Implementation and Utility of an Automated Text Messaging System to Facilitate Symptom Self-Monitoring and Identify Risk for Post-Traumatic Stress Disorder and Depression in Trauma Center Patients

Abstract

Background and Introduction: Comprehensive monitoring and follow-up after traumatic injury is important for psychological recovery. However, scalable services to facilitate this are limited. Automated text message-based symptom self-monitoring (SSM) may be a feasible approach. This study examined its implementation and utility in identifying patients at risk for mental health difficulties after traumatic injury. Materials and Methods: Five hundred two patients admitted to a Level I trauma center between June 20, 2016 and July 31, 2017 were offered enrollment in a text message-based SSM service. Patients who enrolled received daily text message prompts over 30 days and most participated in a mental health screening 30 days postbaseline. Results: Approximately 67% of patients enrolled in the service; of these, 58% responded to the text messages, with an average response rate of 53%. Younger patients and those with elevated peritraumatic distress were more likely to enroll. Patients with higher levels of mental health stigma, who were White, or had been in a motor vehicle collision were more likely to enroll and respond to text messages once enrolled. Patients' daily ratings of distress detected clinically elevated 30-day mental health screens with high sensitivity (83%) and specificity (70%). Discussion and Conclusions: Text message-based SSM can be implemented as a clinical service in Level I trauma centers, and patient participation may increase engagement in mental health follow-up. Further, it can inform the use of risk assessments in practice, which can be used to identify patients with poor psychological recovery who require additional screening.

A Pilot Randomized Controlled Trial of the PTSD Coach App Following Motor Vehicle Crash–related Injury

“…However, our finding that 43% of those approached refused to be screened is slightly higher than the refusal rates of trials recruiting acutely injured patients for Internet-based or in-person PTSD treatment (22%-37%), 19,37 potentially due to the proximity of the initial ED assessment to the point of injury (<24 hours). Contrary to prior findings that minorities are typically less likely to seek treatment or engage in posttrauma symptom monitoring, 47,48 minorities (and younger vs. older patients) were more likely to screen as eligible, and eligible minorities also chose to participate at a higher rate compared to eligible white patients. Notably, a lack of smartphone or inability to download apps (~4%) was not a limiting factor for enrollment.…”

The short‐term dynamics of posttraumatic stress disorder symptoms during the acute posttrauma period

“…Mobile responses obtained between 5 and 34 days posttrauma using a lag of 1 day were used to estimate the networks. The response rate across 30 days was M = 59.4% ( SD = 26.0%, range: 4–30), which is comparable with other samples (Bunnell et al, ; Davidson, Bunnell, & Ruggiero, ; Greene et al, ). A total of 1,439 time points were used with less than 1% missing data within each time point.…”

Scoping review of the literature to ascertain how follow-up care is provided to major trauma patients post discharge from acute care

“…The experience and educational levels of staff involved in delivering follow-up was described in detail by two studies 27 34 with staff described as having a ‘Masters’ level qualification 34 or a bachelor’s or predoctoral. 27 In both studies the advanced qualifications were specific to the psychologists involved in the team. In relation to the nursing roles, studies described educational levels in terms of the position title or experience: nurses were described as experienced 35 having additional qualifications such as a nurse practitioner 38 43 44 or advanced practice nurse.…”

“…Three articles27–29 report separate findings from one study evaluating the ‘Trauma Resilience and Recovery Program’ (TRRP) and similarly two articles30 31 reported separate findings from one study evaluating the ‘Trauma Collaborative Care’ (TCC) programme (see online supplemental file 5).…”