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 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.
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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.
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