New study focuses on hospitalized Black men

Nearly half with physical injuries develop PTSD or depression

Most hospitals don’t screen injury patients for mental illness, which can put patients at risk for poor recovery or even long-term disability.


Nearly half of Black men who come to a Philadelphia hospital with a physical injury — anything from a sports accident to a gunshot wound — develop depression or post-traumatic stress disorder in the following months, a new study found.

The research, conducted by the University of Pennsylvania School of Nursing, was published in JAMA Surgery. Here are the highlights.

The context

A growing body of research supports the idea that patients’ mental health affects their physical outcomes. Some studies have shown that patients with depression have longer hospital stays even when they’re admitted for physical illnesses.

Others have shown that mental illness can slow recovery after surgery or other medical procedures.

People who have experienced a traumatic event, such as a car crash or a violent altercation, are particularly at risk of experiencing symptoms of depression, anxiety, and PTSD.

Yet a national survey found only 7% of trauma centers in U.S. hospitals routinely screen patients for PTSD.

The data

The research is based on 500 adult Black men who were treated for injury at either the Hospital of the University of Pennsylvania or Penn Presbyterian Medical Center.

The study did not include men who had a current psychotic disorder, were hospitalized because of attempted suicide, or were currently receiving treatment for depression or PTSD.

Researchers recruited the men between January 2013 and October 2017, and followed each of them for three months after they left the hospital.

The participants self-reported their symptoms of depression and PTSD through surveys.

The results

Of the 500 men in the study, 225 met criteria for a mental health diagnosis at the three-month follow up period. Of those, 13% screened positive for depression, 10% for PTSD, and 22% for both.

Men with violent injuries were more likely to show symptoms of mental illness than those with non-violent injuries.

Men who had experienced prior trauma or adverse childhood experiences — like having an incarcerated family member or suffering emotional or physical abuse — were at greatest risk.

This is supported by dozens of large-scale studies that show the more adverse experiences people have as children, the more likely they are to have poorer health outcomes as adults, including premature death.

The authors said these results show that discharging men without screening for psychological symptoms puts them at risk for poor recovery, which can sometimes lead to long-term disability or self-medication with prescription or non-prescription drugs.

The caveats

Although this study reinforced previous findings, it’s still important to note it focused on participants from one Philadelphia hospital system. The results might not apply to other populations.

The study also relied on self-reported data for symptoms of depression and PTSD, as well as adverse childhood effects, so these may not have been entirely accurate.

Next steps

The authors suggest that addressing the psychological effects of injury can improve health and reduce the negative outcomes of injury.

Screening patients for mental illness and asking about traumatic childhood experiences could help identify those at greatest risk.

Study co-author and Penn professor of nursing Therese Richmond said in a statement, “We must integrate psychological care into the very essence of trauma care if we are to improve outcomes from serious injuries.”


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