Intentions Matter: Long-Term Patient Outcomes After Intentional, Interpersonal Injury

Any traumatic injury can lead to long-term challenges with physical health, mental health, and social well-being. Intentional injury due to interpersonal violence can further impair patients' sense of safety and may hinder recovery. We compared long-term patient-reported outcomes according to injury intent with the hypothesis that mental health outcomes would be worse in those injured by interpersonal violence compared to unintentional injury.

Beginning in 10/2019, we prospectively collected data on patient demographics, post traumatic stress disorder (PTSD), and patient-reported outcomes using patient reported outcomes measurement information system-29 (PROMIS-29) domains (depression, anxiety, physical function, sleep disturbance, ability to participate in social roles, and pain interference in daily activity) for adult trauma patients admitted to an urban, academic, level 1 trauma center. Participants were screened at the time of injury and at least one follow-up at 6 or 12 mo by January 7, 2024. Injury and treatment characteristics were collected from the institutional trauma registry. We compared patients injured unintentionally to those injured by interpersonal violence using descriptive statistics. Multivariable logistic regression was used to evaluate the contribution of injury intent to those outcomes for which univariate analysis showed a difference at 6 or 12 mo. We screened for PTSD with the PC-PTSD-5, considering a score of ≥3 to be positive. PROMIS-29 outcomes are expressed as the proportion of respondents whose scores were ≥1 standard deviation worse than population norms.

Of 315 participants, 105 were injured by interpersonal violence (gunshot wounds, stabbings, and blunt assaults). Intentionally injured patients were younger (median age 32 versus 50 for unintentional injuries) and more severely injured. Patients with unintentional injury were more often male (85% versus 60% of unintentionally injured patients) and were more often Black (87% versus 53%). At follow-up, 44 (43.6%) of intentionally inured patients screened positive for PTSD, compared to 47 (22.6%) of unintentionally injured patients, P < 0.001. In multivariable analysis accounting for age, gender, and injury severity, intentional injury was associated with a 2.1-fold increase in odds of PTSD (95% confidence interval: 1.1, 3.8). There was no significant association of intent with anxiety or depression.

Intentional injury is associated with higher rates of positive screens for PTSD after trauma. Screening and treatment protocols should attend to the mental health needs of all injured patients, with particular attention to post traumatic stress in survivors of interpersonal violence.