title: The effect of early psychological symptom severity on long-term functional recovery: A secondary analysis of data from a cohort study of minor injury patients.
abstract: BACKGROUND
  The mental health consequences of injuries can interfere with recovery to pre-injury levels of function and long term wellbeing.
  
  
  OBJECTIVE
  The purpose of this study was to explore the relationship between psychological symptoms after minor injury and long-term functional recovery and disability.
  
  
  METHODS
  This exploratory study uses secondary data derived from a longitudinal cohort study of psychological outcomes after minor injury.
  
  
  METHODS
  Participants were recruited from the Emergency Department of an urban hospital in the United States.
  
  
  METHODS
  A cohort of 275 patients was randomly selected from 1100 consecutive emergency department admissions for minor injury. Potential participants were identified as having sustained minor injury by the combination of three standard criteria including: presentation to the emergency department for medical care within 24h of a physical injury, evidence of anatomical injury defined as minor by an injury severity score between 2 and 8 and normal physiology as defined by a triage-Revised Trauma Score of 12. Patients with central nervous system injuries, injury requiring medical care in the past 2 years and/or resulting from domestic violence, and those diagnosed with major depression or psychotic disorders were excluded.
  
  
  METHODS
  Psychological symptom severity was assessed within 2 weeks of injury, and outcome measures for functional limitations and disability were collected at 3, 6 and 12 months. A quasi-least squares approach was used to examine the relationship between psychological symptom scores at intake and work performance and requirement for bed rest in the year after injury.
  
  
  RESULTS
  Adjusting for demographic and injury covariates, depression symptoms at the time of injury predicted (p≤0.05) both poorer work performance and increased number of days in bed due to health in the year after injury. Anxiety symptoms predicted (p≤0.05) bed days at 3, 6, and 12 months and work performance at 3 months.
  
  
  CONCLUSIONS
  Depression and anxiety soon after minor injury may help predict important markers of long-term recovery. With further research, simple assessment tools for psychological symptoms may be useful to screen for patients who are at higher risk for poor long-term recoveries and who may benefit from targeted interventions.
authors.affiliation: Penn Injury Science Center University of Pennsylvania, 937 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; University of Pennsylvania, School of Nursing, Department of Biobehavioral Health Sciences, Claire Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, USA. Electronic address: sfjacoby@mail.med.upenn.edu.
authors.forename: Sara F
authors.initials: SF
authors.lastname: Jacoby
authors.affiliation: University of Pennsylvania, Perelman School of Medicine, Department of Epidemiology and Biostatistics, Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA. Electronic address: jshults@mail.med.upenn.edu.
authors.forename: Justine
authors.initials: J
authors.lastname: Shults
authors.affiliation: Penn Injury Science Center University of Pennsylvania, 937 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA; University of Pennsylvania, School of Nursing, Department of Biobehavioral Health Sciences, Claire Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104, USA. Electronic address: terryr@nursing.upenn.edu.
authors.forename: Therese S
authors.initials: TS
authors.lastname: Richmond
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology; D003866:Depressive Disorder / Q000209:etiology; D005260:Female; D005544:Forecasting; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011897:Random Allocation; D013997:Time Factors; D014481:United States; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology / Q000523:psychology*
keywords: Anxiety; Depressive symptoms; Injuries; Recovery of function