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Violent injury predicts poor psychological outcomes after traumatic injury in a hard-to-reach population: an observational cohort study
  1. Emmylou Rahtz1,
  2. Kamaldeep Bhui2,
  3. Melanie Smuk2,
  4. Iain Hutchison3,
  5. Ania Korszun2
  1. 1European Centre for Environment and Human Health, University of Exeter, Truro, Cornwall, UK
  2. 2Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, London, UK
  3. 3Oral and Maxillofacial Surgery, St Bartholomew's and The Royal London Hospital, London, UK
  1. Correspondence to Ania Korszun; a.korszun{at}


Background People who experience physical trauma face a range of psychosocial outcomes. These may be overlooked by busy clinicians. While some risk factors are understood, understanding of the psychological effects of violent injury remains limited, particularly in UK settings. This study compared psychological outcomes following interpersonal violence and accidental injury, including the persistence of psychological distress.

Methods A questionnaire survey was carried out at two time points of patients admitted to a large teaching hospital in London between July 2012 and April 2014. Participants were consecutive adult patients admitted to the Royal London Hospital with traumatic injuries, with 219 participants at baseline. Follow-up survey was 8  months later (n=109). Standardised measures assessed post-traumatic stress symptoms (PTSS) (Acute Stress Disorder Scale and PTSD Checklist) and depressive symptoms (Hospital Anxiety and Depression Scale).

Results PTSS and depressive symptoms affected 27% and 33%, respectively, at baseline. At 8  months, 27% and 31% reported these symptoms for PTSS and depressive symptoms, respectively. The repeated measures were assessed with multilevel models: after adjusting for demographic factors, patients with violent injury showed more PTSS (OR 6.27, 95% CI 1.90 to 20.66) and depressive symptoms (OR 3.12, 95% CI 1.08 to 8.99).

Conclusions There were high levels of psychological distress among traumatic injury patients. Violent injuries were associated with an increased risk of both post-traumatic and depressive symptoms. People vulnerable to distress would benefit from psychological support, and hospital admission provides a unique opportunity to engage hard-to-reach groups in interventions.

  • Mental health
  • Orthopaedic and taruma surgery
  • Depression and mood disorders
  • Psychiatry

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  • Contributors ER participated in the design, data collection, data analysis and manuscript preparation. KB participated in the design, data analysis and manuscript preparation. MS participated in data analysis. IH participated in the receipt of funding, design and data collection. AK participated in the receipt of funding, design, data collection and manuscript preparation. All authors contributed to manuscript development and approved the final version and agree to be accountable for all aspects of the work.

  • Funding This work was supported by The Facial Surgery Research Foundation-Saving Faces.

  • Competing interests None declared.

  • Ethics approval National Research Ethics Service (NRES), Camberwell St Giles Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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