Researchers from the University of Otago – Faculty of Medicine – Christchurch Ōtautahi are calling for improved long-term psychological support for survivors of major trauma after landmark studies reveal many patients in Aotearoa New Zealand are struggling to access appropriate follow-up care.
The three studies, published in both the Injury and Australia and New Zealand Journal of Surgery journals, examined the prevalence of post-traumatic stress disorder (PTSD) following severe injury, the gap between symptoms and diagnosis, and the barriers patients face navigating care and ACC support during recovery.
Together, they are the largest PTSD studies undertaken of major trauma patients in New Zealand and paint a concerning picture of trauma recovery for many. They show that while physical injuries are often closely monitored and treated, the psychological impact of trauma is frequently overlooked.
Dr Chris Wakeman
The research was supervised by Dr Chris Wakeman of Otago's Department of Surgery and Critical Care. The three studies were separately led by Health New Zealand Waitaha Canterbury clinicians Dr Daniel Jemberie, Dr Nikita Quinn, and Dr Sarah Logan and co-authored by Otago researchers.
Dr Wakeman says the findings collectively highlight the pressing need for a more comprehensive and patient-centred approach to trauma recovery.
"Trauma care has traditionally focused on physical injuries and survival, but these studies show the recovery journey often extends far beyond leaving hospital," he says.
"For many patients, the psychological impact of trauma can persist for months or years, affecting their ability to return to work, maintain relationships, and regain a sense of normality."
The first study, led by Dr Jemberie, found that among 203 patients who suffered severe trauma, 18 per cent experienced probable PTSD. Researchers identified younger patients, those with an initially altered level of consciousness, and people involved in vehicle-related trauma as being at greatest risk.
Dr Wakeman says the findings show psychological distress following major trauma is relatively common and should not be viewed as an unexpected complication.
"We can identify many of the patients who are most vulnerable early in their recovery, yet there are still limited systems in place to ensure they receive ongoing psychological assessment and support," he says.
A second study, led by Dr Quinn, revealed a concerning gap in diagnosis and mental health care. Despite the high prevalence of probable PTSD, only 22 per cent of the same 203 affected patients had received a formal diagnosis, while more than half had never undergone any mental health assessment.
Dr Laura Joyce
A co-author on all three studies, Dr Laura Joyce from Otago's Department of Surgery and Critical Care, says many patients are seemingly "falling through the cracks."
"There is often an assumption that patients will seek help themselves if they are experiencing psychological difficulties, but many people either do not recognise the symptoms or face barriers accessing support," she explains.
"The findings strongly support routine mental health screening for trauma patients at an appropriate point during their recovery, particularly between six months and two years post-injury."
The newest study, led by Dr Logan, explored the wider systemic barriers survivors face once they leave hospital.
Researchers found nearly 15 per cent (of 134) patients reported difficulties accessing follow-up care, while 25 per cent experienced challenges navigating ACC processes. Patients screening positive for PTSD, anxiety, or depression were between three and five times more likely to report problems with healthcare follow-up or ACC support.
Through thematic analysis, the study also identified recurring concerns including insufficient follow-up after discharge, communication breakdowns, limited access to mental health support, and pressure to return to work before patients felt physically or psychologically ready.
Dr Joyce says the findings highlight how psychological distress and systemic barriers can compound one another during recovery.
"Patients who are already struggling with anxiety, depression, or post-traumatic stress are often the very people who find it most difficult to navigate complex healthcare and compensation systems," she says.
Dr Wakeman hopes the studies will help encourage improvements in trauma follow-up services and increase awareness of the hidden burden experienced by survivors of serious injury.
"We cannot simply treat the physical injuries and assume the recovery process is complete. True recovery requires coordinated, long-term support that addresses both physical and psychological wellbeing.
"Identifying these gaps is an important first step towards building a more integrated and compassionate model of trauma recovery in New Zealand," Dr Wakeman says.
Publication details
Under Diagnosis and Under-Treatment of Post Traumatic Stress Disorder Amongst Major trauma Patient in New Zealand. Published in Journal Injury.
Prevalence and Predictors of Post Trsumatic Stress Disorder Following majojr Trauma in New Zealand. Published in ANZ Journal of Surgery.
Left Behind After Impact: The Hidden Toll of Trauma Recovery in New Zealand. Published in ANZ Journal of Surgery.
