Mental Health Issues and Rehabilitation

Original Editor - Khloud Shreif Top Contributors - Habimana Sixbert, Khloud Shreif, Rucha Gadgil, Tolulope Adeniji, Heba El Saeid, Bianca Rus and Kim Jackson

Introduction

A person who experiences an injury or trauma, usually have psychological and emotional response to this injury and mental health issues such depression, anxiety and stress may appear.

Anorexia Nervosa may be triggered as well due to the fear of gaining weight. There is evidence supporting that mental health issues may inhibit outcomes of rehabilitation process. Depression is a common psychological problem that decreases life satisfaction and quality of life, especially in people with spinal cord injury] (SCI) . In a systematic review done by Craig et al. revealed that SCI patients in the rehabilitation phase still have a risk of depression and that almost 30% of those may develop a risk of depression. In addition, the potential depressive risk may be approximately 27% when SCI patients return to their normal life. So good or sound patients' mental health is pre requisite for better rehabilitation outcomes or results. There is also an increased risk of suicide among people with SCI compared to the general population, attributable to both pre- and post-SCI factors (e.g., psychiatric history prior to SCI, increased duress following SCI, and associated changes in functioning), with estimates of 4–11% of deaths following SCI attributable to suicide.

Possible psychosocial responses/reactions

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 responses to injury are normal. But if the symptoms are unresolved or worsen over time it becomes a problem.

The psychological and social reaction following spinal cord injury in an individual may include the following:

• Depression
• Post-traumatic stress disorder
• Suicidal thinking or lack of desire to live
• Apathy and not caring about life
• Inability to provide self-care and follow medical advice
• Marital and relationship conflict
• Lack of motivation for vocational or educational pursuits
• Feeling trapped in the family surroundings
• Unnecessary dependency on others
• Social Isolation
• Negative body image or shame
• Feelings of worthlessness
• Low self-esteem
• Anger and aggression
• Shame and embarrassment
• Feelings of helplessness and hopelessness
• High levels of stress
• Self-Blame

Intervention for these mental health issues

• Explain to the patient about the injury and the recovery process, the demonstration should be introduced in a way the patient can understand well, in a clear way and if any misinformation try to explain to your best and correct it. You could also provide proofs regarding what are you saying, for example, articles from trusted organisations.
• Build trust and good rapport with individual patients, listen carefully to your patient before making a medical diagnosis and also assess and monitor their emotional state. You may experience a range of emotions that make it difficult for care network members to establish a connection. If this happens you could show empathy, actively listen to your patients, not rush them, take as time as needed to listen to them, try to understand them, even if this is not what you feel or think, you do not have to feel or think the same, you just have to let them know you listen and understand them.
• Set goals, help patient to be motivated, to complete their rehabilitation by setting achievable short and long term goals.
• Create a network of support between your patient , family members, and friends.

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

Clinical implications

A study demonstrated that functional recovery is associated with psychosocial factors such as motivation during acute hospitalizations. Also, there were associations found between functional recovery and depression during this same period. This suggests that psychosocial factors can affect physical therapy and rehabilitation outcomes. It has been seen that psychosocial factors are involved in the management of patients with spinal cord injury, thus the physical therapist should be aware of these factors and act accordingly when they are encountered in the management of such persons.

Stroke patients: depression in stroke patients may consider to be a 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 affect lower functional status and stroke survivors’ quality of life, and secondary complications. Post-stroke depression is believed to be caused by changes in brain chemistry and the disruption of neural pathways. These changes in brain chemistry and neural pathways can result from the physical damage caused by the stroke itself. Additionally, post-stroke depression can also be influenced by psychological factors such as the emotional impact of experiencing a life-altering event like a stroke.

Depression is believed to be more common in stroke patients with aphasia than those without, and when it was treated medically the studies show a decrease in the mortality rate. Healthcare professionals need to identify and address this condition early on, as it can significantly impact the overall rehabilitation process and the patient's ability to regain independence. As our overall goal of rehabilitation is to optimize quality of life by improving one’s adaptation to a disability and coping with functional improvement, the physician will sometimes need to deal with depression before dealing with physical rehab. Depression can hinder the progress of physical rehabilitation, as it can lead to decreased motivation and participation in therapy. Therefore, addressing depression can be crucial in achieving successful rehabilitation outcomes.

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 goal setting, cognitive structures,  maintaining patient motivation and psychological support are helpful strategies for faster recovery and coping with the 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. These findings highlight the importance of follow-up care and rehabilitation programs for patients after discharge from critical care, especially for older patients who may be more vulnerable to cognitive decline. Healthcare providers should also consider implementing strategies to prevent or mitigate these long-term effects.