Mental Health Issues and Rehabilitation

Original Editor - Khloud Shreif

Top Contributors - Khloud Shreif, Kim Jackson and Rucha Gadgil  

Introduction[edit | edit source]

When person experience an injury or trauma he/she  may have psychological and emotional response to this injury and mental health issues may be triggered, such as depression, anxiety, eating disorders. There is evidence that support that mental health issues may inhibit outcomes of rehabilitation process[1] so good mental health increase the outcomes of rehabilitation of your patient. Depression is common for about one third during inpatient rehabilitation that interfere with patient quality of life and functional activities[2].

Psychological responses/ mental issues[edit | edit source]

The effect of injury on mental health and psychological response isn’t predictable it extends from the time immediately after injury, to the post-injury phase, rehabilitation phase and finally with return to activity. These emotional reactions and mental response to injury are normal. But if the symptoms are unresolved or worsen over time it becomes a problem[3]. Theses responses affect on the time of rehabilitation.

Depression 2.jpg
  • Sadness.
  • Lack of motivation, the patient will find it is difficult to maintain his motivation without predictable time of return to their activity and full recovery as it is generally unknown like concussion
  • Changes in appetite, for example athletic injury may reflect on one’s appetite they may feel they don’t deserve to eat as they are injured or the failure of their performance.
  • Depression and suicidal ideation.
  • Sleep disturbance.
  • Experience emotional symptoms including feeling of sadness or irritability as a direct result of the brain trauma.
  • Denial of injury severity and they think the injury isn’t bad as the health care providers say.
  • Fear of re–injury: the patient tend to analyze the situation to find out what went wrong, and how to avoid it next time, in patients with emotional and mental health reactions may create overthinking and unhealthy level that in turn hinder the rehabilitation process.
  • Concussion and psychological reaction to concussion such as depression, treated by cognitive therapy and physical rest.
  • Isolation.
  • Irritation.
  • Anger.

How to support mental health issues[edit | edit source]

1- Education, explain to the patient about the the injury and the recovery process, the demonstration should be introduced in the way the patient can understand well, and misinformation from internet should be corrected.

2- Build trust, listen to your patient  to make a medical diagnosis but also to assess and monitor their emotional state, experience a range of emotions that make it difficult for care network members to establish connection.

3- Set goals, help patient to be motivated, to complete the their rehabilitation by setting short and long term goals to achieve.

4-Create a net work support between your patient , family members, and friends.

Depression is considered the first or second response in patient with trauma according to many researchers. Once the patient goes through depression it emotions of disbelief, denial movement, anger. And may find themselves dealing with anti- depressant but this isn’t the only treatment it’s a behavior-change strategy.

It is important for the rehabilitation team members to take care of depression symptoms and emotional difficulties during the process of rehabilitation.

Clinical implications[edit | edit source]

Stroke 2.jpg

Stroke patients: depression in stroke patient may considered to be biological process that correlates with the size and location of the area affected on brain. It is called post-stroke depression and may slow the recovery rate, hinder patient outcomes, negatively affects on lower functional status and stroke survivors’ quality of life, and secondary complication. Depression believed to be more common in stroke patients with aphasia than those without and when it was treated medically the studies show decrease in the mortality rate[4][5]. As our goal of rehabilitation is to improve one’s adaptation to a disability in cope with functional improvement, the physician will sometimes need to deal with depression before dealing with physical rehab.

Athletic injury rehab: the rehab process may be affected by psychological responses such as loss of identity, fear, anxiety, loss of confidence, denial of injury, rapid mood swing, and unreasonable fear of re-injury. Though using goal setting, cognitive structures,  maintain patient motivated, and psychological support are helpful strategies for faster recovery and cope with process of rehabilitation and social strategy.

In critical care: after discharge from critical care younger and older patients showed significant incidence of long-term cognitive and psychological dysfunction that impact on long-term function and quality of life[6].

References[edit | edit source]

  1. Bruijning JE, van Rens GH, Fick M, Knol DL, van Nispen RM. Longitudinal observation, evaluation and interpretation of coping with mental (emotional) health in low vision rehabilitation using the Dutch ICF Activity Inventory. Health and quality of life outcomes. 2014 Dec;12(1):1-6.
  2. Cully JA, Gfeller JD, Heise RA, Ross MJ, Teal CR, Kunik ME. Geriatric depression, medical diagnosis, and functional recovery during acute rehabilitation. Archives of physical medicine and rehabilitation. 2005 Dec 1;86(12):2256-60.
  3. American College of Sports Medicine, American Academy of Family Physicians, American Academy of Orthopaedic Surgeons, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, American Osteopathic Academy of Sports Medicine. Psychological issues related to injury in athletes and the team physician: a consensus statement. Medicine and science in sports and exercise. 2006 Nov;38(11):2030-4.
  4. Jeong YJ, Kim WC, Kim YS, Choi KW, Son SY, Jeong YG. The relationship between rehabilitation and changes in depression in stroke patients. Journal of physical therapy science. 2014;26(8):1263-6.
  5. Kincheloe HB. The Impact of Depression on Treatment Outcomes for Patients with Aphasia who Participate in an Intensive Comprehensive Aphasia Program (ICAP).
  6. Clancy O, Edginton T, Casarin A, Vizcaychipi MP. The psychological and neurocognitive consequences of critical illness. A pragmatic review of current evidence. Journal of the Intensive Care Society. 2015 Aug;16(3):226-33.