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Clinical outcomes following major trauma for patients with a diagnosis of depression: a large UK database analysis
  1. Jamie Large1,
  2. David N Naumann1,
  3. Jodie Fellows2,
  4. Clare Connor3,
  5. Zubair Ahmed1,4
  1. 1Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
  2. 2University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  3. 3Aneurin Bevan University Health Board, Newport, UK
  4. 4NIHR Surgical Reconstruction Microbiology Research Centre, Birmingham, UK
  1. Correspondence to Jamie Large; jxl1005{at}


Background More than a quarter of the UK population are affected by depression during their lifetime. For major trauma patients, postinjury depression can result in poorer long-term outcomes, but there is limited evidence regarding outcomes for patients with pre-existing depression. This study investigated the relationship between a diagnosis of depression prior to hospital admission and clinical outcomes after major trauma.

Methods Trauma patients at a UK major trauma center were identified during a 6.5-year period using the Trauma Audit and Research Network database. Patients with Injury Severity Score >15 who did not die in the emergency department (ED) were included. Logistic regression models were used to compare in-hospital mortality (excluding ED), requirement for surgery, and length of stay (LOS) between those with depression and those without.

Results There were 4602 patients included in the study and 6.45% had a diagnosis of depression. Depression was associated with a significant reduction in mortality (OR 0.54, 95% CI 0.30 to 0.91; p=0.026). However, patients with depression were more likely to have longer LOS (OR 124, 95% CI 8.5 to 1831; p<0.001) and intensive care unit LOS (OR 9.69, 95% CI 3.14 to 29.9; p<0.001). Patients with depression were also more likely to undergo surgery (OR 1.36, 95% CI 1.06 to 1.75; p=0.016).

Discussion A pre-existing diagnosis of depression has complex association with clinical outcomes after major trauma, with reduced mortality but longer LOS and higher likelihood of surgical intervention. Further prospective investigations are warranted to inform optimal management strategies for major trauma patients with pre-existing depression.

Level of evidence III.

  • mental disorders
  • mortality
  • length of stay
  • intensive care units

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors Conceived and designed the study: JL. Data collection: JL. Statistical analysis: DN. Data interpretation: JL. Drafted the article: JL. Reviewed the article and participated in critical revisions: JL, DN, JF, CC, and ZA. Supervision: DN and ZA. All authors approved the final version of the article. Gaurantor: ZA

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.