title: Psychological morbidity and health-related quality of life after injury: multicentre cohort study.
abstract: To demonstrate the impact of psychological morbidity 1 month post-injury on subsequent post-injury quality of life (HRQoL) in a general injury population in the UK to inform development of trauma care and rehabilitation services.
  
  
  
  Multicentre cohort study of 16-70-year-olds admitted to 4 UK hospitals following injury. Psychological morbidity and HRQoL (EQ-5D-3L) were measured at recruitment and 1, 2, 4 and 12 months post-injury. A reduction in EQ-5D compared to retrospectively assessed pre-injury levels of at least 0.074 was taken as the minimal important difference (MID). Multilevel logistic regression explored relationships between psychological morbidity 1 month post-injury and MID in HRQoL over the 12 months after injury.
  
  
  
  A total of 668 adults participated. Follow-up rates were 77% (1 month) and 63% (12 months). Substantial reductions in HRQoL were seen; 93% reported a MID at 1 month and 58% at 12 months. Problems with pain, mobility and usual activities were commonly reported at each time point. Depression and anxiety scores 1 month post-injury were independently associated with subsequent MID in HRQoL. The relationship between depression and HRQoL was partly explained by anxiety and to a lesser extent by pain and social functioning. The relationship between anxiety and HRQoL was not explained by factors measured in our study.
  
  
  
  Hospitalised injuries result in substantial reductions in HRQoL up to 12 months later. Depression and anxiety early in the recovery period are independently associated with lower HRQoL. Identifying and managing these problems, ensuring adequate pain control and facilitating social functioning are key elements in improving HRQoL post-injury.
authors: Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK. denise.kendrick@nottingham.ac.uk.
authors: D
authors: 0000-0003-3603-6542
authors: D
authors: Kendrick
authors: Division of Psychology, Nottingham Trent University, Nottingham, NG1 4BU, UK.
authors: B
authors: B
authors: Kelllezi
authors: Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
authors: C
authors: C
authors: Coupland
authors: Division of Primary Care, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
authors: A
authors: A
authors: Maula
authors: Research and Innovation, University of the West of England, Bristol, BS2 8AE, UK.
authors: K
authors: K
authors: Beckett
authors: Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, NG7 2TU, UK.
authors: R
authors: R
authors: Morriss
authors: School of Education, University of Nottingham, Nottingham, NG8 1BB, UK.
authors: S
authors: S
authors: Joseph
authors: Loughborough Design School, Loughborough University, Loughborough, LE11 3TU, UK.
authors: J
authors: J
authors: Barnes
authors: Department of Sociology, University of Surrey, Guildford, GU2 7XH, UK.
authors: J
authors: J
authors: Sleney
authors: Centre for Transport Studies, University College London, London, WC1E 6BT, UK.
authors: N
authors: N
authors: Christie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D015331:Cohort Studies; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends*; D018434:Sickness Impact Profile; D014947:Wounds and Injuries / Q000523:psychology*; D055815:Young Adult
keywords: Anxiety; Cohort study; Depression; Quality of life; Unintentional injury