Primary Care Utilization and Detection of Emotional Distress After Adolescent Traumatic Injury: Identifying an Unmet Need

Abstract

Injured adolescents represent a high-risk pediatric population, a substantial number of whom develop mental health problems postinjury. Furthermore, almost 40% of adolescents in our study reported no source of primary care. These results suggest that referrals from trauma centers to PCPs are necessary and that an increase in awareness of and screening for adolescent emotional distress postinjury during follow-up appointments and at school should be routine components of postinjury care.

Association Between Posttraumatic Stress and Depressive Symptoms and Functional Outcomes in Adolescents Followed Up Longitudinally After Injury Hospitalization

“…4,8 Interviews contained measures that assessed adolescent posttraumatic stress, depressive symptoms, and functional and quality-of-life outcomes. Adolescent self-report was used to assess all adolescent symptoms.…”

“…6,7 The relevance of adolescent psychological development to recovery from traumatic injury currently may be underappreciated in trauma care systems and could contribute to observed deficits in the quality of mental health service delivery for injured teens. 8 Acute care inpatient settings hold unique promise for the dissemination of evidence-based mental health screening and intervention procedures. 9 Trauma surgery policy makers have demonstrated their willingness to act on clinical trial evidence substantiating the effectiveness of alcohol screening and brief intervention procedures through the implementation of policy mandates for these services.…”

An epidemiologic approach to the development of early trauma focused intervention

“…For example, the standardized regular appointments and intact health service delivery systems that constitute an implicit foundation of treatment delivery in efficacy trials are often impossible to attain in early posttraumatic treatment contexts such as postdisaster or acute care medical settings (Sabin, Zatzick, Jurkovich, & Rivara, 2006). Also, population-based clinical investigation suggests that, in contrast to the highly motivated patients recruited into efficacy trials, patients in the early aftermath of trauma experience multiple other posttraumatic concerns that extend beyond seeking treatment for PTSD (Zatzick et al, 2001;Zatzick et al, 2007).…”

Collaborative Care Interventions in General Trauma Patients

“…3,13,22,26,27,30,46,54,57 Within trauma care systems, patients often receive aftercare that is fragmented between the hospital, follow-up clinics and their primary care providers, with few to no services offered onsite to bridge this gap. 14,37,48 Patients see several providers in a variety of contexts: hospital aftercare, rehabilitation, mental health services, and primary care medicine without a connecting source. Also, many patients leave the emergency department or inpatient ward without an established or referred primary care provider, compounding the disconnect between physical and mental health care.…”