|
Affiliation
|
Indiana University School of Medicine, carrbw@iupui.edu Indiana University School of Medicine, sseveran@iu.edu Indiana University School of Medicine, terebell@iupui.edu University of Wisconsin School of Medicine and Public Health, zarzaur@surgery.wisc.edu. |
|
Abstract
|
BACKGROUND: Traumatic injury is not only physically devastating, but also psychologically isolating, potentially leading to poor quality of life, depression and post-traumatic stress disorder (PTSD). Perceived social support (PSS) is associated with better outcomes in some populations. What is not known is if changes in PSS influence long-term outcomes following non-neurologic injury. We hypothesized that a single drop in PSS during recovery would be associated with worse quality of life.
METHODS: This is a post-hoc analysis of a prospectively collected database that included patients ≥18 years old admitted to a Level 1 trauma center with injury severity score (ISS) of >10, and no traumatic brain or spinal cord injury. Demographic and injury data were collected at the initial hospital admission. Screening for depression, PTSD, and Medical Outcomes Study Short Form 36 Mental Composite Score (MCS) were obtained at the initial hospitalization, 1, 2, 4, and 12 months post-injury. The Multidimensional Scale of Perceived Social Support (MSPSS) was obtained at similar time points. Patients with high MSPSS (>5) at baseline were included and grouped by those that ever reported a score ≤ 5 (DROP), and those that remained high (STABLE). Outcomes were determined at 4 and 12 months.
RESULTS: 411 patients were included with 96 meeting DROP criteria at 4mo, and 97 at 1yr. There were no differences in gender, race, or injury mechanism. DROP patients were more likely to be single (p=0.012 at 4mo, p=0.0006 at 1yr) and unemployed (p=0.016 at 4mo, and p=0.026 at 1yr) compared to STABLE patients. At 4mo and 1yr, DROP patients were more likely to have PTSD, depression, and a lower MCS (p=0.0006, p<0.0001).
CONCLUSION: Patients who have a drop in PSS during the first year of recovery have significantly higher odds of poor psychological outcomes. Identifying these socially frail patients provides an opportunity for intervention to positively influence an otherwise poor quality of life. LEVEL OF EVIDENCE: IV STUDY TYPE: Prognostic and Epidemiological.
Language: en |