Health and Well-Being of Physical Trauma Survivors: Who Follows Up?
Moran, Mary E.
Given the growing number of physical trauma survivors, it is imperative that mental health clinicians, medical providers, researchers, and policy makers are aware of their unique biological, psychological, and social health concerns, as well as the role of their primary support persons. Resiliency theory proposes that within each individual there are protective factors and negative outcomes. This dissertation was written to help identify the protective factors and negative outcomes that impact physical trauma survivors' biological, psychological, and social health, an area of the literature that is underexplored. This dissertation includes three articles: (a) a systematic review of literature published on the protective factors and negative outcomes of traumatic musculoskeletal injury survivors, (b) a research study on the health and well-being of physical trauma survivors, and (c) a policy brief synthesizing the findings from a systematic review of the literature and descriptive quantitative study to offer policy-, programmatic-, and screening recommendations to best support physical trauma patients' BPS recovery. The research question that guided the systematic review was, "What are the biopsychosocial-spiritual (BPS-S) protective factors that impact negative health outcomes among adult survivors of traumatic musculoskeletal injuries?" According to the studies reviewed, the biological factors that impacted negative outcomes included patients who underwent longer hospitalizations and whose perceptions of their injuries were more severe reported poorer physical functioning during follow-ups. The connection between biological health and psychological health was found among physical trauma patients' whose injuries were worse (measured by hospitalization) or perceptions of injuries was worse reported higher PTSD symptom severity. Additionally, patients with psychiatric histories had a higher likelihood of worse physical functioning. A positive correlation was found between depression and PTSD at baseline and during multiple follow-up time points with higher depression scores predicting greater likelihood for manifesting PTSD. It was surprising and unfortunate that there were no studies admitted to the systematic review that evaluated social or spiritual factors of physical trauma patients. In general, the systematic review pointed to the need for more studies looking at the biopsychosocial-spiritual health factors of traumatic musculoskeletal injury survivors, particularly within the United States. Specifically, researchers reported the importance of age and time passed after the injury on negative recovery outcomes and the utilization of pharmacological interventions as a protective factor for physical trauma patients. Additional research with larger sample sizes and more diverse demographic samples are needed to further these findings. The research question that guided the dissertation research study was, "What are the health and well-being factors that impact physical trauma survivor patients' adherence to follow up appointments?" The dissertation research study found older and self-pay/uninsured patients were less likely to attend follow-up appointments. Whereas patients who experienced motor vehicle accidents or motorcycle crashes (whether it was the vehicle or pedestrian) were more likely to attend the follow-up appointments than any other modality of injury (e.g., gunshot wounds, stabbings, assaults, falls, or others), as well as patients who reported higher levels of PTSD symptoms or higher levels of general health and well-being. Upon completion of a binary logistic regression on studies' independent variables, which controlled for other factors, including patients' health insurance type (e.g., Medicaid/Medicare, private insurance, and self-pay/uninsured), race, the presence of any substances (e.g., ethanol alcohol or legal/illegal substances), the distance from the patient home to the follow-up clinic, or the injury severity score of the patient. The systematic review and dissertation research study were the inspiration for the final chapter's policy brief advocating for mandatory mental health screening, brief intervention, referral, and treatment in outpatient and inpatient trauma care facilities.
Moran, Mary E.. (April 2018). Health and Well-Being of Physical Trauma Survivors: Who Follows Up? (Doctoral Dissertation, East Carolina University). Retrieved from the Scholarship. (http://hdl.handle.net/10342/6758.)
Moran, Mary E.. Health and Well-Being of Physical Trauma Survivors: Who Follows Up?. Doctoral Dissertation. East Carolina University, April 2018. The Scholarship. http://hdl.handle.net/10342/6758. October 24, 2020.
Moran, Mary E., “Health and Well-Being of Physical Trauma Survivors: Who Follows Up?” (Doctoral Dissertation., East Carolina University, April 2018).
Moran, Mary E.. Health and Well-Being of Physical Trauma Survivors: Who Follows Up? [Doctoral Dissertation]. Greenville, NC: East Carolina University; April 2018.
East Carolina University