan, and Adjunct Professor, Faculty of Nursing, Universitas Airlangga, Indonesia
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Rauch SAM, Simon NM, Rothbaum BO. Rising Tide: Responding to the Mental Health Impact of the COVID-19 Pandemic. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:243-246. [PMID: 34690589 PMCID: PMC8475908 DOI: 10.1176/appi.focus.19204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
(Reprinted with permission from Depress Anxiety. 2020;37:505-509).
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Zatzick D, Jurkovich G, Heagerty P, Russo J, Darnell D, Parker L, Roberts MK, Moodliar R, Engstrom A, Wang J, Bulger E, Whiteside L, Nehra D, Palinkas LA, Moloney K, Maier R. Stepped Collaborative Care Targeting Posttraumatic Stress Disorder Symptoms and Comorbidity for US Trauma Care Systems: A Randomized Clinical Trial. JAMA Surg 2021; 156:430-474. [PMID: 33688908 PMCID: PMC7948109 DOI: 10.1001/jamasurg.2021.0131] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022]
Abstract
Importance To date, few multisite investigations have evaluated early interventions for injured patients with posttraumatic stress disorder (PTSD) symptoms. Objective To simultaneously assess the effectiveness and implementation of a brief stepped collaborative care intervention targeting PTSD and comorbidity. Design, Setting, and Participants A stepped-wedge cluster randomized clinical trial was conducted at 25 US level I trauma centers. Participants included hospitalized survivors of physical injury who underwent a 2-step evaluation for PTSD symptoms. Patients reporting high levels of distress on the PTSD Checklist (PCL-C) were randomized (N = 635) per the stepped-wedge protocol to enhanced usual care control (n = 370) or intervention (n = 265) conditions. The study was conducted from January 4, 2016, through November 2018. Data analysis was performed from November 4, 2019, to December 8, 2020. Interventions The Trauma Survivors Outcomes and Support collaborative care intervention included proactive injury case management that assisted patients transitioning from hospital inpatient to outpatient and community settings. The intervention also integrated evidence-based pharmacotherapy and psychotherapeutic elements targeting PTSD symptoms and comorbidity. Main Outcomes and Measures The primary study outcome was PTSD symptoms assessed with the PCL-C at baseline in the surgical ward and at 3, 6, and 12 months postinjury. Secondary outcomes included depressive symptoms, alcohol use, and physical function. Subgroup analyses examined the effect of baseline risk factors for enduring PTSD and quality of protocol implementation on study outcomes. Primary statistical analyses were conducted using the intent-to-treat sample. Results A total of 327 men (51.5%) were included in analysis; mean (SD) age was 39.0 (14.2) years. The investigation attained follow-up of 75% to 80% of the participants at 3 to 12 months. The intervention lasted a mean (SD) of 122 (132) minutes. Mixed model regression analyses revealed statistically significant changes in PCL-C scores for intervention patients compared with control patients at 6 months (difference, -2.57; 95% CI, -5.12 to -0.03; effect size, 0.18; P < .05) but not 12 months (difference, -1.27; 95% CI, -4.26 to 1.73; effect size, 0.08; P = .35). Subgroup analyses revealed larger PTSD treatment effects for patients with 3 or more baseline risk factors for enduring PTSD and for patients, including firearm injury survivors, treated at trauma centers with good or excellent protocol implementation. Intervention effects for secondary outcomes did not attain statistical significance. Conclusions and Relevance A brief stepped collaborative care intervention was associated with significant 6-month but not 12-month PTSD symptom reductions. Greater baseline PTSD risk and good or excellent trauma center protocol implementation were associated with larger PTSD treatment effects. Orchestrated efforts targeting policy and funding should systematically incorporate the study findings into national trauma center requirements and verification criteria. Trial Registration ClinicalTrials.gov Identifier: NCT02655354.
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Affiliation(s)
- Douglas Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Gregory Jurkovich
- Department of Surgery, UC Davis School of Medicine, Sacramento, California
| | - Patrick Heagerty
- Department of Biostatistics, University of Washington School of Public Health, Seattle
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Doyanne Darnell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Lea Parker
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Psychology, Drexel University College of Arts and Sciences, Philadelphia, Pennsylvania
| | - Michelle K. Roberts
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle
| | - Rddhi Moodliar
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Department of Psychology, University of California, Los Angeles
| | - Allison Engstrom
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle
| | - Eileen Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lauren Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle
| | - Lawrence A. Palinkas
- Department of Children, Youth and Families, USC Suzanne Dworak-Peck School of Social Work, Los Angeles, California
| | - Kathleen Moloney
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | - Ronald Maier
- Department of Surgery, University of Washington School of Medicine, Seattle
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Haider A, Shahbaz H. Leveraging Collaborative Care Models to Mitigate Posttraumatic Stress Disorder After Injury: We Can Do This! JAMA Surg 2021; 156:442-443. [PMID: 33688934 DOI: 10.1001/jamasurg.2021.0132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Adil Haider
- Aga Khan University, Karachi, Pakistan.,Deputy Editor, JAMA Surgery
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McCarty CA, Zatzick DF, Marcynyszyn LA, Wang J, Hilt R, Jinguji T, Quitiquit C, Chrisman SPD, Rivara FP. Effect of Collaborative Care on Persistent Postconcussive Symptoms in Adolescents: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e210207. [PMID: 33635325 PMCID: PMC7910815 DOI: 10.1001/jamanetworkopen.2021.0207] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
IMPORTANCE Despite the high level of impairment for adolescents with persistent postconcussive symptoms, few studies have tested whether such problems can be remediated. OBJECTIVE To examine whether collaborative care treatment is associated with improvements in postconcussive, quality of life, anxiety, and depressive symptoms over 1 year, compared with usual care. DESIGN, SETTING, AND PARTICIPANTS The Collaborative Care Model for Treatment of Persistent Symptoms After Concussion Among Youth II Trial was a randomized clinical trial conducted from March 2017 to May 2020 with follow-up assessments at 3, 6, and 12 months. Participants were recruited from pediatric primary care, sports medicine, neurology, and rehabilitation clinics in western Washington. Adolescents aged 11 to 18 years with a diagnosed sports-related or recreational-related concussion within the past 9 months and with at least 3 symptoms persisting at least 1 month after injury were eligible. Data analysis was performed from June to September 2020. INTERVENTIONS The collaborative care intervention included cognitive behavioral therapy and care management, delivered mostly through telehealth, throughout the 6-month treatment period, with enhanced medication consultation when warranted. The comparator group was usual care provided in specialty clinics. MAIN OUTCOMES AND MEASURES Primary outcomes were adolescents' reports of postconcussive, quality of life, anxiety, and depressive symptoms. Secondary outcomes were parent-reported symptoms. RESULTS Of the 390 eligible adolescents, 201 (51.5%) agreed to participate, and 200 were enrolled (mean [SD] age, 14.7 [1.7] years; 124 girls [62.0%]), with 96% to 98% 3- to 12-month retention. Ninety-nine participants were randomized to usual care, and 101 were randomized to collaborative care. Adolescents who received collaborative care reported significant improvements in Health Behavior Inventory scores compared with usual care at 3 months (3.4 point decrease; 95% CI, -6.6 to -0.1 point decrease) and 12 months (4.1 point decrease; 95% CI, -7.7 to -0.4 point decrease). In addition, youth-reported Pediatric Quality of Life Inventory scores at 12 months improved by a mean of 4.7 points (95% CI, 0.05 to 9.3 points) in the intervention group compared with the control group. No differences emerged by group over time for adolescent depressive or anxiety symptoms or for parent-reported outcomes. CONCLUSIONS AND RELEVANCE Although both groups improved over time, youth receiving the collaborative care intervention had fewer symptoms and better quality of life over 1 year. Intervention delivery through telehealth broadens the reach of this treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03034720.
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Affiliation(s)
- Carolyn A. McCarty
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
| | - Douglas F. Zatzick
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Lyscha A. Marcynyszyn
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, University of Washington, Seattle
| | - Jin Wang
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
| | - Robert Hilt
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
- Seattle Children’s Department of Psychiatry and Behavioral Medicine, University of Washington, Seattle
| | - Thomas Jinguji
- Department of Pediatrics, University of Washington, Seattle
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle
| | - Celeste Quitiquit
- Department of Pediatrics, University of Washington, Seattle
- Department of Orthopedics and Sports Medicine, University of Washington, Seattle
| | - Sara P. D. Chrisman
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
| | - Frederick P. Rivara
- Seattle Children’s Research Institute, Center for Child Health, Behavior and Development, University of Washington, Seattle
- Department of Pediatrics, University of Washington, Seattle
- Harborview Injury Prevention and Research Center, University of Washington, Seattle
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Whiteside LK, Vrablik MC, Russo J, Bulger EM, Nehra D, Moloney K, Zatzick DF. Leveraging a health information exchange to examine the accuracy of self-report emergency department utilization data among hospitalized injury survivors. Trauma Surg Acute Care Open 2021; 6:e000550. [PMID: 33553651 PMCID: PMC7845668 DOI: 10.1136/tsaco-2020-000550] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/07/2020] [Accepted: 01/05/2021] [Indexed: 11/09/2022] Open
Abstract
Background Accurate acute care medical utilization history is an important outcome for clinicians and investigators concerned with improving trauma center care. The objective of this study was to examine the accuracy of self-report emergency department (ED) utilization compared with utilization obtained from the Emergency Department Information Exchange (EDIE) in admitted trauma surgery patients with comorbid mental health and substance use problems. Methods This is a retrospective cohort study of 169 injured patients admitted to the University of Washington’s Harborview Level I Trauma Center. Patients had high levels of post-traumatic stress disorder and depressive symptoms, suicidal ideation and alcohol comorbidity. The investigation used EDIE, a novel health technology tool that collects information at the time a patient checks into any ED in Washington and other US states. Patterns of EDIE-documented visits were described, and the accuracy of injured patients’ self-report visits was compared with EDIE-recorded visits during the course of the 12 months prior to the index trauma center admission. Results Overall, 45% of the sample (n=76) inaccurately recalled their ED visits during the past year, with 36 participants (21%) reporting less ED visits than EDIE indicated and 40 (24%) reporting more ED visits than EDIE indicated. Patients with histories of alcohol use problems and major psychiatric illness were more likely to either under-report or over-report ED health service use. Discussion Nearly half of all patients were unable to accurately recall ED visits in the previous 12 months compared with EDIE, with almost one-quarter of patients demonstrating high levels of disagreement. The improved accuracy and ease of use when compared with self-report make EDIE an important tool for both clinical and pragmatic trial longitudinal outcome assessments. Orchestrated investigative and policy efforts could further examine the benefits of introducing EDIE and other information exchanges into routine acute care clinical workflows. Level of evidence II/III. Trial registration number ClinicalTrials.gov NCT02274688.
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Affiliation(s)
- Lauren K Whiteside
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Marie C Vrablik
- Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Joan Russo
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Eileen M Bulger
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Deepika Nehra
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kathleen Moloney
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Douglas F Zatzick
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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Kendrick D, das Nair R, Kellezi B, Morriss R, Kettlewell J, Holmes J, Timmons S, Bridger K, Patel P, Brooks A, Hoffman K, Radford K. Vocational rehabilitation to enhance return to work after trauma (ROWTATE): protocol for a non-randomised single-arm mixed-methods feasibility study. Pilot Feasibility Stud 2021; 7:29. [PMID: 33472707 PMCID: PMC7816441 DOI: 10.1186/s40814-021-00769-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Traumatic injuries are common amongst working-age adults. Survivors often experience physical and psychological problems, reduced quality of life and difficulty returning to work. Vocational rehabilitation improves work outcomes for a range of conditions but evidence of effectiveness for those with traumatic injuries is lacking. This study assesses feasibility of delivering a vocational rehabilitation intervention to enhance return to work and improve quality of life and wellbeing in people with at least moderate trauma to inform design of a definitive randomised controlled trial (RCT). Methods Non-randomised, single-arm, multi-centre mixed-methods feasibility study with nested case studies and qualitative study. The case studies comprise interviews, observations of clinical contacts and review of clinical records. The qualitative study comprises interviews and/or focus groups. Participants will be recruited from two UK major trauma centres. Participants will comprise 40 patients aged 16–69 with an injury severity score of > 8 who will receive the intervention and complete questionnaires. Interviews will be conducted with 10 patients and their occupational therapists (OTs), clinical psychologists (CPs), employers and commissioners of rehabilitation services. Fidelity will be assessed in up to six patients by observations of OT and CP—patient contacts, review of patient records and intervention case report forms. OT and CP training will be evaluated using questionnaires and competence to deliver the intervention assessed using a team objective structured clinical examination and written task. Patients participating in and those declining participation in the study will be invited to take part in interviews/focus groups to explore barriers and facilitators to recruitment and retention. Outcomes include recruitment and retention rates, intervention fidelity, OT and CP competence to deliver the intervention, experiences of delivering or receiving the intervention and factors likely to influence definitive trial delivery. Discussion Effective vocational rehabilitation interventions to enhance return to work amongst trauma patients are urgently needed because return to work is often delayed, with detrimental effects on health, financial stability, healthcare resource use and wider society. This protocol describes a feasibility study delivering a complex intervention to enhance return to work in those with at least moderate trauma. Trial registration ISRCTN: 74668529. Prospectively registered on 23 January 20
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Affiliation(s)
- Denise Kendrick
- School of Medicine, University Park, Floor 13, Tower Building, Nottingham, NG7 2RD, UK.
| | - Roshan das Nair
- School of Medicine, Institute of Mental Health, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Blerina Kellezi
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK
| | - Richard Morriss
- School of Medicine, Institute of Mental Health, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Jade Kettlewell
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Jain Holmes
- School of Medicine, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Stephen Timmons
- Centre for Health Innovation, Leadership and Learning, Nottingham University Business School, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, UK
| | - Kay Bridger
- School of Medicine, University Park, Floor 13, Tower Building, Nottingham, NG7 2RD, UK
| | - Priya Patel
- Centre for Trauma Sciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT, UK
| | - Adam Brooks
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK
| | - Karen Hoffman
- Centre for Trauma Sciences, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark St, London, E1 2AT, UK
| | - Kathryn Radford
- School of Medicine, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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Kirven JC, Everhart JS, DiBartola AC, Jones J, Flanigan DC, Harrison R. Interventional Efforts to Reduce Psychological Distress After Orthopedic Trauma: A Systematic Review. HSS J 2020; 16:250-260. [PMID: 33088239 PMCID: PMC7534886 DOI: 10.1007/s11420-019-09731-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unanticipated severe injury to part of the musculoskeletal system, referred to as orthopedic trauma, can be debilitating. It can also be accompanied by equally debilitating psychological distress, but little is known about the effective interventions for psychological sequelae of orthopedic trauma. QUESTIONS/PURPOSES We sought to determine the effectiveness of interventions on psychological outcomes, such as post-traumatic stress disorder (PTSD), depression, and pain catastrophizing (feelings of helplessness, excessive rumination, and exaggerated description of pain), after major orthopedic trauma. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement as guidelines, we systematically searched Scopus, PubMed, and Google Scholar. Studies included for review were English-language interventional studies in an orthopedic trauma population that included assessment of post-injury psychological distress or disability as either a primary or secondary aim. RESULTS Twelve studies were identified, including six randomized trials, three prospective cohort studies, and three retrospective cohort studies. Study sample sizes ranged from 48 to 569 patients, the mean age ranged from 29 to 52.8 years, and the percentage of male patients ranged from 38 to 90%. We examined four categories of interventions. Peer group treatment (one study) significantly reduced rates of depression but had low participation rates. Brief interventions to teach coping and self-efficacy skills (two studies) decreased depression, pain catastrophizing, and anxiety scores while increasing self-efficacy on short-term follow-up. Individualized counseling and rehabilitation (four studies) resulted in a consistent reduction in the risk of PTSD. Early amputation was found to result in lower rates of PSTD than limb salvage in US military personnel (four studies). One study examined surgeons' confidence in dealing with possible psychological distress; surgeons who participated in a program on collaborative care were significantly more confident that they could help their patients with such issues. CONCLUSION Interventional strategies, including group interventions, brief individual interventions, longitudinal counseling, and consideration of early amputation in selected populations have proved effective in reducing negative psychological sequelae of major orthopedic trauma. Further research that determines the effects of interventions in this population is needed.
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Affiliation(s)
- James C. Kirven
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Joshua S. Everhart
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Alex C. DiBartola
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - Jeremy Jones
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
| | - David C. Flanigan
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA ,grid.412332.50000 0001 1545 0811Sports Medicine, Ohio State University Wexner Medical Center, Columbus, OH USA ,grid.412332.50000 0001 1545 0811Cartilage Restoration Program, Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Ryan Harrison
- grid.412332.50000 0001 1545 0811Department of Orthopaedics, Ohio State University Wexner Medical Center, 725 Prior Hall, Columbus, OH 43210 USA
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Ruggiero KJ, Davidson TM, Anton MT, Bunnell B, Winkelmann J, Ridings LE, Bravoco O, Crookes B, McElligott J, Fakhry SM. Patient Engagement in a Technology-Enhanced, Stepped-Care Intervention to Address the Mental Health Needs of Trauma Center Patients. J Am Coll Surg 2020; 231:223-230. [PMID: 32335320 PMCID: PMC7491334 DOI: 10.1016/j.jamcollsurg.2020.03.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Annually, post-traumatic stress disorder, depression, or both, develop in the first year after injury in more than 400,000 adults treated in US trauma centers (≥20%). Yet, few trauma centers monitor and address mental health recovery, and there is limited evaluation and high structural variability across existing programs. More research is needed to guide efforts to establish such programs and to inform national standards and recommendations. STUDY DESIGN This article describes patient engagement in a stepped-care service to address patients' mental health needs. Trauma-activation patients admitted to our Level I trauma center for at least 24 hours were approached before discharge. Patients were provided education in person at the bedside (step 1), symptom monitoring via a 30-day text-messaging tool (step 2), telephone screening approximately 30 days post injury (step 3), and, when appropriate, mental health treatment referrals and treatment (step 4). RESULTS We approached and educated 1,122 patients (56%) on the floor during a 33-month period. Of these, 1,096 patients (98%) enrolled in our program and agreed to 30-day follow-up mental health screening. We reached 676 patients for the 30-day screen, 243 (36%) of these patients screened positive for post-traumatic stress disorder and/or depression. Most of the 243 patients who graduated to step 4 accepted treatment referrals (68%) or were already receiving services from a provider (7%). Home-based telemental health was preferred by 66% of patients who accepted referrals. CONCLUSIONS This work demonstrates the feasibility of an evidence-based, technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. Strategies to reach a higher percentage of patients in follow-up are needed. We recommend trauma centers test and adopt broad-based approaches to ensure optimal long-term patient outcomes.
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Affiliation(s)
- Kenneth J Ruggiero
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC.
| | - Tatiana M Davidson
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Margaret T Anton
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Brian Bunnell
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Jennifer Winkelmann
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Leigh E Ridings
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Olivia Bravoco
- Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC
| | - Bruce Crookes
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC
| | - James McElligott
- Medical University of South Carolina Center for Telehealth, Medical University of South Carolina, Charleston, SC; South Carolina Telehealth Alliance, Medical University of South Carolina, Charleston, SC
| | - Samir M Fakhry
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC
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50
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A Survey of Trauma Surgeon Perceptions of Resources for Patients With Psychiatric Comorbidities. J Surg Res 2020; 256:31-35. [PMID: 32683053 DOI: 10.1016/j.jss.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 04/04/2020] [Accepted: 06/16/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Psychiatric illness is an independent risk factor for trauma and recidivism and is often comorbid in the trauma population. There is no current standard for the delivery of mental health services in trauma care. The purpose of this study was to gauge trauma surgeon perceptions of needed and currently available resources for this patient population at level 1 trauma centers in the United States. MATERIALS AND METHODS A 10-question survey was developed to capture the estimated volume of psychiatric patients admitted to level 1 trauma centers, their available psychiatric services, and perceived need for resources. It was sent to 27 trauma surgery colleagues at different level 1 trauma centers across the United States using a public survey tool. Descriptive analyses were performed. RESULTS Twenty-two of 27 trauma surgeons responded (81% response rate). Ten centers (48%) estimated admitting 1-5 patients with preexisting serious mental illness weekly, whereas others admitted more. Eight (36%) reported not having acute situational support services available. Ten respondents (46%) did not know how many psychiatric consultants were available at their institution. Twelve surgeons (55%) reported no designated outpatient follow-up for psychiatric issues. Sixteen trauma surgeons (73%) stated that expanded psychiatric services are needed at their trauma center. CONCLUSIONS Trauma patients frequently present with preexisting serious mental illness and many struggle with psychological sequelae of trauma. Over half of the surveyed surgeons reported no outpatient follow-up for these patients, and almost three quarters perceived the need for expansion of psychiatric services. In addition to a lack of resources, these findings highlight an overlooked gap in high-quality patient-centered trauma care.
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