Table 3.
PTSD, Depression and Suicide Screening and Intervention Practices at Level I and II Trauma Centers
| Variable | PTSD symptom screening and intervention | Depression screening and intervention | Suicide screening and intervention | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total (n=269) | Level I (n=143) | Level II (n=126) | p Value | Total (n=269) | Level I (n=144) | Level II (n=125) | p Value | Total (n=267) | Level I (n=142) | Level II (n=125) | p Value | |
| Institution routinely screens admitted trauma patients for symptoms, n (%) | 75(27.9) | 49(34.3) | 26(20.6) | 0.03 | 103(38.3) | 49(34.0) | 54(43.2) | 0.23 | 207(77.5) | 109(76.8) | 98(78.4) | 0.94 |
| Percent of the time, mean (SD)* | 73.7(24.6) | 77.9(21.1) | 64.5(29.4) | 0.05 | 89.7(19.0) | 87.7(20.2) | 91.9(17.5) | 0.34 | 92.8(17.2) | 90.7(20.6) | 95.2(12.1) | 0.10 |
| Institution routinely uses a screening questionnaire*, n (%) | 50(66.7) | 33(67.4) | 17(65.4) | 0.89 | 77(76.2) | 33(68.8) | 44(83.0) | 0.24 | 158(77.5) | 73(68.2) | 85(87.6) | 0.001 |
| Percent of admitted trauma patients screened with a questionnaire, mean (SD) * | 68.2(28.6) | 66.7(27.9) | 71.2(31.0) | 0.65 | 90.0(19.1) | 86.3(24.2) | 93.1(13.0) | 0.20 | 90.4(20.5) | 86.0(26.3) | 94.3(12.4) | 0.03 |
| Institution routinely uses the EHR to screen, n (%) | 23(30.7) | 13(26.5) | 10(38.5) | 0.53 | 67(66.3) | 32(66.7) | 35(66.0) | 0.69 | 132(63.8) | 69(63.3) | 63(64.3) | 0.26 |
| EHR screen method*, n (%) | 0.67 | 0.58 | 0.22 | |||||||||
| Automated screen | 8(36.4) | 5(41.7) | 3(30.0) | 39(59.1) | 20(62.5) | 19(55.9) | 86(65.7) | 48(70.6) | 38(60.3) | |||
| Manual review | 14(63.6) | 7(58.3) | 7(70.0) | 27(40.9) | 12(37.5) | 15(44.1) | 45(34.3) | 20(29.4) | 25(39.7) | |||
| Institution provides services to admitted trauma patients with symptomsa, n (%) | 68(90.7) | 47(95.9) | 21(80.8) | 0.03 | 91(88.4) | 45(91.8) | 46(85.2) | 0.24 | 196(95.2) | 102(94.4) | 94(95.9) | 0.85 |
| Intervention available at the trauma center*, n (%) | ||||||||||||
| Medication | 27(36.0) | 20(40.8) | 7(26.9) | 0.23 | 71(68.9) | 31(63.3) | 40(74.1) | 0.24 | 140(67.6) | 72(66.1) | 68(69.4) | 0.61 |
| Supportive bedside counseling | 50(66.7) | 37(75.5) | 13(50.0) | 0.03 | 69(67.0) | 34(69.4) | 35(64.8) | 0.62 | 155(74.9) | 81(74.3) | 74(75.5) | 0.84 |
| Evidence-based psychotherapy | 38(50.7) | 30(61.2) | 8(30.8) | 0.01 | 50(48.5) | 25(51.0) | 25(46.3) | 0.63 | 95(45.9) | 53(48.6) | 42(42.9) | 0.41 |
| Community referrals | 57(76.0) | 38(77.6) | 19(73.1) | 0.67 | 73(70.9) | 39(79.6) | 34(63.0) | 0.06 | 147(71.0) | 74(67.9) | 73(74.5) | 0.30 |
| Other | 9(12.0) | 8(16.3) | 1(3.9) | 0.11 | 12(11.7) | 11(22.5) | 1(1.9) | 0.001 | 29(14.0) | 18(16.5) | 11(11.2) | 0.27 |
| Don’t know | 0(0.0) | 0(0.0) | 0(0.0) | NA | 2(1.9) | 1(2.0) | 1(1.9) | 1.0 | 5(2.4) | 3(2.8) | 2(2.0) | 1.0 |
| Type of staff person responsible for conducting consults and interventions*, n (%) | ||||||||||||
| Social worker | 39(52.0) | 30(61.2) | 9(34.6) | 0.03 | 58(56.3) | 31(63.3) | 27(50.0) | 0.18 | 108(52.2) | 58(53.2) | 50(51.0) | 0.75 |
| Chemical dependency counselor | 4(5.3) | 4(8.2) | 0(0.0) | 0.29 | 10(9.7) | 6(12.2) | 4(7.4) | 0.51 | 19(9.2) | 11(10.1) | 8(8.2) | 0.63 |
| Psychologist | 28(37.3) | 23(46.9) | 5(19.2) | 0.02 | 33(32.0) | 18(36.7) | 15(27.8) | 0.33 | 79(38.2) | 44(40.4) | 35(35.7) | 0.49 |
| Psychiatrist | 22(29.3) | 17(34.7) | 5(19.2) | 0.16 | 60(58.3) | 28(57.1) | 32(59.3) | 0.83 | 153(73.9) | 85(78.0) | 68(69.4) | 0.16 |
| RN | 11(14.7) | 10(20.4) | 1(3.9) | 0.08 | 29(28.2) | 11(22.5) | 18(33.3) | 0.22 | 42(20.3) | 17(15.6) | 25(25.5) | 0.08 |
| Other | 17(22.7) | 10(20.4) | 7(26.9) | 0.52 | 9(8.7) | 4(8.2) | 5(9.3) | 1.0 | 22(10.6) | 12(11.0) | 10(10.2) | 0.85 |
| No one designated | 1(1.3) | 0(0.0) | 1(3.9) | 0.35 | 0(0.0) | 0(0.0) | 0(0.0) | NA | 0(0.0) | 0(0.0) | 0(0.0) | NA |
| Don’t know | 2(2.7) | 0(0.0) | 2(7.7) | 0.12 | 2(1.9) | 1(2.0) | 1(1.9) | 1.0 | 1(0.5) | 0(0.0) | 1(1.0) | 0.47 |
| Same person who is called for alcohol also called for mental health symptoms*, n (%) | 36(54.6) | 26(56.5) | 10(50.0) | 0.77 | 44(48.4) | 21(46.7) | 23(50.0) | 0.95 | 67(34.2) | 31(30.4) | 36(38.3) | 0.15 |
| Hospital provides salary support (FTE) to individual(s) to provide screening and intervention services*, n (%) | 26(39.4) | 21(45.7) | 5(25.0) | 0.25 | 29(31.9) | 21(46.7) | 8(17.4) | 0.01 | 52(26.9) | 29(29.3) | 23(24.5) | 0.50 |
| Number of FTE, mean (SD) | 1.8(2.2) | 1.5(1.5) | 3.0(4.8) | 0.66 | 3.4(4.9) | 3.6(5.1) | 0.2(NA) | 0.53 | 3.1(4.0) | 3.5(4.5) | 1.8(1.6) | 0.19 |
| Are both pediatric and adult patients screened? *, n (%) | 0.02 | 0.53 | 0.03 | |||||||||
| Only adult patients | 27(37.0) | 12(25.5) | 15(57.7) | 25(24.8) | 9(19.2) | 16(29.6) | 35(17.2) | 13(12.3) | 22(22.4) | |||
| Only peds patients | 8(11.0) | 6(12.8) | 2(7.7) | 3(3.0) | 1(2.1) | 2(3.7) | 16(7.8) | 13(12.3) | 3(3.1) | |||
| Both | 37(50.7) | 29(61.7) | 8(30.8) | 63(62.4) | 31(66.0) | 32(59.3) | 137(67.2) | 73(68.9) | 64(65.3) | |||
| Don’t know | 1(1.4) | 0(0.0) | 1(3.8) | 10(9.9) | 6(12.8) | 4(7.4) | 16(7.8) | 7(6.6) | 9(9.2) | |||
| Are interventions available for both pediatric and adult patients who screen positive? *, n (%) | 0.13 | 0.09 | 0.01 | |||||||||
| Only adult patients | 22(32.8) | 11(23.9) | 11(52.4) | 25(27.5) | 8(17.8) | 17(37.0) | 38(19.6) | 11(11.0) | 27(28.7) | |||
| Only peds patients | 7(10.5) | 5(10.9) | 2(9.5) | 3(3.3) | 1(2.2) | 2(4.4) | 12(6.2) | 9(9.0) | 3(3.2) | |||
| Both | 35(52.2) | 28(60.9) | 7(33.3) | 59(64.8) | 35(77.8) | 24(52.2) | 135(69.6) | 75(75.0) | 60(63.8) | |||
| Don’t know | 3(4.5) | 2(4.4) | 1(4.8) | 4(4.4) | 1(2.2) | 3(6.5) | 9(4.6) | 5(5.0) | 4(4.3) | |||
*
Denominator is number of institutions who endorsed routinely screening admitted trauma patients for symptoms