Facial trauma patients have unmet needs for mental health and social services, study shows

Facial injuries caused by physical assault can intensify existing mental health and social problems, a study of indigent patients at an inner-city trauma center shows.

Facial injuries caused by physical assault can intensify existing mental health and social problems, a study of indigent patients at an inner-city trauma center shows. According to the study, published in the January 2005 issue of the Journal of Oral and Maxillofacial Surgery, these problems often go untreated and may interfere with recovery.

Facial trauma patients, most of whom had been involved in interpersonal violence, showed significantly higher rates of depression, anxiety, hostility and phobic and obsessive-compulsive tendencies than a control group of patients undergoing elective wisdom tooth surgery, according to the study of adults treated for mandible (lower jaw) fractures between 1996 and 2001 at King/Crew Medical Center, a hospital serving the socioeconomically disadvantaged, predominantly minority populations of South-Central Los Angeles. 

The trauma group also reported a significantly higher incidence of current or previous mental health and social problems, such as alcohol and drug use, problems with the law, unemployment, school suspensions, suicide attempts and homelessness.

Although the intensity of some psychological symptoms, such as depression, declined over time within the trauma group, patients continued to report higher levels of mental health and social service needs than the control group at all assessment intervals, notes principal author Jennifer Lento, Ph.D., a research associate with the VA Greater Los Angeles Health Care System at the time of the study. Despite the group's relatively high service needs, however, their service use was less than half that of the control.

"These data indicate substantial, and largely unmet, mental health and social service needs among vulnerable individuals presenting with facial injury to inner-city trauma centers," says Dr. Lento, who is currently an assistant professor of psychology at the University of San Diego.

Previous research has shown that the psychological symptoms following a facial injury due to violence may be intrusive enough to meet the diagnostic criteria for post-traumatic stress disorder (PTSD) and can impair social and occupational functioning for extended periods, Dr. Lento notes. One study found PTSD symptoms in patients up to seven weeks following facial injury.

The current study administered brief psychological and mental health/social service needs assessments to 336 facial trauma patients and 119 non-trauma patients 10 days, 6 months, and 12 months after treatment.

The vast majority of facial injuries resulted from physical violence (82 percent), with the rest resulting from a fall or accident (14 percent) or a motor vehicle accident (4 percent). The trauma and non-trauma groups consisted predominantly of African-American and Latino males. The two groups did not differ significantly in rates of high school graduation, employment, marital status or ethnicity.

The study points to the need for a more comprehensive, "case management" approach to facial injury care that links patients with mental health and social services while providing surgical treatment and follow-up, Dr. Lento says.

The authors recommend training for trauma care providers in administering brief psychological assessments to facial trauma patients. They also urge oral and maxillofacial surgeons to probe for signs of psychosocial distress and be prepared to refer patients to appropriate resources.

The Journal of Oral and Maxillofacial Surgery is the peer-reviewed journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS), the professional organization representing more than 7,000 oral and maxillofacial surgeons in the United States, supports its members' ability to practice their specialty through education, research, and advocacy. AAOMS members comply with rigorous continuing education requirements and submit to periodic office examinations, ensuring the public that all office procedures and personnel meet stringent national standards.

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