Summary: Researchers find people with anxiety and depression experience poorer work performance and more ‘bed rest’ 12 months after a minor injury.
Source: University of Pennsylvania.
When someone breaks a leg or fractures a rib, injuries considered relatively minor, providers often don’t look beyond what’s initially required to help that person heal. But new research from Therese Richmond and Sara Jacoby of the University of Pennsylvania shows that may not be the best approach.
Their work, published in the International Journal of Nursing Studies, revealed that someone who arrives in the emergency department needing help for a minor injury and who also expresses symptoms of depression and anxiety at that time will likely experience poorer work performance and increased health-related time in bed 12 months out.
“If an injury is not life-threatening, we tend to patch people up and send them home,” said Richmond, the Andrea B. Laporte Professor of Nursing and Associate Dean for Research and Innovation at the Penn School of Nursing. Yet “one out of 10 U.S. adults goes to an emergency department every year for injury. That’s millions and millions of people.”
Richmond and Jacoby, a postdoctoral fellow in the Penn Injury Science Center wanted to find out how such patients fared long-term, something relatively well-studied for people with severe injury but uncharted in this context. They turned to data they had collected from previous work about long-term recovery from minor injuries.
In that initial study, published in 2009, the researchers used standard criteria to identify 1,110 patients who had sustained minor injuries, after excluding those with head trauma, those with a previous psychiatric diagnosis and those hospitalized during the past year for another minor injury. From this group, 275 men and women of varying races and ethnicities were randomly selected and interviewed at intake in the emergency room, as well as at three, six and 12 months after injury.
“Along with the larger diagnostic exams that were given, we collected each patient’s symptoms of depression and anxiety using symptom-severity scales” called the Hamilton Depression Rating Scale and Hamilton Anxiety Rating Scale, Jacoby said.
Ninety percent of participants continued for the entire study duration, which helped Richmond and Jacoby draw some strong conclusions. They learned that people with more symptoms of depression at the time of their injury still had trouble working a year later and more frequently required bed rest due to health problems. They found connections, though less substantial, for anxiety, too. The researchers stress, however, that they determined correlation, not causation.
“We don’t know what’s driving the relationship between psychological symptoms at the time of injury and long-term recovery,” Jacoby said. “But we do know there is a spectrum of symptoms which, if evaluated, could change the way we allocate resources or suggest more intensive follow-up for certain people who might be at higher risk for poor outcomes.”
It’s an important link between physical and mental well-being for these patients, Richmond added.
“What our work over time shows, and this reinforces, is we can’t separate people into psych and physical because there’s an interplay that’s important to understand,” she said. “My goal of care as a nurse is, ‘I want you to live your life to the best that you can, I want you to have optimal function, I want you to be able to go back to your normal activities.’ If we don’t incorporate the psychological wellness after injury, I’m not going to help people reach that goal.”
Broad but simple changes to integrated care systems could make a difference, such as dismantling disciplinary silos that currently exist between physical and mental-health care or using electronic health-record systems to set reminders for providers to ask patients about psychological symptoms at follow-up visits.
“If you can embed the change in a system, it’s more likely to be successful than having to educate thousands of providers,” Richmond said.
The researchers note that future research should focus on building a better understanding of the pathways through which psychological symptoms influence long-term recovery.
Funding: This work was funded by the National Institute of Mental Health.
Source: Michele W. Berger – University of Pennsylvania
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Original Research: Full open access research for “The effect of early psychological symptom severity on long-term functional recovery: A secondary analysis of data from a cohort study of minor injury patients” by Sara F. Jacoby, Justine Shults, and Therese S. Richmond in International Journal of Nursing Studies. Published online November 8 2016 doi:10.1016/j.ijnurstu.2016.11.004
The effect of early psychological symptom severity on long-term functional recovery: A secondary analysis of data from a cohort study of minor injury patients
The mental health consequences of injuries can interfere with recovery to pre-injury levels of function and long term wellbeing.
The purpose of this study was to explore the relationship between psychological symptoms after minor injury and long-term functional recovery and disability.
This exploratory study uses secondary data derived from a longitudinal cohort study of psychological outcomes after minor injury.
Participants were recruited from the Emergency Department of an urban hospital in the United States.
A cohort of 275 patients was randomly selected from 1100 consecutive emergency department admissions for minor injury. Potential participants were identified as having sustained minor injury by the combination of three standard criteria including: presentation to the emergency department for medical care within 24 h of a physical injury, evidence of anatomical injury defined as minor by an injury severity score between 2 and 8 and normal physiology as defined by a triage-Revised Trauma Score of 12. Patients with central nervous system injuries, injury requiring medical care in the past 2 years and/or resulting from domestic violence, and those diagnosed with major depression or psychotic disorders were excluded.
Psychological symptom severity was assessed within 2 weeks of injury, and outcome measures for functional limitations and disability were collected at 3, 6 and 12 months. A quasi-least squares approach was used to examine the relationship between psychological symptom scores at intake and work performance and requirement for bed rest in the year after injury.
Adjusting for demographic and injury covariates, depression symptoms at the time of injury predicted (p ≤ 0.05) both poorer work performance and increased number of days in bed due to health in the year after injury. Anxiety symptoms predicted (p ≤ 0.05) bed days at 3, 6, and 12 months and work performance at 3 months.
Depression and anxiety soon after minor injury may help predict important markers of long-term recovery. With further research, simple assessment tools for psychological symptoms may be useful to screen for patients who are at higher risk for poor long-term recoveries and who may benefit from targeted interventions.
“The effect of early psychological symptom severity on long-term functional recovery: A secondary analysis of data from a cohort study of minor injury patients” by Sara F. Jacoby, Justine Shults, and Therese S. Richmond in International Journal of Nursing Studies. Published online November 8 2016 doi:10.1016/j.ijnurstu.2016.11.004