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Harborview Injury Prevention and Research Center
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DATE: January 06, 2006

Follow-Up Care for Adolescent Trauma Survivors' Emotional Distress: A Need Unmet

Adolescents who suffer physical injuries are vulnerable to emotional distress in the months following their hospitalization, yet almost 40 percent of hospitalized adolescents interviewed for a new study had no source for the follow-up medical care that could diagnose and treat symptoms of posttraumatic stress (PTS). These young trauma survivors are at risk for high levels of PTS and depressive symptoms, as well as high levels of alcohol use, according to research by investigators at the Harborview Injury Prevention & Research Center (HIPRC).

“Primary Care Utilization and Detection of Emotional Distress After Adolescent Traumatic Injury: Identifying an Unmet Need” is published in the January 2006 issue of Pediatrics. The research involved injured adolescents, aged 12 to 18, who were hospitalized at a level I regional trauma center. They were screened for PTS symptoms, depressive symptoms and alcohol use on the surgical ward, and again 4-6 months after hospitalization.

The researchers also conducted interviews with the adolescents' primary care providers 4-6 months after the injury. Of the 99 adolescents who agreed to participate in the study, 39.4 percent reported that they had no usual source of primary medical care. The follow-up interviews indicated that 30 percent demonstrated a high level of PTS symptoms, 11 percent reported depressive symptoms, and 16.6 percent reported problem alcohol use.

Of the adolescents who did receive follow-up care from their primary care providers, 45.2 percent had at least one symptom of psychological distress, yet these symptoms were not detected during the follow-up appointments. Previous studies have shown that screening for emotional distress is not a routine part of adolescent primary care.

Pediatric recommendations for post-injury care for adolescents include screening for emotional problems by the patient's pediatrician or primary care provider. Establishing a continuity of care between the trauma center and the community setting requires intensive follow-up by hospital staff. The researchers found that it took them as many as 13 phone calls to conduct an interview with a primary care provider.

“Our study identifies an unmet need in the care of adolescents after injury,” says Janice Sabin, M.S.W., Ph.C., the principal investigator for the study. “There's a need for increased linkage between trauma centers and community systems of care for injured adolescent patients, and a need for increased attention to detection and treatment for emotional distress after adolescent injury.”

The study is the first to follow injured adolescents and assess their access to primary care after being discharged from a trauma center. Differences in age, gender, race, injury severity, or prior mental health problems did not correlate with whether an adolescent did or did not identify a usual source of primary care.

In addition to Sabin, the investigators are Doug Zatzick, M.D., a University of Washington (UW) associate professor of psychiatry and behavioral sciences; Gregory Jurkovich, M.D., a UW professor surgery; and Frederick Rivara, M.D., M.P.H., a UW professor pediatrics and adjunct professor of epidemiology.

The research was supported in part by the National Institute of Mental Health, the UW Royalty Research Foundation, and the Centers for Disease Control and Prevention.