Trauma Stories: The Effect of Eliciting a Semi Structured Narrative of Events on the Mood of Trauma Patients

Research Article

Austin Emerg Med. 2016; 2(8): 1043.

Trauma Stories: The Effect of Eliciting a Semi Structured Narrative of Events on the Mood of Trauma Patients

Sodhi S¹*, Reeves K2,3, Charles S4, Goldberg A2,4 and Jones N3

¹Cooper University Hospital, Cooper One Plaza, Camden, NJ, 08103, USA

²Temple University School of Medicine, 3500 N Broad St, Philadelphia, PA 19140, USA

³Center for Bioethics, Urban Health and Policy, Temple University School of Medicine, 3500 N Broad St, Philadelphia, PA 19140, USA

4Temple University Hospital, 3401 N Broad Street, Philadelphia, PA, 19130, USA

*Corresponding author: Sarab Sodhi, Kelemen 152, Cooper University Hospital, Cooper One Plaza, Camden, NJ, 08103, USA

Received: August 12, 2016; Accepted: September 22, 2016; Published: September 23, 2016


Objective: To determine the influence of telling one’s trauma story on a victim of violent trauma‘s mood.

Background: Interpersonal violent trauma is an unfortunate reality in modern America. Numerous approaches aimed at reducing the rates of violence are underway, with many focusing on the role of psychological and emotional interventions on victims’ health and recidivism. The connection between psychological and physical health is well established, with an individual’s positive mood correlated to his or her better health outcomes. This study submits new data to this scholarship by addressing the question of whether trauma victims’ mood can be improved through the act of telling stories about one’s trauma.

Method: This study involved pre- and post- semi-structured interview administration of POMS mood scales.

Level of Evidence: Pilot level IV therapeutic.

Results: Of the 22 participants, none had a worsening of mood, and almost a third (31%) showed a statistically significant overall increase in mood after telling their trauma story. Decreasing levels of felt tension and anxiety and increased levels of vigor and activity were the most significant areas of change.

Conclusion: Talking about trauma, within the limitations of this study, appears to be safe and even beneficial. The benefits appear to be much greater in patients with a more disturbed mood, suggesting a possible target group for the intervention for maximum effectiveness and efficiency.

Keywords: Trauma; Narrative medicine; Mood; Violent trauma


Being the victim of a violent trauma has been shown to have a significant negative clinical impact on a patient’s health. For patients with trauma, returning to previous function is often challenging, impacted by mental health disturbances, PTSD, drug and alcohol use [1]. Urban trauma patients were found to develop PTSD symptoms (by the PC-PTSD tool) at a rate of 42% significantly higher than their cohort of urban, low income, non-trauma exposed peers (PTSD symptom rate of 22-32%), a worrisome trend when considering the personal and societal cost of PTSD [2]. Further, 60% of those who tested positive on the PC-PTSD tool agreed with the survey question that they thought it would be helpful for them to talk to someone, indicating that ways to address the mental health aspect of trauma, including addressing mood, could be of great benefit to both the patient and the health care system.

A recent meta-analysis identified 9 clinical studies on the influence of mood on disease processes and found a significant correlation of mood with mortality for a variety of disease states- from asthma to terminal cancer - adjusting for disease severity [3]. Conversely, poor mood, as measured by the HADS (Hospital Anxiety and Depression Scale), has been shown to be highly correlated with increased pain sensation [4] and increased mortality in heart failure patients [5]. This body of research suggests that the impact of mood on clinical outcomes is significant.

Research on how narratives impact mood is beginning to be done. A small study in the mid-1980s found that patient driven written narratives administered upon admission led to 6-month decreased physician follow up, a change the authors define as being a positive impact on qualitative health measures [6]. A study on PTSD patients specifically found that writing about the trauma experience did improve the mood of these PTSD patients [7], however participation in this study required a dedicated visit separate from their follow up care and specialized resources and training for the person running the session.

The question this pilot study looked to answer was if in an urban hospital setting, at the point of visit for follow-up care, talking to a patient about their trauma improved their mood. Our hypothesis was that talking about the trauma would improve mood.4. Methods

Participants were recruited from the waiting room of a trauma clinic at a Level 1 Trauma Center. After having the project and the process explained, interested subjects completed the consent form, which indicated that the study consisted of the completion of 2 moodscales and a short interview. Prior to their physician visit participants completed a POMS mood scale form - a well-validated measurement of mood [8]. Subjects were then interviewed in the patient rooms using a semi-structured interview guide (Appendix I) conducted by a social science methods trained medical student. Subjects were alone during the interview except for 1 occasion where the subject was required to be accompanied by a prison guard. The interview guide included questions about the trauma event itself, the experience of getting to the hospital, memories of the experiences in the emergency department and hospital, about perceptions of care by the medical team, and a set of general questions about perceptions of violence in their community. Immediately after the interview, each participant then completed a second POMS mood scale. All interviews were recorded and anonymized, but remained linked to the mood scales. Temple University’s IRB approved this study.

The POMS Short Form Mood scale was our primary analytical tool for relating narrative to mood. The POMS short form scale is a measurement tool that uses 37 descriptors with options to choose a numerical value that best represents the degree to which that descriptor is consistent with the subject’s mood. Then the collection of responses is used to determine the degree of psychological distress [9]. The POMS Short Form shows good internal consistency, test–retest reliability, and convergent validity with its long form compatriot suggesting that the short form is an equally valid tool that requires less time [10-14].



Twenty-six subjects were recruited, 24 men and 2 women, with an average age of 29.1 (range 17-47), and an average length of education of 12 years (ranging from sixth grade to college). The majority of our participants had experience with the criminal justice system, with 73% having a history of arrest and 65% with incarceration. While residences and locations of trauma span the city, our participants and their traumas are concentrated in North Philadelphia (Table 1). 4 subjects’ mood scales could not be properly scored and are thus excluded from this analysis.