Social drivers of health associated with mental health risk, adherence, and health care engagement among trauma inpatients: A prospective pilot study.

Abstract

Social drivers of health influence trauma patients' outcomes, yet specific associations between social drivers of health domains and post-trauma recovery remain poorly understood. We prospectively examined relationships between specific social drivers of health and 2 critical recovery domains: mental health risk and comprehensive health care engagement, defined as adherence to acute care plans combined with long-term health care utilization. We conducted a pilot study of adult trauma inpatients at a level 1 trauma center from July to August 2023 who completed social drivers of health and Injured Trauma Survivor Screens, the latter assessing patient mental health risk factors. Electronic health records were reviewed 6 months after discharge to understand comprehensive health care engagement. Multivariable logistic regression models adjusted for age and injury severity examined associations between social drivers of health domains and outcomes. We report adjusted odds ratios with 95% confidence intervals. We included a total of 79 patients. High daily stress was associated with increased depression risk (adjusted odds ratio: 3.4; 95% confidence interval: 1.3-9.2) and post-traumatic stress disorder risk (adjusted odds ratio: 6.3; 95% confidence interval: 2.2-17.8). Difficulty paying for basics (adjusted odds ratio: 2.6; 95% confidence interval: 1.0-7.0) and high daily stress (adjusted odds ratio: 2.4; 95% confidence interval: 0.9-6.6) were potentially associated with nonadherence to acute care plans. Lack of social support was associated with reduced comprehensive health care engagement (adjusted odds ratio: 0.24; 95% confidence interval: 0.05-1.15). In a post-hoc analysis, mental health risk was also found to be associated with lower comprehensive engagement. Social drivers of health are associated with successful trauma recovery and may help identify patients at risk for mental health issues, nonadherence, and long-term comprehensive health care engagement. Targeted social drivers of health screening, particularly for stress and financial risk, may identify particularly vulnerable trauma patients who would benefit from early intervention and support.