Kenneth J Ruggiero1, Tatiana M Davidson2, Margaret T Anton2, Brian Bunnell3, Jennifer Winkelmann2, Leigh E Ridings2, Olivia Bravoco2, Bruce Crookes4, James McElligott5, Samir M Fakhry4. 1. Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC. Electronic address: ruggierk@musc.edu. 2. Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, Charleston, SC. 3. Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL. 4. Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC. 5. Medical University of South Carolina Center for Telehealth, Medical University of South Carolina, Charleston, SC; South Carolina Telehealth Alliance, Medical University of South Carolina, Charleston, SC.
Abstract
BACKGROUND: Annually, post-traumatic stress disorder, depression, or both, develop in the first year after injury in more than 400,000 adults treated in US trauma centers (≥20%). Yet, few trauma centers monitor and address mental health recovery, and there is limited evaluation and high structural variability across existing programs. More research is needed to guide efforts to establish such programs and to inform national standards and recommendations. STUDY DESIGN: This article describes patient engagement in a stepped-care service to address patients' mental health needs. Trauma-activation patients admitted to our Level I trauma center for at least 24 hours were approached before discharge. Patients were provided education in person at the bedside (step 1), symptom monitoring via a 30-day text-messaging tool (step 2), telephone screening approximately 30 days post injury (step 3), and, when appropriate, mental health treatment referrals and treatment (step 4). RESULTS: We approached and educated 1,122 patients (56%) on the floor during a 33-month period. Of these, 1,096 patients (98%) enrolled in our program and agreed to 30-day follow-up mental health screening. We reached 676 patients for the 30-day screen, 243 (36%) of these patients screened positive for post-traumatic stress disorder and/or depression. Most of the 243 patients who graduated to step 4 accepted treatment referrals (68%) or were already receiving services from a provider (7%). Home-based telemental health was preferred by 66% of patients who accepted referrals. CONCLUSIONS: This work demonstrates the feasibility of an evidence-based, technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. Strategies to reach a higher percentage of patients in follow-up are needed. We recommend trauma centers test and adopt broad-based approaches to ensure optimal long-term patient outcomes.
BACKGROUND: Annually, post-traumatic stress disorder, depression, or both, develop in the first year after injury in more than 400,000 adults treated in US trauma centers (≥20%). Yet, few trauma centers monitor and address mental health recovery, and there is limited evaluation and high structural variability across existing programs. More research is needed to guide efforts to establish such programs and to inform national standards and recommendations. STUDY DESIGN: This article describes patient engagement in a stepped-care service to address patients' mental health needs. Trauma-activation patients admitted to our Level I trauma center for at least 24 hours were approached before discharge. Patients were provided education in person at the bedside (step 1), symptom monitoring via a 30-day text-messaging tool (step 2), telephone screening approximately 30 days post injury (step 3), and, when appropriate, mental health treatment referrals and treatment (step 4). RESULTS: We approached and educated 1,122 patients (56%) on the floor during a 33-month period. Of these, 1,096 patients (98%) enrolled in our program and agreed to 30-day follow-up mental health screening. We reached 676 patients for the 30-day screen, 243 (36%) of these patients screened positive for post-traumatic stress disorder and/or depression. Most of the 243 patients who graduated to step 4 accepted treatment referrals (68%) or were already receiving services from a provider (7%). Home-based telemental health was preferred by 66% of patients who accepted referrals. CONCLUSIONS: This work demonstrates the feasibility of an evidence-based, technology-enhanced, stepped-care intervention to address the mental health needs of trauma center patients. Strategies to reach a higher percentage of patients in follow-up are needed. We recommend trauma centers test and adopt broad-based approaches to ensure optimal long-term patient outcomes.
Authors: Ellen J MacKenzie; Frederick P Rivara; Gregory J Jurkovich; Avery B Nathens; Katherine P Frey; Brian L Egleston; David S Salkever; Daniel O Scharfstein Journal: N Engl J Med Date: 2006-01-26 Impact factor: 91.245
Authors: Douglas Zatzick; Gregory J Jurkovich; Frederick P Rivara; Jin Wang; Ming-Yu Fan; Jutta Joesch; Ellen Mackenzie Journal: Ann Surg Date: 2008-09 Impact factor: 12.969
Authors: Samir M Fakhry; Pamela L Ferguson; Jama L Olsen; Jennifer J Haughney; Heidi S Resnick; Kenneth J Ruggiero Journal: Am Surg Date: 2017-11-01 Impact factor: 0.688
Authors: Ronald C Kessler; Jennifer Greif Green; Michael J Gruber; Nancy A Sampson; Evelyn Bromet; Marius Cuitan; Toshi A Furukawa; Oye Gureje; Hristo Hinkov; Chi-Yi Hu; Carmen Lara; Sing Lee; Zeina Mneimneh; Landon Myer; Mark Oakley-Browne; Jose Posada-Villa; Rajesh Sagar; Maria Carmen Viana; Alan M Zaslavsky Journal: Int J Methods Psychiatr Res Date: 2010-06 Impact factor: 4.035
Authors: Erica K Yuen; Daniel F Gros; Matthew Price; Stephanie Zeigler; Peter W Tuerk; Edna B Foa; Ron Acierno Journal: J Clin Psychol Date: 2015-03-25
Authors: Richard A Bryant; Meaghan L O'Donnell; Mark Creamer; Alexander C McFarlane; C Richard Clark; Derrick Silove Journal: Am J Psychiatry Date: 2010-01-04 Impact factor: 18.112
Authors: Donte L Bernard; Kerry O'Loughlin; Tatiana M Davidson; Alex Rothbaum; Margaret T Anton; Leigh E Ridings; John L Cooley; Yulia Gavrilova; Ashley B Hink; Kenneth J Ruggiero Journal: J Trauma Acute Care Surg Date: 2022-04-01 Impact factor: 3.697