Perceived Need and Unmet Need for Vocational, Mental Health, and Other Support Services After Severe Lower-Extremity Trauma

Archer KR, Castillo RC, MacKenzie EJ, Bosse MJ, and the LEAP Study Group. Perceived need and unmet need for vocational, mental health, and other support services following severe lower-extremity trauma. Objectives: To examine the perceived need and unmet need for support services, the reasons for not obtaining services, and the factors contributing to unmet need for vocational and mental health services in patients with traumatic lower-extremity injury. Design: Multicenter, prospective observational study. Setting: Eight level I trauma centers. Participants: Patients (N=545) undergoing lower-extremity reconstruction or amputation from March 1994 to June 1997. Interventions: Not applicable. Main Outcome Measures: Perceived need and unmet need for support services at 3, 6, and 12 months after hospitalization. Results: Eighty-five percent of patients reported a need for at least 1 support service, and 32% reported an unmet need over the 12 months. The highest perceived need was for home nursing and legal, and for unmet need was vocational and mental health services. The main reason for patients not trying to obtain mental health assistance was thinking they would get better on their own, and for other support services was not knowing where to go. Patients treated by reconstruction compared with amputation, and being nonwhite were statistically associated with unmet needs for vocational and mental health services. Conclusions: The results suggest a significant amount of unmet need for vocational and mental health services during the first year after hospitalization in the severe lower-extremity trauma population with perceived need. Areas for future research are to objectively measure need and unmet need, and further investigate the disparities in unmet need by race and treatment type in this patient population. Recommendations for trauma centers include education and screening for mental health conditions and the need for support services during hospitalization and clinic visits, and increasing communication between surgeons and providers specializing in vocational, psychological, and socioeconomic issues.