Outcome from injury: General health, work status, and satisfaction 12 months after trauma

Objective: We evaluated outcomes 12 months after trauma in terms of general health, satisfaction, and work status. Methods: Two hundred forty-seven patients without severe neurotrauma were e valuated by interview during admission and by mailed self-report 6 and 12 m onths after trauma. Data were obtained from the Trauma Registry, interviews , and survey instruments. Baseline assessment was obtained with the Short F orm 36 (SF36) and the Sickness Impact Profile (SIP) work scale. Outcome mea sures were the SF36, SIP work scale, Brief Symptom Inventory (BSI) depressi on scale, the Civilian Mississippi Scale for Posttraumatic Stress Disorder (PTSD), and a satisfaction questionnaire. Three regressions were determined for outcome. The dependent variables were general health and work status ( linear) and satisfaction (logistic), Each regression controlled for baselin e status and mental health, Injury Severity Score (ISS), and 12-month SF36 physical function before evaluating the effect of outcome mental health. Results: Follow-up data were available for 75% of the patients at 6 months and 51% at 12 months. The mean age of patients was 37.2 +/- 0.9 years (+/-S EM), and 73% were male. Their average ISS was 13.9 +/- 0.6. Seventy percent of injuries were blunt force, 13.5% were penetrating, and 16.5% were burn injuries (mean total body surface area, 13.3 +/- 1.5%). Sixty-four percent of the patients had returned to work at 12 months. Follow-up SF36 mental he alth was associated with the dependent outcome in each regression. After co ntrolling for baseline status and mental health, ISS, and outcome SF36 phys ical function, outcome mental health was associated with outcome SF36 gener al health (p < 0.001), SIP work, status (p = 0.017), and satisfaction with recovery (p = 0.005). Outcome SF36 mental health was related to baseline me ntal health, 12-month PTSD and BSI depression scores, and increased drug an d alcohol use. Conclusions: Twelve months after trauma, patients' work status, general hea lth, and overall satisfaction with recovery are dependent on outcome mental health. This dependency persists despite measured baseline status, ISS, or physical recovery, The mental disease after trauma is attributable to poor mental health, the development of symptoms of PTSD and depression, and inc reased substance abuse. Trauma centers that fail to recognize, assess, and treat these injury-related mental health outcomes are not fully assisting t heir patients to return to optimal function.