Resilience and long-term outcomes after trauma: An opportunity for early intervention?

J Trauma Acute Care Surg. 2019 Oct;87(4):782-789. doi: 10.1097/TA.0000000000002442.

Abstract

Background: Resilience, or the ability to cope with difficulties, influences an individual's response to life events including unexpected injury. We sought to assess the relationship between patient self-reported resilience traits and functional and psychosocial outcomes 6 months after traumatic injury.

Methods: Adult trauma patients 18 years to 64 years of age with moderate to severe injuries (Injury Severity Score, ≥9) admitted to one of three Level I trauma centers between 2015 and 2017 were contacted by phone at 6 months postinjury and asked to complete a validated Trauma Quality of Life (T-QoL) survey and PTSD screen. Patients were classified into "low" and "high" resilience categories. Long-term outcomes were compared between groups. Adjusted logistic regression models were built to determine the association between resilience and each of the long-term outcomes.

Results: A total of 305 patients completed the 6-month interview. Two hundred four (67%) of the 305 patients were classified as having low resilience. Mean age was 42 ± 14 years, 65% were male, 91% suffering a blunt injury, and average Injury Severity Score was 15.4 ± 7.9. Patients in the low-resilience group had significantly higher odds of functional limitations in activities of daily living (odds ratio [OR], 4.81; 95% confidence interval [CI], 2.48-9.34). In addition, patients in the lower resilience group were less likely to have returned to work/school (OR, 3.25; 95% CI, 1.71-6.19), more likely to report chronic pain (OR, 2.57; 95% CI, 1.54-4.30) and more likely to screen positive for PTSD (OR, 2.96; 95% CI, 1.58-5.54).

Conclusion: Patients with low resilience demonstrated worse functional and psychosocial outcomes 6 months after injury. These data suggest that screening for resilience and developing and deploying early interventions to improve resilience-associated traits as soon as possible after injury may hold promise for improving important long-term functional outcomes.

Level of evidence: Prognostic, level II.

MeSH terms

  • Activities of Daily Living*
  • Adaptation, Psychological
  • Adult
  • Early Medical Intervention / methods
  • Female
  • Humans
  • Long Term Adverse Effects* / prevention & control
  • Long Term Adverse Effects* / psychology
  • Male
  • Outcome Assessment, Health Care
  • Quality of Life*
  • Resilience, Psychological*
  • Self-Assessment
  • Stress Disorders, Post-Traumatic* / diagnosis
  • Stress Disorders, Post-Traumatic* / etiology
  • Stress Disorders, Post-Traumatic* / psychology
  • Trauma Centers / statistics & numerical data
  • Trauma Severity Indices
  • Wounds and Injuries / psychology*
  • Wounds and Injuries / rehabilitation