Brief bedside intervention improves mental health follow-up among patients in a Level I trauma center.
Abstract
Background
Each year, nearly 3 million Americans are hospitalized for traumatic injuries, and many experience significant psychological distress during recovery. Between 20% and 40% of trauma survivors develop post-traumatic stress disorder (PTSD) and/or depression within a year, leading to substantial individual and economic costs. Sustainable interventions that enhance continuity of care and reduce psychiatric morbidity are needed. Trauma centers are uniquely positioned to improve behavioral health trajectories post-injury. We examined the impact of a brief, single-session bedside intervention that aimed to reduce acute distress and promote mental health follow-up, which was delivered in the context of a stepped-care mental health model in a Level I trauma center.
Methods
We examined uptake of the brief bedside intervention, its impact on patients' participation in mental health follow-up screening, and psychiatric symptoms 30 days post-injury.
Results
Among 887 adult patients who screened positive for PTSD/depression risk, 683 (77.0%) were offered the brief bedside intervention, 555 (81.3%) of whom accepted. Of those, 452 (81.4%) received it; 103 (18.6%) were missed due to patient/provider unavailability or early discharge. Violent injury was significantly associated with receipt of the brief bedside intervention and engagement in the mental health follow-up screening. After adjusting for violent injury, patients who received the intervention were 84% more likely to engage in the 30-day mental health follow-up screening (odds ratio=1.84; 95% CI=1.19-2.85). In contrast, the intervention did not significantly improve follow-up screening rates for survivors of violent injury. Bedside intervention completion was not significantly associated with PTSD and depression symptoms at 30 days or with referrals.
Conclusions
Bedside behavioral health interventions may enhance mental health follow-up screening rates for nonviolent trauma patients, but appear insufficient for victims of violence. These findings highlight a critical gap for violently injured patients, suggesting the need for integration with specialized, culturally responsive violence intervention programs. LEVEL OF EVIDENCE Level II, therapeutic/care management type.