Three distinct patterns of mental health response following accidents in mountain sports – A follow-up study of individuals treated at a tertiary trauma center

Abstract

Introduction & Purpose The restorative effect of physical activity in alpine environments on mental and physical health is well recognized. However, a risk of accidents and post-accident mental health problems is inherent to every sport. We aimed to characterize mental health in individuals following mountain sport accidents requiring professional medical management. Here we summarize the most important results of our study which has already been published (Salvotti et al., 2024). Methods Adult victims of mountain sport accidents treated at the hospital of the Medical University of Innsbruck (Austria) between 2018 and 2020 completed a cross-sectional survey at least six months following the admission (median 44 months, n = 307). Symptoms of post-traumatic stress disorder (PTSD, PCL-5), anxiety, depression, and somatization (PHQ), resilience (RS-13), sense of coherence (SOC-9L), post-traumatic growth (PTGI) and quality of life (EUROHIS-QOL), as well as sociodemographic and clinical information were obtained from an online survey and extracted from electronic health records. Mental health outcome patterns were investigated by semi-supervised medoid clustering and modeled by machine learning. Results Symptoms of PTSD were observed in 19% of participants. Three comparably sized subsets of participants were identified: a (1) neutral, (2) post-traumatic growth and (3) post-traumatic stress cluster. The post-traumatic stress cluster was characterized by high prevalence of symptoms of mental disorders, low resilience, low sense of coherence and low quality of life as well as by younger age, the highest frequency of pre-existing mental disorders and persisting physical health consequences of the accident. Individuals in this cluster self-reported a need for psychological or psychiatric support following the accident and more cautious behavior during mountain sports since the accident. Reliability of machine learning-based prediction of the cluster assignment based on 40 variables available during acute medical treatment of accident victims was limited. Discussion The findings demonstrate that symptoms of PTSD can occur following mountain sport accidents, which is significant considering that mountain sport athletes are typically perceived as physically and mentally exceptionally healthy individuals. The cross-sectional design of the study limits the ability to assess peri-traumatic mental health, which has been shown to be critical for identifying vulnerable patients in other populations (Schultebraucks et al., 2020). Our findings align with recent initiatives to implement peri-traumatic screening tools and enhance mental health support in trauma care (American College of Surgeons, 2022). Conclusion A subset of individuals show symptoms of mental health disorders including symptoms of PTSD when assessed at least 6 months after mountain sport accident. Since early identification of these vulnerable patients remains challenging, psychoeducational measures for all patients and low-threshold access to mental health support are key until the robust screening procedures for at risk individuals are available. References American College of Surgeons. (2022). Best practices guidelines: Screening and intervention for mental health disorders and substance use and misuse in the acute trauma patient. https://www.facs.org/media/nrcj31ku/mental-health-guidelines.pdf Salvotti, H. V., Tymoszuk, P., Ströhle, M., Paal, P., Brugger, H., Faulhaber, M., Kugler, N., Beck, T., Sperner-Unterweger, B., & Hüfner, K. (2024). Three distinct patterns of mental health response following accidents in mountain sports: A follow-up study of individuals treated at a tertiary trauma center. European Archives of Psychiatry and Clinical Neuroscience, 274, 1289-1310. https://doi.org/10.1007/s00406-024-01807-x Schultebraucks, K., Shalev, A. Y., Michopoulos, V., Grudzen, C. R., Shin, S. M., Stevens, J. S., Maples-Keller, J. L., Jovanovic, T., Bonanno, G. A., Rothbaum, B. O., Marmar, C. R., Nemeroff, C. B., Ressler, K. J., & Galatzer-Levy, I. R. (2020). A validated predictive algorithm of post-traumatic stress course following emergency department admission after a traumatic stressor. Nature medicine, 26(7), 1084–1088. https://doi.org/10.1038/s41591-020-0951-z