Social Need Burden, Long-Term Outcomes, and Social Service Engagement After Traumatic Injury

Trauma survivors often experience abrupt physical, psychological, and financial disruption that may compound pre-existing social vulnerability. We aimed to (1) examine the association between cumulative social need and long-term patient-reported outcomes, (2) identify factors associated with engaging with government-provided social services among trauma patients reporting social needs, and (3) examine whether engagement with social services is associated with long-term outcomes for patients with expressed social needs.

Moderately to severely injured patients from three level I trauma centers were enrolled, January 2022 to July 2024. Data were obtained from trauma registries and 6 mo postinjury telephone surveys. Patients reported social needs (food insecurity, unemployment, and functional disability), service engagement, and long-term outcomes.

Among 1794 patients, 82 (4.6%) reported food insecurity, 161 (9.0%) unemployment, and 492 (27.4%) functional disability. Increasing cumulative social needs were associated with progressively higher rates of financial hardship, post-traumatic stress disorder, anxiety, depression, and social impairment (all P < 0.001). Individuals engaging with food resources used rehabilitation services less often (40.0% versus 67.2%, P = 0.05). Those engaging with unemployment resources were younger (39.33 versus 50.19 y, P = 0.02) and less likely to have a psychiatric diagnosis (0% versus 25.2%, P = 0.03). Patients engaging with disability services were also younger (54.98 versus 70.95 y, P < 0.001). Engagement with individual social services for those expressing social needs was not significantly associated with long-term outcomes.

Despite expressed need, social service engagement among trauma survivors remains low. Greater cumulative social need burden is strongly associated with worse long-term financial and psychological outcomes.