Differences in mental health engagement and follow-up among Black and White patients after traumatic injury

Abstract

BACKGROUND:Severe injury necessitating hospitalization is experienced by nearly three million US adults annually. Posttraumatic stress disorder and depression are prevalent clinical outcomes. The mechanisms by which programs equitably promote mental health recovery among trauma-exposed patients are understudied. We evaluated clinical outcomes and engagement among a cohort of Black and White patients enrolled in the Trauma Resilience and Recovery Program (TRRP), a stepped-care model to accelerate mental health recovery after traumatic injury. METHODS: Trauma Resilience and Recovery Program is a four-step model that includes (1) bedside psychoeducation about mental health recovery following traumatic injury, (2) a text-messaging symptom tracking system, (3) a 30-day postinjury mental health screen, and (4) referrals to mental health services. Data describe 1,550 patients enrolled in TRRP within a Level I trauma center (M age = 40.86; SD, 17.32), 611 of whom identified as Black (74.5% male) and 939 of whom identified as White (67.7% male). RESULTS:Enrollment in TRRP was nearly universal (97.9%) regardless of race or injury mechanism. Enrollment and usage of the textmessage system were statistically similar between Black (35.7%) and White patients (39.5%). Trauma Resilience and Recovery Program reengaged Black and White patients at a similar rate at the 30-day postinjury follow-up. However, Black patients were more likely to report peritraumatic distress at the bedside and clinical elevations in posttraumatic stress disorder and depression on the 30-day screen. Referrals were more likely to be accepted by Black patients relative to White patients with clinically elevated symptoms. CONCLUSION:Enrollment and engagement were comparable among Black and White patients served by TRRP. Data provide preliminary evidence to suggest that TRRP is feasible and acceptable and engages patients in mental health follow-up equitably. However, research that includes careful measurement of social determinants of health and long-term follow-up examining initiation, completion, and benefit from treatment is needed.

Trends in disparities research on trauma and acute care surgery outcomes: A 10-year systematic review of articles published in The Journal of Trauma and Acute Care Surgery

“…Of these publications, 4,104 were excluded and 74 articles were included (Supplemental Digital Content, Supplementary Figure 1, http://links.lww.com/TA/D174). 2–76 A bimodal distribution shows that location and access disparities represented the majority of articles, followed by age and race (Fig. 1).…”

Engagement With Mental Health Services Among Survivors of Firearm Injury

“…For instance, a technology-based, stepped, access-to-care model has shown high rates of acceptability and engagement among trauma survivors, including those impacted by violence . Encouragingly, similarly high rates of engagement in recommended treatment services have been observed among participants regardless of racial or ethnic background . Adapting such interventions for survivors of firearm injury and families is a clear future direction.…”

Mental health symptoms and engagement in a stepped-care mental health service among patients with a violent versus nonviolent injury

“…Researchers have pointed to the role of social determinants of health (e.g., poverty, racism, built environment/community violence) in perpetuating these disparities in the rates of violent injury and adverse psychosocial sequelae. [1][2][3]11,27,28 For instance, previous research has found that Black men who experience adverse life events, have had previous traumatic injuries, and reside in neighborhoods with higher levels of disadvantage are at heightened risk for poor recovery postinjury. 1,25 Relative to other racial groups, Black adults are more likely to experience adverse psychological outcomes (e.g., PTSD, depression) and mortality after their injury.…”

“…Using a scalable and sustainable stepped care model, TRRP provides early identification and best-practice treatments to equitably improve access to mental health care to patients who are hospitalized after violent and nonviolent traumatic injury. [11][12][13] The model includes in-hospital mental health education, screening, and enrollment in TRRP services (Step 1); automated symptom self-monitoring via daily text-messaging (Step 2); telephone-based 30-day mental health screening (Step 3); and, when appropriate, referral to evidence-based mental health treatment services (Step 4). Trauma Resilience and Recovery Program has been found to be feasible and acceptable to both adult and child traumatic injury patients.…”

“…Prior research has found that young men of color are more likely to sustain violent injuries and experience psychological distress during and after hospitalization. 11,16,17 As a result, age, sex, race, and ethnicity were included as demographic covariates.…”