Bedside mental health risk screening of traumatic injury patients is enhanced by measurement of injury mechanism and social support

•Many traumatic injury survivors who initially screen negative on post-trauma mental health screens go on to develop mental health symptoms.•Violent injury type and lower levels of social support may put patients who screen initially negative at a higher risk for developing mental health symptoms.•Initial mental health screens may benefit from including measures that assess patient social support and injury mechanism at time of injury. The American College of Surgeons now requires mental health screening and follow up for hospitalized patients in trauma centers. National estimates indicate that 20–40 % of these patients will develop posttraumatic stress disorder (PTSD) and/or depression within one year post-injury. Research has identified brief bedside screens that predict PTSD and depression post-discharge, such as the Injured Trauma Survivor Screen and Peritraumatic Distress Inventory. However, false negatives are common; almost a quarter of patients with a negative bedside risk screen may develop PTSD or depression post-discharge and may not receive appropriate follow up. As such, there is critical need to improve bedside risk-screening tools. We aimed to identify demographic, social, and trauma-related predictors of mental health symptoms among patients with negative bedside screens. Patients were injury survivors served by a Level I trauma center who were identified as “low risk for development of PTSD/depression” by the Injured Trauma Survivor Screen. Patient injury type and demographics were collected from the medical record. Violent injuries (e.g., gunshot wound) and lower levels of available social support predicted elevated PTSD symptoms 30-days post-injury. Lower social support also was associated with increased risk for depressive symptoms 30 days post-injury. Findings suggest that risk-screening tools may be improved by including items that capture injury mechanism and social support. Alternatively, trauma centers should consider mental health referral for patients who have experienced violent trauma or have low levels of social support, even when bedside screening tools identify them as having low mental health risk.