By Lisa Rapaport
(Reuters Health) - Nearly half of trauma patients, even those without brain injuries, experience social deficits that make it harder for them to interact with friends and stay involved in the community, a recent study suggests.
Traumatic brain injuries have long been linked to an increased risk of a wide range of short-term and long-term physical and mental health problems that can dramatically reduce quality of life, researchers note in the journal Surgery. But doctors don't yet have a clear picture of what type of social impairments may follow other types of traumatic injuries.
"Social functioning is considered a critical determinant of quality of life," said lead study author Dr. Juan Herrera-Escobar of Brigham and Women's Hospital and Harvard Medical School in Boston.
Broadly speaking, social function includes the ability to participate in organized and informal activities with friends, relatives, and people in the community or the workplace. Serious injuries can lead to physical and emotional issues that contribute to social deficits, and long hospital stays that keep patients away from their daily routines for weeks on end can make matters worse.
For the current study, researchers followed 805 adults hospitalized for moderate to severe traumatic injuries. During the year after the injury, 364 of them, or 45%, reported experiencing social dysfunction.
In the study, researchers assessed social function 6 months and 12 months after injuries. Each time, they asked patients how often physical or emotional challenges interfered with social activities in the previous four weeks.
Compared to patients who reported no social dysfunction, those who did tended to be younger and were more likely to be African American and have no more than a high school education. Patients with social dysfunction were also more likely to have had longer hospital stays, required mechanical ventilation in the hospital and have previous psychiatric illness.
People with a history of a major psychiatric illness, for example, were almost three times more likely to experience social dysfunction. Low education, meanwhile, more than doubled the risk of social dysfunction.
In addition, people with social dysfunction were over 16 times more likely to have post-traumatic stress disorder (PTSD) than those without social dysfunction, and about five and a half times more likely to have not returned to work after their accident.
It's possible that people with lots of social support from family and friends or from patient support groups might have fewer challenges with social dysfunction after their injuries, Herrera-Escobar said by email.
"A strong family environment fosters resilience, which has been associated with better long-term outcomes after trauma," Herrera-Escobar added. "We also believe that getting appropriate and timely treatments (rehabilitation, mental health services, etc.) for physical and mental health conditions can also help improve their social outcomes."
The study lacked data on social functioning before patients' injuries, and it's possible that some people had impairments beforehand, the study team notes.
Even so, the results underscore the importance of considering social function in trauma care from the start instead of waiting to address this until after patients go home from the hospital, said Dr. Tim Platts-Mills, an emergency medicine researcher at the University of North Carolina at Chapel Hill who wasn't involved in the study.
Pain management and treating people for depression, PTSD and other psychiatric issues may help minimize the social dysfunction, Platt-Mills said by email.
"The best approach is not to wait six weeks and then conclude that there is a problem," Platt-Mills said. "A better approach is to work with the patient's clinical team to try to address these problems early on."
SOURCE: http://bit.ly/2Xb9NsA Surgery, online May 17, 2019.