Whole Assessment of Trauma Recovery-2 (WATR2)

摘要

ABSTRACT Traumatic injuries are a significant public health issue, affecting citizens of all ages, genders, and races, and responsible for the most deaths in individuals 44 years and younger. While public health resources have begun to address emotional recovery after large scale disasters, little attention has been paid to the emotional recovery of non-disaster-related trauma patients, and less still to what previous patients feel they needed to know about emotional recovery at discharge. Few trauma centers routinely provide injured patients with psychological support or information at discharge from the hospital. Research with discharged trauma inpatients, including our recent pilot study of structured interviews, Whole Assessment of Trauma Recovery-1 (WATR-1), demonstrated higher rates of major depression, posttraumatic stress disorder (PTSD), psychological distress, and smoking when compared to the general public. Yet only a small percentage of those who considered seeking professional help for emotional and psychological distress (EPD) actually received help. Providing patient-centered awareness, education, and referral regarding emotional health, based on the experiences of previous trauma patients, could affect years of potential employment and social stability, as well as quality of life of the patients, and improve health care quality. This project aims to identify what resources trauma patients need to improve their recovery after discharge, and how best to communicate this information to them. Semi-structured, open-ended telephone interviews with recently discharged patients will be conducted using a purposive sample to obtain a mix of demographic and injury characteristics, stratified by urban versus rural residence. These interviews will be used to create new discharge information for patients by: 1) Learning what discharged trauma inpatients experienced emotionally after discharge, 2) Soliciting recommendations from discharged trauma inpatients about peri-discharge information that may have been valuable in their emotional and mental health trajectory, and 3) Assessing modifiable barriers and facilitators to mental health care after discharge. While the WATR-1 pilot study identified some post-discharge mental health needs, this research project would allow patients the freedom to voice what they believe they most need and how to provide it. The information learned will serve to both increase awareness of the post-discharge emotional needs of trauma patients, as well as to develop and implement patient-oriented discharge materials in user-friendly formats. The new discharge format may involve technology such as interactive smart phone applications for education and monitoring. Future research could then evaluate the ensuing patient outcomes in terms of mental health, quality of life, and return to function. By more completely assisting trauma patients in obtaining maximum function, this project could affect not only patient outcome, but that of their families and society.