The Effects of a Stepped-Care Mental Health Program on Trauma Recidivism at a Level 1 Trauma Center.

Abstract

Objectives: This study aimed to analyze the effects of a stepped-care mental health program (TRRP) on trauma recidivism at a single institution.

Methods: Designs: Retrospective review.

Setting: single Level 1 trauma center.

Patient selection criteria: Trauma activation patients presenting at a single Level 1 trauma center between 2017-2021 were selected. Data on demographics, mechanism of injury, readmissions, and TRRP participation were recorded.

Outcome measures and comparisons: Main outcomes included recidivism rates, risk factors for re-presentation, and determining if a change in readmission risk existed after participation in TRRP.

Results: 4,484 patients were included, with a mean age of 44.8 years. 65.9% were males and 34.1% were female. 14.2% (637/4,484) patients presented to the same institution having experienced an unrelated traumatic incident after their index injury. 75.6% patients identified by TRRP participated in at least one TRRP service. Patients who did not participate in TRRP were statistically significantly more likely to be recidivists (15.6%) compared to those who did (10.9%, p<0.001). Multivariable binary logistic regression analysis demonstrated statistically significant associations between increased trauma recidivism and being unmarried, Black/African American race, no use of seatbelts, alcohol intoxication at index injury, history of depression, alcohol use disorder, smoking, and government insurance (p≤0.024). The multivariable regression model predicted a decrease in trauma recidivism by 33% in privately insured patients (p=0.002), by 33% after participation in TRRP (p<0.001), and by 18% after participation in each additional step of the TRRP program (p<0.001).

Conclusions: Results demonstrate reduced rates of trauma recidivism with involvement of the Trauma Resilience and Recovery Program. While programs focused solely on psychosocial interventions may be sufficient to reduce the risk of subsequent traumatic events, further development of trauma rehabilitation programs should address both the psychosocial consequences of traumatic injuries as well as re-injury and readmission prevention.

Level of evidence: III.