Clinical Practice Guideline Recommendations on Mental Health in Trauma

Importance: Many survivors of traumatic injuries are affected by mental disorders, which has recently led to the publication of clinical practice guidelines (CPGs). However, there is no comprehensive synthesis of guideline recommendations to inform clinicians on those that should be prioritized for implementation and thus promote adherence to them. Objective: To identify guideline recommendations for the prevention and management of mental disorders in patients with traumatic injuries, appraise their quality, and synthesize the quality of evidence and the strength of included recommendations. Evidence Review: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Central, Web of Science, and 61 websites of professional associations and guideline repositories were searched between January 2008 and September 2024. We included CPGs pertinent to the acute and early recovery phases (<3 months) of adult patients (≥18 years) with traumatic injuries with at least 1 recommendation on mental health. Pairs of reviewers independently extracted data and assessed guideline quality using the Appraisal of Guidelines Research and Evaluation (AGREE) II tool. The quality of evidence on recommendations was synthesized using a matrix based on the categories of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Mental health recommendations had to target prevention, screening, evaluation, intervention, referral for follow-up or specialized services, and a patient- and family-centered care approach. Findings: Forty-three CPGs were included, 25 of which (58%) were high quality. Rigor of development, applicability, lack of involvement from all interested parties, and editorial independence were the most common methodological weaknesses. High-quality CPGs included 200 recommendations; of these, 50 (25%) were supported by moderate- to high-quality evidence and 30 (60%) targeted patients with traumatic brain injury. They covered mainly nonpharmacological and pharmacological interventions to treat acute stress disorder, substance use disorders, posttraumatic stress disorder, depression, or aggression. Fewer recommendations related to prevention, screening, evaluation, and referral were identified as having high empirical support. Conclusions and Relevance: Fifty recommendations were identified that may be considered for implementation in clinical settings in patients with traumatic brain injury and other trauma populations. Our review underlines important areas for future research, including training for clinicians, a patient- and family-centered care approach, and health care equity.