The impact of psychological factors on recovery from injury: a multicentre cohort study

Purpose: Unintentional injuries have a significant long-term health impact in working age adults. Depression, anxiety and post-traumatic stress disorder are common post-injury, but their impact on self-reported recovery has not been investigated in general injury populations. This study investigated the role of psychological predictors one month post-injury in subsequent self-reported recovery from injury in working aged adults. Methods: Multicentre cohort study of 668 unintentionally injured adults admitted to 5 UK hospitals followed-up at 1, 2, 4 and 12 months post-injury. Logistic regression explored relationships between psychological morbidity one month post-injury and self-reported recovery 12 months post-injury, adjusting for health, demographic, injury, and socio-legal factors. Multiple imputation was used to impute missing values. Results: A total of 668 adults participated at baseline, 77% followed up at one month and 63% at 12 months, of whom 383 (57%) included in the main analysis. Multiple imputation analysis included all 668 participants. Increasing levels of depression scores and increasing levels of pain at one month and an increasing number of nights in hospital were associated with significantly reduced odds of recovery at 12 months, adjusting for age, sex, centre, employment and deprivation. Findings were similar in the multiple imputation analysis, except pain was of borderline statistical significance. Conclusions Depression one month post-injury is an important predictor of recovery, but other factors, especially pain and nights spent in hospital also predict recovery. Identifying and managing depression and providing adequate pain control are essential in clinical care post-injury