The Echoes of Trauma in Healthcare: Assessing the Relationship between Interpersonal Trauma and Satisfaction with Physical Medicine and Rehabilitation Care in the VA

Research Objectives: To examine associations between Interpersonal Trauma (IT) and satisfaction with overall healthcare and physical medicine and rehabilitation (PM&R) services received from Veterans Health Administration (VHA) facilities. Satisfaction with healthcare services is associated with favorable outcomes. Understanding factors related to satisfaction can assist providers tailor outreach and optimize rehabilitation outcomes. IT is intentional in nature and impairs one's ability to trust others, which may influence the patient-provider relationship.

Design: A retrospective cohort study. IT and non-interpersonal trauma (NIT) data were collected from the Life Events Checklist (LEC-5).

Setting: VHA, as a national healthcare system.

Participants: 1,109 Veterans who were screened for mental health disorders and traumatic brain injury between 2006-18, completed a follow-up survey in 2020-21, and received care from VHA in the six months before contact.

Interventions: N/A

Main Outcome Measures: Self-reported satisfaction with overall VHA and PM&R services rated on a 1 (extremely unsatisfied) to 5 (extremely satisfied) scale.

Results: Preliminary analyses using Spearman’s rank test revealed correlations between overall healthcare satisfaction and the presence of IT (p = 0.0044), but not the presence of NIT (p = 0.4483). Neither IT (p = 0.3101) nor NIT (p = 0.3523) were found to be correlated with satisfaction with PM&R services. Demographic and health characteristics were assessed to generate a parsimonious model. Adjusted Odds ratios revealed small and insignificant effects due to the presence of NIT (Adjusted OR: 1.172 [0.653, 2.104]) and IT (Adjusted OR: 0.831 [0.585, 1.182]). Odds ratios for satisfaction with PM&R services revealed similar small and statistically insignificant results.

Conclusions: Findings support other studies that found no correlation between IT and overall healthcare satisfaction or satisfaction with PM&R services. These results may indicate that VHA efforts to support veterans who have experienced interpersonal trauma exposure have reduced barriers to patient-clinician relationships, and the resulting impact on satisfaction with care. Further investigation into the IT characteristics, such as type of trauma, is required.

Author(s) Disclosures: This work was supported by Merit Review Award Number (IIR 17-051) from the United States (U.S.) Department of Veterans Affairs Health Service R&D (HSR&D) and with resources provided by the James A. Haley Veterans’ Hospital. The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official Department of Veterans Affairs position or any other federal agency, policy, or decision unless so designated by other official documentation.