(PS4-C52) The Relationship Between Immediate Stress Responses and Attitudes Towards Treatment in Traumatically Injured Emergency Department Patients

Friday, November 18, 2022

1:30 PM – 2:30 PM EST

Location: Westside Ballroom, 5th Floor

Author(s)

Kathy Benhamou, M.A.

Graduate Student
Case Western Reserve University
Cleveland, Ohio

Co-Author(s)

NF

Norah C. Feeny, Ph.D.

Professor
Case Western Reserve University
Cleveland, Ohio
JC

John J. Como, M.D.

Associate Professor
Case Western Reserve University School of Medicine
Cleveland, Ohio
VH

Vanessa P. Ho, M.D.

Associate Professor
Case Western Reserve University School of Medicine
Cleveland, Ohio
AR

Alex O. Rothbaum, Ph.D.

Postdoctoral Fellow
Medical University of South Carolina
Cleveland, Ohio
AK

Alexandra B. Klein, M.A.

Doctoral Candidate
Case Western Reserve University
Cleveland, Ohio
AB

Allison L. Baier, M.A.

Doctoral Candidate
Case Western Reserve University
Cleveland, Ohio
AK

Alexander Kline, Ph.D.

Postdoctoral Fellow
UCSD/VA San Diego Healthcare System
Cleveland, Ohio
AC

Alice Coyne, Ph.D.

Postdoctoral Fellow
Case Western Reserve University
Cleveland, Ohio
AV

Avalon Vu, M.A.

Doctoral Candidate
Case Western Reserve University
Cleveland, Ohio

Background

Though most who experience traumatic injury will not experience significant psychological impacts, a substantial number of individuals are likely to develop one or more mental health disorders, including posttraumatic stress disorder (PTSD). As such, the American College of Surgeons recommends that trauma centers provide PTSD screening and care. The Immediate Stress Response Checklist (ISRC) has been identified as a measure which may predict PTSD symptom development, though individuals may still choose not to pursue treatment. Emergency departments (ED) provide a unique setting in which screening, monitoring, and care may be offered shortly following trauma exposure to increase treatment engagement. As standards of care are developed, understanding whether measures which predict symptom development are related to treatment seeking behaviors may inform the development of more concise and efficient screening.

Methods

Participants were traumatically injured patients aged 18-65 who presented at an urban Level I trauma center within 24 hours of DSM-5 criterion A trauma exposure (N = 25). Consenting patients were assessed in the ED using the ISRC and a hypothetical treatment choice questionnaire, which assessed treatment history and preference between hypothetical therapy and medication to treat potential PTSD symptoms.

Results

We examined the relationship between ISRC and treatment history, as well as patient attitudes towards treatment type and desire to seek treatment. Lower ISRC scores were seen in patients who preferred psychotherapy over medication (M = 19.2) compared to those who preferred medication (M = 28.6), t(21) = -1.5, p = .14. Those who have previously received psychotherapy had lower ISRC scores (M = 19.8) compared to those who had not (M = 22.1), t(21) = .42, p = .68. We observed a similar trend for those who received medication (M = 20.5) compared to those who had not (M = 21.5), t(21) = .17, p = .87. Additionally, patients who did not endorse a desire for there to be a preventative treatment had higher ISRC scores (M = 28), t(21) = .79, p = .44.

Conclusion

Recently injured trauma patients assessed in the ED who preferred psychotherapy and those who had previously received any type of mental health treatment experienced fewer immediate stress responses following trauma exposure. These pilot data suggest that those who may be in the most distress are the least open to treatment. One possibility is that individuals who have previously received treatment know there is treatment available and may experience less stigma associated with needing treatment. Further, patients with increased immediate stress responses may experience higher distress, which may influence any optimism regarding preventative treatment. Given that there is an average 12-year delay between exposure and seeking treatment, future research should focus on better understanding whether specific stress responses may influence these choices may be warranted to better understand possible areas for intervention. Given the unique nature of the peritraumatic period, better understanding patient experiences and preferences will help address barriers in treatment seeking in order to increase treatment engagement following the development of PTS symptoms.