Geographic variations in reported and treated pain and mental health problems in the first two years after transport-related major trauma

Context: Persistent pain and mental health conditions are prevalent and disabling after transport injury. To date, few studies have explored geographic variations in the prevalence of those conditions, or treatments received, for those conditions. Aims and methods: This study aimed to examine the prevalence and population adjusted incidence of (a) patient reported problems of persistent or worsening pain or discomfort, and anxiety or depression, over 6, 12 and 24 months (EQ-5D); and (b) treatments received for pain and mental health conditions up to 24-months (funded by the compensation system) after transport-related major trauma across residential locations in Victoria, Australia. People aged >15 years, living in Victoria, with unintentional road transport-related major trauma who survived to 24 months post-injury were included from the Victorian State Trauma Registry (N = 6,434 eligible cases). Results: A total of 4,440 cases had two or more follow-ups to generate a reported problems profile, and 4,222 cases had a linked compensation claim to identify treatments. After adjusting for demographic, health and injury-related covariates, there was a lower probability of reported problems (pain: AOR = 0.81, 95%CI: 0.69, 0.95; mental health: AOR = 0.76, 95%CI: 0.65, 0.89) and treatment (pain: AOR = 0.64, 95%CI: 0.54, 0.76; mental health: AOR = 0.67, 95%CI: 0.55, 0.81) for people living in regional versus metropolitan areas. Across all cases reporting problems with pain or mental health in local government areas a median of 55% and 42% of people had received pain or mental health treatment, respectively; however, treatments were limited to those paid for by the compensation scheme, and it is possible that people received treatment privately or through Medicare. Conclusions: The variations in reported problems and treatment suggest a high level of potential unmet treatment need. Targeted strategies should now be developed to facilitate access to pain or mental health treatment when it is needed, regardless of where one lives.