Elsevier

Injury

Volume 49, Issue 5, May 2018, Pages 990-1000
Injury

Financial and recovery worry one year after traumatic injury: A prognostic, registry-based cohort study

https://doi.org/10.1016/j.injury.2018.03.013Get rights and content

Abstract

Background

Levels of stress post-injury, especially after compensable injury, are known to be associated with worse long-term recovery. It is therefore important to identify how, and in whom, worry and stress manifest post-injury. This study aimed to identify demographic, injury, and compensation factors associated with worry about financial and recovery outcomes 12 months after traumatic injury.

Methods

Participants (n = 433) were recruited from the Victorian Orthopaedic Trauma Outcomes Registry and Victorian State Trauma Registry after admission to a major trauma hospital in Melbourne, Australia. Participants completed questionnaires about pain, compensation experience and psychological wellbeing as part of a registry-based observational study.

Results

Linear regressions showed that demographic and injury factors accounted for 11% and 13% of variance in financial and recovery worry, respectively. Specifically, lower education, discharge to inpatient rehabilitation, attributing fault to another and having a compensation claim predicted financial worry. Worry about recovery was only predicted by longer hospital stay and attributing fault to another. In all participants, financial and recovery worry were associated with worse pain (severity, interference, catastrophizing, kinesiophobia, self-efficacy), physical (disability, functioning) and psychological (anxiety, depression, PTSD, perceived injustice) outcomes 12 months post-injury. In participants who had transport (n = 135) or work (n = 22) injury compensation claims, both financial and recovery worry were associated with sustaining permanent impairments, and reporting negative compensation system experience 12 months post-injury. Financial worry 12 months post-injury was associated with not returning to work by 3–6 months post-injury, whereas recovery worry was associated with attributing fault to another, and higher healthcare use at 6–12 months post-injury.

Conclusions

These findings highlight the important contribution of factors other than injury severity, to worry about finances and recovery post-injury. Having a compensation claim, failure to return to work and experiencing pain and psychological symptoms also contribute to elevated worry. As these factors explained less than half of the variance in worry, however, other factors not measured in this study must play a role. As worry may increase the risk of developing secondary mental health conditions, timely access to financial, rehabilitation and psychological supports should be provided to people who are not coping after injury.

Section snippets

Background

The consequences of traumatic injury are frequently complex. Several stressors affect life post-injury, and may bring about intrusive worry, especially in those who experience difficult ‘non-recovery’ trajectories, with persistent disability, chronic pain and/or secondary psychological health conditions [[1], [2], [3]]. While the majority of injured persons do recover and return to work and regular activities soon after injury, a significant minority report poorer quality of life and greater

Participant recruitment

Participants were recruited from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) and Victorian State Trauma Registry (VSTR) between October 2012 and October 2014. These registries monitor orthopaedic and major trauma cases in Victoria, Australia, and have been described in detail elsewhere [[34], [35]]. Participants were eligible if they were proficient in spoken or written English and aged 18–75, and were excluded if they had cognitive impairment, assessed qualitatively during

Trauma cohort overview

A total of 732 individuals expressed interest in participating in the study between October 2013 and December 2014, of whom 429 patients aged 17 to 75 (M = 45, SD = 14) participated and gave consent for the extraction of compensation claim data. A total of 70 potential participants could not be contacted, 12 were ineligible, 221 declined to participate or dropped out after providing consent, and two had died after expressing interest in the study but before completing the questionnaires, giving

Discussion

Worry is experienced by all of us at some point in our lives [23], and is a common response to stressful life events [30]. This is the first study to explore the levels of worry experienced about financial matters, recovery and pain in a trauma cohort. The study showed that around half of persons who experienced a traumatic injury report being worried about their finances and recovery at 12 months post-injury. The key predictors of financial worry were lower level of education, discharge to

Conclusion

In conclusion, the present study found that worry about financial matters and recovery is associated with having a more serious injury, and experiencing persistent pain, poor physical health and high psychological distress. Moreover, several demographic (i.e., age and education), injury (multi-trauma, hospital stay, discharge to rehabilitation, external attribution of fault) and compensation factors (high health service use, treatment for pain and mental health, and negative compensation system

Conflicts of Interest

All authors declare that they have no conflict of interest.

Acknowledgements

This research was funded by an Australian Research Council (ARC) Linkage Grant (LP120200033) in collaboration with the Transport Accident Commission (TAC), and a Platform Access Grant from Monash University. MJG was supported by a National Health & Medical Research Council of Australia (NHMRC) Early Career Fellowship (APP1036124) and Australian Research Council Discovery Early Career Researcher Award (DE170100726) and PC by a NHMRC Practitioner Fellowship (APP545926). The VSTR is a Department

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