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In 2019, over two million people were hospitalized for traumatic injury (National Center for Injury Prevention, 2019). Injuries are one of the leading causes of death among people in the United States and can result in acquired disability and notable medical spending both for individuals and health care systems (Zonfrillo et al., 2018). Unfortunately, people who sustain a traumatic injury are at an increased risk for numerous mental health conditions including posttraumatic stress disorder (PTSD), depression and anxiety (Wiseman et al., 2013). PTSD prevalence rates are higher among individuals hospitalized for traumatic injury compared to the general population with estimates ranging between 26% to 31% (Joseph et al., 2020; Shih et al., 2010). Bryant and colleagues (2015) examined six-year trajectories of posttraumatic stress following traumatic injury and found that although 73% of the sample fell into the resilient trajectory (i.e., very few symptoms at any point in time), 4% exhibited chronic posttraumatic stress over time and 10% exhibited worsening posttraumatic stress.

Despite the risk of PTSD and other mental health conditions following traumatic injury, few structured programs exist addressing mental health concerns during the acute hospital phase (Wiseman et al., 2013). Although there remains a dearth of empirical research evaluating early intervention during the acute hospitalization phase for mental health following traumatic injury, some work has examined possible points of intervention that may be helpful in preventing PTSD following injury. Outlined below is a list of considerations when working with individuals in the acute phase of recovery following traumatic injury who may be at risk for PTSD. These suggestions are informed both from research in the field of traumatic injury and from my own clinical experiences providing mental health care in a Level 1 trauma center’s traumatic injury unit.

  1. Screen at multiple time points. Early screening during an injury survivor’s hospital stay can allow for the identification of PTSD risk and current acute stress disorder and enable delivery of prevention and intervention protocols to those who might have the greatest need (Wiseman et al., 2013; Zatzick et al., 2013). Screening for PTSD, as well as other risk factors for PTSD such as presence of traumatic brain injury, intensive care unit admission and length of hospital stay may help to better identify individuals at risk for PTSD (Bryant et al., 2015; Galatzer-Levy et al., 2014; Russo et al., 2013). Screening at multiple time points is essential as some individuals may develop worsening and clinically significant PTSD symptoms following hospital discharge (Grieger et al., 2006; Zatzick et al., 2013). Beginning screening during acute hospitalization and continuing to screen at one-, three-, six-, nine- and twelve-month timepoints following discharge can ensure that individuals who are struggling or will struggle are identified and subsequently provided with immediate intervention. In my work with injury survivors, there have been a range of posttraumatic stress symptom presentations. Anecdotally, individuals with typical trauma-related risk factors for PTSD, such as peritraumatic dissociation and peritraumatic fear (Hunt et al., 2018), seemed to present with more severe early posttraumatic stress symptoms.
  2. Attend to the physical injury. Low initial rates of posttraumatic stress symptoms are not uncommon among injury survivors (Bryant et al., 2015; Grieger et al., 2006). It is possible that this is related to the energy and focus being placed on medical needs and acute injury stability (Grieger et al., 2006). Additionally, posttraumatic stress symptoms may present later during longer term injury recovery when survivors are experiencing pain and navigating rehabilitation (Bryant et al., 2015). Attending to the physical injury and awareness of how that may influence posttraumatic stress and mental health is key to providing comprehensive care to injury survivors. Many of the injury survivors I work with identify medical communication and coordination as anxiety provoking. Helping these individuals develop communication skills for effective communication with their medical team appears to boost their self-efficacy around their medical care and reduce anxiety. They also become more informed about their injury and medical care, which could promote longer-term physical recovery. 
  3. Continue to follow up upon discharge. As previously mentioned, some individuals may be missed in early screening. Additionally, new or different needs appropriate for psychological intervention may arise following hospitalization (Bryant et al., 2015; Grieger et al., 2006). Maintaining regular communication following discharge provides a line of communication between clinicians and injury survivors so that if or when needs arise, it is clear where survivors can access support.  In my own work, survivors are often overwhelmed by their injury and medical needs while in the hospital. It can be days, weeks or even months following discharge before posttraumatic stress symptoms or other mental health needs arise. By continuing to stay in contact, we are able to assess changes and intervene quickly and appropriately when necessary, possibly preventing more severe or long-lasting mental health challenges.

The number of people hospitalized each year to traumatic injury is high, and it is crucial that we stay attuned to their mental health. In working with clients who are hospitalized due to traumatic injury, I have become attuned to the unique trajectories and needs that present. Medical stability, injury factors and hospitalization factors all appear to contribute to survivors’ mental health. Early screening and continued follow-up represent one avenue to provide care and support for injury survivors that could protect against mental health challenges in the future.

About the Author

Emmeline N. Taylor, BS, is a third year in clinical psychology doctorate student with an emphasis in trauma at the University of Colorado Colorado Springs. She works in collaboration with the Lyda Hill Institute for Human Resilience as a graduate research assistant and student clinician in a Level 1 trauma center. Emmeline’s research interests include the role of emotion regulation in trauma recovery, and how complex systems strategies can help the field better understand the phenomena of resilience, co-occurring conditions and trauma recovery. She also works part-time as a remote research assistant for the U.S. Department of Veterans Affairs Palo Alto’s Center for Innovation to Implementation. Please note that the opinions expressed in this piece are my own and do not necessarily reflect the position of the University of Colorado Colorado Springs nor the U.S. Department of Veterans Affairs. 


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