Polytrauma continues to be an important contributor to morbidity and mortality throughout the world. As advances in emergency medicine and imaging improve the morbidity and mortality rates for patients with severe injuries, the focus of polytrauma has shifted from short-term survival to long-term outcomes, including the importance of addressing psychosocial complications, such as mental health disorders, which have a significant impact on patient recovery, quality of life, and function [2]. Two of the most prevalent psychiatric disorders found in patients that experience trauma are depression and anxiety, yet they often go undiagnosed or are poorly treated in a standard trauma setting [3].

Polytrauma can also affect the mind due to the combination of the physical injuries sustained, the length of time in the hospital and related pain, the disability resulting from those injuries and the loss of employment and other economic impacts due to injuries [4]. Collectively, these factors create conditions that increase the proclivity for emotional distress (anxiety and depression) during the early stages following a traumatic injury. If the emotional distress is not addressed in a timely manner, they may become a continued source of psychiatric problems [5]. Continuing mental health issues, such as depression and anxiety, in patients with trauma-related conditions have been related to delays in rehabilitation and less adherence to recommended treatments and subsequently more medical visits and poorer functional results [6]. Imaging in Radiology serves as a very important way to assess a patient who is a victim of polytrauma, using CT and MRI scans to help accurately determine the pattern and severity of injuries. Radiology has created and continues to develop scoring systems to objectively measure the amount of trauma patients have experienced, which are routinely used as tools to provide guidance to healthcare providers with respect to making decisions regarding treatment and prognosing patient outcomes [7].

Currently, scoring systems for assessing the severity of trauma injuries rather than the presence of depression or anxiety have been the primary focus, however, research is lacking regarding the relationship between imaging scores and the prevalence of either depression or anxiety. Evaluating the relationship between the documented severity of injuries obtained through a CT and MRI scan and the prevalence and severity of depression and anxiety can provide healthcare providers with a more comprehensive understanding of high-risk patients early in their treatment. Integrating a psychological evaluation with the evaluation of injury severity via imaging can allow for a more comprehensive approach to trauma management [8].

For this reason, it is necessary to examine the prevalence of both depression and anxiety in patients who have sustained polytrauma and to look at the relationship between these two aspects and the injury severity scores assigned based on the images obtained from CT and MRI scans.

Aim and objectives

Aim

To determine the prevalence of depression and anxiety among polytrauma patients and to evaluate their correlation with CT/MRI-based injury severity scores.

Objectives

1. To estimate the prevalence of depression in adult polytrauma patients using validated psychological assessment scales.
2. To estimate the prevalence of anxiety in adult polytrauma patients using validated psychological assessment scales.
3. To assess injury severity in polytrauma patients using CT and MRI–based injury severity scoring systems.
4. To analyse the correlation between injury severity scores and levels of depression.
5. To analyse the correlation between injury severity scores and levels of anxiety.
6. To identify patient subgroups at higher risk of psychological morbidity based on radiological injury severity.

Aim and objectives

Aim

To determine the prevalence of depression and anxiety among polytrauma patients and to evaluate their correlation with CT/MRI-based injury severity scores.

Objectives

1. To estimate the prevalence of depression in adult polytrauma patients using validated psychological assessment scales.
2. To estimate the prevalence of anxiety in adult polytrauma patients using validated psychological assessment scales.
3. To assess injury severity in polytrauma patients using CT and MRI–based injury severity scoring systems.
4. To analyse the correlation between injury severity scores and levels of depression.
5. To analyse the correlation between injury severity scores and levels of anxiety.
6. To identify patient subgroups at higher risk of psychological morbidity based on radiological injury severity.

Study design

This was a hospital-based cross-sectional analytical study conducted to assess the prevalence of depression and anxiety among polytrauma patients and to evaluate their correlation with CT/MRI-based injury severity scores.

Study setting and duration

The study was carried out in the Department of Trauma Care of a tertiary care teaching hospital. Data collection was conducted over a period of 18 months.

Study population

The study population consisted of adult polytrauma patients admitted to the trauma centre during the study period.

Eligibility criteria

Inclusion criteria

• Adult patients aged 18 years and above
• Diagnosed cases of polytrauma involving injuries to two or more body regions
• Underwent CT and/or MRI evaluation as part of trauma assessment
• Haemodynamically stable at the time of psychological assessment
• Provided informed consent

Exclusion criteria

• Patients with a prior documented psychiatric illness
• Severe cognitive impairment or altered sensorium precluding assessment
• Patients on sedative or psychotropic medications at the time of evaluation
• Patients unwilling to participate

Sample size calculation

The sample size was calculated using the formula for estimating prevalence in a cross-sectional study:

n = Z² × p × (1 − p) / d²

Where:
Z = 1.96 corresponding to a 95% confidence level
p = anticipated prevalence of depression/anxiety in polytrauma patients (assumed as 0.50 due to wide variability in previous literature)
d = absolute precision set at 0.09

Substituting the values:

n = (1.96)² × 0.5 × 0.5 / (0.09)²
n ≈ 119

Accordingly, a sample size of 120 polytrauma patients was included in the study.

Injury severity assessment

All volunteers had CT and/or MRI imaging as part of usual trauma assessment processes. The degree of injury was assessed by a trained radiologist using standard methods for assessing injury severity according to imaging findings via computer tomography (CT) and magnetic resonance imaging (MRI), with numeric values assigned to each of the criteria established for both imaging types. Higher numeric scores were associated with more severe injuries.

Assessment of depression and anxiety

Depression and anxiety were assessed using validated and standardised psychological screening scales administered once the patient was clinically stable. Scores were interpreted according to recommended cut-off values to classify the severity of depressive and anxiety symptoms.

Data collection procedure

We used a Structured Data Collection Form to obtain demographic information, clinical characteristics, imaging findings, and psychological assessment to collect the data from patients via direct patient interviews as well as reviewing the patients' medical records.

Statistical analysis

Data collected was analysed using SPSS (version 26). Descriptive statistics were used to characterise the demographic variables, injury severity scores and psychological assessment results. Depressive and anxious states were calculated as rates and percentages. Correlation between CT and MRI injury severity scores and scores for depression and anxiety were calculated using appropriate correlation coefficients. A statistical level of p-value < .05 will be considered as statistically significant.

Ethical considerations

Before enrolling in the study, a written consent was received from all participants. All records of patient information were confidential and maintained throughout the project. Approval was received by the approval of the study protocol through the Ethics Committee of the conducting institution.

In the final analysis, there were 120 adult poly-trauma patients included in the 18-month study period. The cohort of study patients represented an age group typically classified as young to middle-aged adults which is consistent with what has been reported for this age group via trauma admission data. Most patients evaluated for psychological disorders produced signs of both depressive disorder and anxiety disorder and therefore demonstrated a significant burden of mental health distress. The overall injury severity as measured via CT and MRI imaging for these same individuals revealed that the injury severity scores varied widely indicating that there is a considerable degree of variability in the amount of trauma that each poly-trauma patient experienced. Patients with higher radiological injury severity scores demonstrated greater psychological distress. Both depression and anxiety scores increased progressively with increasing injury severity. The prevalence of anxiety was marginally higher than that of depression across most injury severity categories. Correlation analysis revealed a statistically significant positive relationship between injury severity scores and psychological morbidity. Patients with severe injuries were more likely to have moderate to severe depression and anxiety. Overall, the results indicate that psychological morbidity is common in polytrauma patients and is closely associated with radiological injury severity.

Table 1. Demographic characteristics of the study population (n = 120)

This table presents the age and sex distribution of the study participants.

Table 2. Distribution of CT/MRI-based injury severity scores

This table summarises the radiological injury severity categories.

Table 3. Prevalence of depression among polytrauma patients

This table shows the distribution of depressive symptoms based on severity.

Table 4. Prevalence of anxiety among polytrauma patients

This table displays the severity distribution of anxiety symptoms.

Table 5. Association between injury severity and depression

This table illustrates the relationship between radiological injury severity and depressive symptoms.

Table 6. Association between injury severity and anxiety

This table outlines the association between injury severity and anxiety symptoms.

Table 7. Correlation between injury severity scores and depression scores

This table shows the correlation analysis between injury severity and depression.

Table 8. Correlation between injury severity scores and anxiety scores

This table presents the correlation between injury severity and anxiety.

The Age and Sex Distribution of polytrauma in Table 1 shows that the majority of polytrauma patients are adult males between the ages of 15-40 years; these individuals are generally surrounded by numerous high-risk activities, which contribute to an increased risk of trauma. This is a demographic that is financially productive, yet is also highly vulnerable to developing long-term physical and psychological sequelae as a result of their injuries.

The Injury Severity Distribution in Table 2 indicates that the majority of patients in this study experienced moderate (II) to severe (IV) trauma. This demonstrates that there are a large number of individuals who will experience a high burden of trauma within the population.

Table 3 shows that there is a large prevalence of depression amongst those diagnosed with polytrauma; the prevalence of moderate (II) to severe (IV) depression in the study population indicates that depression represents a common psychological consequence of traumatic injuries.

The significant number of individuals who have been diagnosed with either moderate or severe anxiety, shown in Table 4 illustrates that anxiety is actually more prevalent than depression as a psychological response to polytrauma. The notable prevalence of patients who have a diagnosis of moderate (II) to severe (IV) anxiety, illustrates the increased level of psychological distress associated with the injury, hospitalisation and the uncertainty of recovering from the injury.

As injury severity increases, the percentage of patients experiencing depressive symptoms also increases. Table 5 shows that there is a very strong association between higher levels of physical trauma from injuries and higher levels of depression. Therefore, there appears to be a dose-response relationship between the level of injury severity and the level of depression experienced.

In Table 6, as anxiety has been shown to have a strong correlation with the level of severity of the injury, patients who sustain moderate and severe injuries are significantly more likely than those with mild injuries to experience symptoms of anxiety. Thus, these findings make it clear that anxiety should be considered one of the most significant psychological ramifications of severe trauma and, therefore, should be the subject of focused, clinical intervention.

Table 7 reveals a statistically significant positive correlation between both injury severity scores and depression score, meaning that as the radiological burden of the injury increases, so too do the symptoms of depression. This finding indicates that objective measures of severity derived from either CT scan or MRI may identify patients with a higher likelihood of developing depression.

Table 8 shows a statistically significant and positive correlation between injury severity scores and anxiety scores. As trauma severity increases, anxiety levels significantly increase. This supports the finding that radiological injury severity is a key predictor of the psychological impact (morbidity) of individuals who have experienced polytrauma (multi-system injuries).

Research has revealed that a high proportion of Disability Adjusted Life Years lost among patients with multiple traumatic injuries (i.e., polytrauma) is attributable to significant mental health morbidity, and that there is a strong correlation between mental health morbidity and the severity of injury (as assessed via CT (computed tomography) or MRI (magnetic resonance imaging) scans) [9]. These findings support previous research which shows that emotional distress is often a result of physical injuries experienced from traumatic events and leads to pain, difficulties with normal activities of daily living, prolonged hospitalisation, and uncertainty about future health status (which can contribute to post-traumatic stress disorder) [10]. The strong association between levels of depressive symptoms experienced by patients with polytrauma and delay in receiving rehabilitation services, non-adherence to rehabilitation regimens, and poorer functional outcomes from rehabilitation services emphasises that depression is one of the leading causes of poor rehabilitative outcomes in polytrauma patients [11,12].

Anxiety was found to be more prevalent than depression in the study sample, indicating a significantly greater amount of psychological distress associated with the experience of trauma in this group throughout both the acute and subacute phases of trauma care. Potential increased levels of anxiety may be related to concerns regarding the severity of the patient's injury, the type of surgical procedure that was performed, concerns about possible long-term disability, and issues related to financial support. The higher level of anxiety in this group suggests that intensive efforts are needed to identify and provide supportive interventions at an early stage during hospitalization. [13,14].

A significant discovery of this study is the well-defined increase in psychological illness based on the extent of the injury diagnosed by imaging tests. The more severe the imaging-defined injury score as measured by CT/MRI, the more likely the patient was to exhibit an increased incidence of depression and anxiety. This correlation indicates that an objective measurement of the degree of injury as measured by imaging tests could provide information about not just the physical prognosis but also a potential insight into mental health risk. Consequently, the integration of psychological evaluation into the assessment of patients with severe radiological injuries may allow early intervention to occur [15].

There were significant correlations between the Injury Severity Score (ISS) and the Psychological Assessment Score (PAS). These correlations underscore the benefit of utilizing a multidisciplinary approach to managing trauma patients. Trauma surgeons, radiologists, psychiatrists, and rehabilitation specialists all play an integral role in addressing the physical and psychological aspects of polytrauma; thus, their partnership is critical to provide optimal care for trauma patients. For example, providing support immediately following an injury to individuals at high risk for further complications will help them develop coping strategies, commit to rehabilitation, and improve their quality of life.

Although the current study provides valuable insight into the relationship between psychological assessments and injury severity, it contains some limitations. First, the cross-sectional design limits the ability of the researchers to draw definitive conclusions about causation. Thus, psychological assessments taken once may not represent the entire course of an individual’s recovery. Second, the research was conducted at a single tertiary care facility; therefore, the findings may not be generalizable to all trauma centres. Nonetheless, since validated scales were used to measure psychological status and objective radiologic measures were taken to assess trauma severity, the reliability of the findings is supported.

This suggests that mental health screenings should be routinely incorporated into trauma care for patients with severe traumatic brain injuries confirmed by CT or MRI. Early recognition and treatment of psychological morbidities can play a pivotal role in enhancing recovery and improving long-term outcomes for polytrauma patients.

Both Depression and Anxiety are often found with a higher prevalence for all poly-trauma patients. The prevalence (or "burden") of these disorders has been shown to have significantly positive correlations to the imaging based injury severity scores (CT / MRI) which indicates that the more severe the trauma, the greater the psychological morbidity associated with it. Based on the association of these disorders with other injuries via imaging based assessments, integrating routine psychological screening along with early intervention for Mental Health, into the standard trauma care protocols, are necessary for optimal recovery and long-term treatment success with polytrauma patients.

Limitations

This research has utilized a cross-sectional study design, which restricts the ability to identify a cause-effect relationship between the severity of injuries and the psychological impact upon an individual. Psychological assessments were conducted only at one point in time and, therefore, cannot determine if there are any changes in the levels of depression and anxiety during recovery. Additionally, since this research was carried out at one tertiary care facility, it is possible that the findings may not be generalised to other locations or populations.

Recommendations

Routine assessments for anxiety and depression must be integrated into the Evaluation standard for polytrauma patients (especially those assessed via CT/MRI with high injury severity). We recommend adopting a Multidisciplinary Trauma Care approach that includes Mental Health Professionals to facilitate the early recognition and treatment of Psychological Morbidity. We believe that Future Studies should involve Longitudinal Follow-Ups and Multi-Centre designs to improve Understanding of the Time Relatedness between Injury Severity and Psychological Outcomes.

1. Mashayekhi Y, Baba-Aissa S, Assefa AK, Mutamba FT, Nur AM, Shahid ZY, Salimon NM, Habahbeh A, Ali N, Shandi IM, Al Niazi R, Habib F. Depression and Anxiety as Predictors of Quality of Life in Osteoarthritis Patients. Cureus. 2025 Oct 5;17(10):e93872. doi: 10.7759/cureus.93872. PMID: 41059025; PMCID: PMC12498169.
2. Halvachizadeh S, Teuber H, Berk T, Allemann F, von Känel R, Zelle B, Cinelli P, Pape HC, Pfeifer R. Prevalence, injury-, and non-injury-related factors associated with anxiety and depression in polytrauma patients - A retrospective 20 year follow-up study. PLoS One. 2020 May 4;15(5):e0232678. doi: 10.1371/journal.pone.0232678. PMID: 32365087; PMCID: PMC7197792.
3. Al Zomia AS, Alqarni MM, Alaskari AA, Al Qaed A, Alqarni AM, Muqbil AM, Alshehri DM, Lahiq LA, Alhifthi MA, Alshahrani Y. Child Anxiety, Depression, and Post-traumatic Stress Disorder Following Orthopedic Trauma. Cureus. 2023 Jul 19;15(7):e42140. doi: 10.7759/cureus.42140. PMID: 37602069; PMCID: PMC10438159.
4. Lee MS, Huh HJ, Chae JH. Latent Profile Analysis of Resilience and Its Association With Psychological Factors in Patients Diagnosed With Depression and Anxiety Disorders. Psychiatry Investig. 2025 Aug;22(8):949-959. doi: 10.30773/pi.2025.0018. Epub 2025 Aug 7. PMID: 40840925; PMCID: PMC12370433.
5. Thompson KN, Hübel C, Cheesman R, Adey BN, Armour C, Davies MR, Hotopf M, Jones IR, Kalsi G, McIntosh AM, Monssen D, Peel AJ, Rogers HC, Skelton M, Smith DJ, Walters JTR, Breen G, Eley TC. Age and sex-related variability in the presentation of generalized anxiety and depression symptoms. Depress Anxiety. 2021 Oct;38(10):1054-1065. doi: 10.1002/da.23213. Epub 2021 Sep 8. PMID: 34496112.
6. Pakpour AH, Rahnama P, Saberi H, Saffari M, Rahimi-Movaghar V, Burri A, Hajiaghababaei M. The relationship between anxiety, depression and religious coping strategies and erectile dysfunction in Iranian patients with spinal cord injury. Spinal Cord. 2016 Nov;54(11):1053-1057. doi: 10.1038/sc.2016.7. Epub 2016 Feb 16. Erratum in: Spinal Cord. 2017 Jul;55(7):711. doi: 10.1038/sc.2017.32. PMID: 26882493.
7. Shabani N, Alavi NM, Aghajani M. Depression, anxiety, stress and related factors among husbands of Iranian women with cancer: A cross-sectional study. Eur J Oncol Nurs. 2024 Dec;73:102697. doi: 10.1016/j.ejon.2024.102697. Epub 2024 Sep 26. PMID: 39406179.
8. Benavides AM, Finn JA, Tang X, Ropacki S, Brown RM, Smith AN, Stevens LF, Rabinowitz AR, Juengst SB, Johnson-Greene D, Hart T. Psychosocial and Functional Predictors of Depression and Anxiety Symptoms in Veterans and Service Members With TBI: A VA TBI Model Systems Study. J Head Trauma Rehabil. 2021 Nov-Dec 01;36(6):397-407. doi: 10.1097/HTR.0000000000000647. PMID: 33656470.
9. Luo L, Yang T, Zheng X, Zhang X, Gao S, Li Y, Stamatakis EA, Sahakian B, Becker B, Lin Q, Kendrick KM. Altered centromedial amygdala functional connectivity in adults is associated with childhood emotional abuse and predicts levels of depression and anxiety. J Affect Disord. 2022 Apr 15;303:148-154. doi: 10.1016/j.jad.2022.02.023. Epub 2022 Feb 11. Erratum in: J Affect Disord. 2023 Dec 15;343:166. doi: 10.1016/j.jad.2023.09.032. PMID: 35157948.
10. Falkenberg L, Zeckey C, Mommsen P, Winkelmann M, Zelle BA, Panzica M, Pape HC, Krettek C, Probst C. Long-term outcome in 324 polytrauma patients: what factors are associated with posttraumatic stress disorder and depressive disorder symptoms? Eur J Med Res. 2017 Oct 30;22(1):44. doi: 10.1186/s40001-017-0282-9. PMID: 29084612; PMCID: PMC5663112.
11. Kendrick D, Baker R, Hill T, Beckett K, Coupland C, Kellezi B, Joseph S, Barnes J, Sleney J, Christie N, Morriss R. Early risk factors for depression, anxiety and post-traumatic distress after hospital admission for unintentional injury: Multicentre cohort study. J Psychosom Res. 2018 Sep;112:15-24. doi: 10.1016/j.jpsychores.2018.06.008. Epub 2018 Jun 12. PMID: 30097131.
12. Huh HJ, Kim KH, Lee HK, Chae JH. The relationship between childhood trauma and the severity of adulthood depression and anxiety symptoms in a clinical sample: The mediating role of cognitive emotion regulation strategies. J Affect Disord. 2017 Apr 15;213:44-50. doi: 10.1016/j.jad.2017.02.009. Epub 2017 Feb 7. PMID: 28189964.
13. Yani DI, Wong JCM, Pikkarainen M, Chua JYX, Wong HC, Goh YSS, Shorey S. Factors Associated With Mental Health Literacy, Depression, and Anxiety Amongst Indonesian Adolescents. J Adv Nurs. 2025 Sep;81(9):5937-5962. doi: 10.1111/jan.16742. Epub 2025 Jan 9. PMID: 39788556.
14. Svensén S, Bolstad I, Skomakerstuen Ødbehr L, Larsson G. Perceptions of self-efficacy, everyday stress, and symptoms of anxiety and depression among traumatized women in comprehensive treatment. Eur J Psychotraumatol. 2025 Dec;16(1):2582354. doi: 10.1080/20008066.2025.2582354. Epub 2025 Nov 14. PMID: 41236747; PMCID: PMC12621347.
15. Sinclair VG, Wallston KA, Strachan E. Resilient Coping Moderates the Effect of Trauma Exposure on Depression. Res Nurs Health. 2016 Aug;39(4):244-52. doi: 10.1002/nur.21723. Epub 2016 May 13. PMID: 27176758.