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. 2019 Sep 1;154(9):836-843.
doi: 10.1001/jamasurg.2019.1622.

Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries

Therese S Richmond  1   2 , Douglas J Wiebe  2   3 , Patrick M Reilly  2   4 , John Rich  5 , Justine Shults  3 , Nancy Kassam-Adams  6   7
Affiliations

Contributors to Postinjury Mental Health in Urban Black Men With Serious Injuries

Therese S Richmond et al. JAMA Surg. .

Abstract

Importance: Physical injury is associated with postinjury mental health problems, which typically increase disability, cost, recidivism, and self-medication for symptoms.

Objective: To determine risk and protective factors across the life span that contribute to depression and posttraumatic stress symptom severity at 3 months after hospital discharge.

Design, setting, and participants: This prospective cohort study used a 3-month postdischarge follow-up of patients who had been treated at an urban, level 1 trauma center in the Northeastern United States. Men with injuries who were hospitalized, self-identified as black, were 18 years or older, and resided in the Philadelphia, Pennsylvania, region were eligible and consecutively enrolled. Those who were experiencing a cognitive dysfunction or psychotic disorder, hospitalized because of attempted suicide, or receiving current treatment for depression or posttraumatic stress disorder (PTSD) were excluded. Data were collected from January 2013 to October 2017. Data analysis took place from January 2018 to August 2018.

Exposures: A serious injury requiring hospitalization; adverse childhood experiences, childhood neighborhood disadvantage, and preinjury physical and mental health; and emotional resources, injury intent, and acute stress responses.

Main outcomes and measures: Depression and PTSD symptom severity were assessed with the Quick Inventory of Depressive Symptoms-Self-report and the PTSD Check List-5. The a priori hypothesis was that risk and protective factors are associated with depression and PTSD symptom severity. The analytic approach was structural equation modeling.

Results: A total of 623 black men were enrolled. Of these, 502 participants (80.6%) were retained at 3-month follow-up. Their mean (SD) age was 35.6 (14.9) years; 346 (55.5%) had experienced intentional injuries, and the median (range) Injury Severity Score was 9 (1-45). Of the 500 participants with complete primary outcome data, 225 (45.0%) met the cut point criteria for mental health diagnoses at 3 months. For both mental health outcomes, the models fit the data well (depression: root mean square error of approximation [RMSEA], 0.044; comparative fit index [CFI], 0.93; PTSD: RMSEA = 0.045; CFI = 0.93), and all hypothesized paths were significant and in the hypothesized direction. Outcomes were associated with poor preinjury health (standardized weights: depression, 0.28; P < .001; PTSD, 0.17; P = .02), acute psychological reactions (depression, 0.34; PTSD, 0.38; both P < .001), and intentional injury (depression, 0.16; PTSD, 0.24; both P < .001). Acute psychological reactions were associated with childhood adversity (depression, 0.33; PTSD, 0.36; both P < .001). A history of prior mental health challenges (depression, 0.70; PTSD, 0.70; both P < .001) and psychological or emotional health resources (depression, -0.22; PTSD, -0.23; both P = .003) affected poor preinjury health, which was in turn associated with acute psychological reaction (depression, 0.44; PTSD, 0.42; both P < .001).

Conclusions and relevance: The intersection of prior trauma and adversity, prior exposure to neighborhood disadvantage, and poorer preinjury health and functioning are important, even in the midst of acute medical care for traumatic injury. These results support the importance of trauma-informed health care and focused assessment to identified patients with injuries who are at highest risk for poor postinjury mental health outcomes.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Richmond reported personal fees from Sigma Theta Tau International outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Measurement Model
Latent constructs are represented in dark squares and standardized weights as numbers placed above light squares. The root mean square error of approximation is 0.019; the comparative fit index is 0.99. ACEs indicates adverse childhood experiences.
Figure 2.
Figure 2.. Model of Life Trajectory Risk and Protective Factors for Postinjury Depression Symptoms
The root mean square error of approximation is 0.044; the comparative fit index, 0.93. Standardized weights appear as numbers placed atop arrows.
Figure 3.
Figure 3.. Model of Life Trajectory Risk and Protective Factors for Postinjury Posttraumatic Stress Disorder (PTSD) Symptoms
The root mean square error of approximation is 0.045; the comparative fit index, 0.93. Standardized weights appear as numbers placed atop arrows.
See this image and copyright information in PMC

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