title: The experience of emotional wellbeing for patients with physical injury: A qualitative follow-up study.
abstract: BACKGROUND
  Traumatic physical injury is abrupt, painful, debilitating, costly and life-altering. The experience of emotional wellbeing following traumatic physical injury has not been well investigated, and the role of health services and how services can support the emotional recovery of injured patients has not been well understood. This has impacted on care provision and contributed to a lack of evidence-informed guidance for clinicians to support patients' emotional wellbeing.
  
  
  OBJECTIVE
  To explore the patient experience of emotional wellbeing following injury and to understand how injured patients manage their emotional wellbeing.
  
  
  METHODS
  The study comprises the follow-up qualitative phase of a mixed-methods explanatory sequential study. Semi-structured interviews were conducted with a purposive sample of 14 participants admitted to hospital following physical injury. Participants were purposely selected where they had reported high levels of depression, anxiety and stress on the DASS-21 at 3 and 6-months after injury. The qualitative data were analysed using thematic analysis.
  
  
  RESULTS
  Three main themes were identified: experiencing the many impacts of injury; facing the emotional journey following injury; and being supported and managing the impacts of injury. Key findings were the extreme negative emotional responses experienced many months after the injury; a strong physical link between the emotional and physical aspects of health; participant reluctance to seek emotional support; a lack of emotional support provision by the health service and a subsequent need for individual and group support in order to develop resilience in the injured person. Finally, male participants who reported extreme emotional responses after injury, including suicidality, were less likely to seek help for their symptoms.
  
  
  CONCLUSIONS
  Injured patients can experience substantial negative emotional responses following injury. The lack of support provided by health services to injured patients identified highlights the importance of in-hospital screening for emotional wellbeing and follow-up post-discharge, and a support network for patients to reduce the negative impacts of injury on their mental health. There is a need for anticipatory guidance frameworks for clinicians.
authors.affiliation: Trauma Service, St George Hospital, Kogarah, NSW, Australia; Sydney Nursing School, University of Sydney, NSW, Australia. Electronic address: Taneal.wiseman@sesiahs.health.nsw.gov.au.
authors.forename: Taneal
authors.initials: T
authors.lastname: Wiseman
authors.affiliation: Faculty of Health, University of Canberra, Australia; Sydney Nursing School, University of Sydney, NSW, Australia. Electronic address: kim.foster@canberra.edu.au.
authors.forename: Kim
authors.initials: K
authors.lastname: Foster
authors.affiliation: Sydney Nursing School, University of Sydney, NSW, Australia; Trauma Service, St George Hospital, Kogarah, NSW, Australia; St George Clinical School, Faculty of Medicine, University of NSW, Australia. Electronic address: kate.curtis@sydney.edu.au.
authors.forename: Kate
authors.initials: K
authors.lastname: Curtis
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001007:Anxiety; D001315:Australia / Q000453:epidemiology; D003863:Depression; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D055500:Resilience, Psychological; D012944:Social Support; D014947:Wounds and Injuries / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D055815:Young Adult
keywords: Emergency; Emotional wellbeing; Injury; Mental health; Patient outcome; Support