Resiliency and quality of life trajectories after injury

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Abstract

BACKGROUND

Injury can greatly impact patients' long-term quality of life. Resilience refers to an individual’s ability to positively adapt after facing stress or trauma. The objective of this study was to examine the relationship between preinjury resiliency scores and quality of life after injury.

METHODS

Two hundred twenty-five adults admitted with an Injury Severity Score greater than 10 but without neurologic injury were included. The 36-item Short Form was administered at the time of admission and repeated at 1 month, 2 months, 4 months, and 12 months after injury. The Connor–Davidson Resilience Scale was completed at admission and scores were categorized into high resiliency or not high resiliency. Group-based trajectory modeling was used to identify distinct recovery trajectories for physical component scores (PCS) and mental component scores (MCS) of the 36-item Short Form. Multinomial logistic regression was used to determine whether baseline resiliency scores were predictive of PCS and MCS recovery trajectories.

RESULTS

Age, race, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, presence of hypotension on admission, and insurance status were not associated with high resiliency. Compared with those who made less than US $10,000 per year, those who made more than US $50,000 per year had higher odds of being in the high resilience group (odds ratio, 10.92; 95% confidence interval, 2.58–46.32). Three PCS and 5 MCS trajectories were identified. There was no relationship between resilience and PCS trajectory. However, patients with high resiliency scores were 85% less likely to belong to trajectory 1, the trajectory that had the lowest mental health scores over the course of the study. Follow-up for the study was 93.8% for month 1, 82.7% for month 2, 69.4% for month 4, and 63.6% for month 12.

CONCLUSION

Patient resiliency predicts quality of life after injury in regards to mental health with over 25% of patients suffering poor mental health outcome trajectories. Efforts to teach resiliency skills to injured patients could improve long-term mental health for injured patients. Trauma centers are well positioned to carry out such interventions.

LEVEL OF EVIDENCE

Prognostic/epidemiologic study, level III.

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