Twelve months after trauma, patients' work status, general health, 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 increased substance abuse. Trauma centers that fail to recognize, assess, and treat these injury-related mental health outcomes are not fully assisting their patients to return to optimal function.

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Psychological morbidity after injury compromises return to work independent of preinjury employment and psychopathologic condition, Injury Severity Score, or ambulation. A high Impact of Events Scale score or peritraumatic dissociation at admission predicts this morbidity.

PTSD occurred in 42.3% of injured adults 6 months after trauma and was related to assault, dissociation, female gender, youth, poor mental health, and prior illness. By modeling PTSD, we may learn more of the etiology, risk stratification, and potentials for the treatment of this common and important morbidity of injury.

Six studies investigated a possible link between hopeless explanatory style-that is, the habitual explanation of bad events with stable and global causes-and risk for traumatic injuries. In samples of college students, dancers, athletes, and trauma patients (total n = 2274), stable and global explanations for bad events correlated with the occurrence of mishaps. The link appeared to be mediated in part by a preference for potentially hazardous settings and activities in response to negative moods associated with hopelessness. Taken together, these findings suggest that catastrophizing individuals may be motivated to escape negative moods by preferring exciting but risky courses of action.

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