(PS2-18) One Size Doesn’t Fit All: Comparing Healthcare Needs Arising From Acute Physical Versus Mental Health-Related Healthcare Experiences

Abstract Text: The BITTEN Model is an applied trauma-impact framework designed to elucidate how healthcare institutional betrayal can impact patients’ future healthcare engagement (Lewis et al., 2019; Rastegar & Langhinrichsen-Rohling, 2024). BITTEN posits that a patient's history of healthcare institutional betrayal (HIB), which occurs when a trusted healthcare institution fails to act in the patient's best interest (Smith & Freyd, 2014), can interact with their current reason for seeking care (presenting concern, PC) to change what patients’ expect and need during their current healthcare appointment. Aligned with BITTEN, we’ve shown HIB impacts young adults' future healthcare expectations (Gigler et al., 2022). However, little is known about how various PCs impact young adults’ perceived needs during their worst healthcare visit. To address this gap, we assessed college students’ self-selected worst healthcare experience and why they were seeking healthcare (i.e., the PC). Two contrasting PCs were chosen to consider whether the same needs would be endorsed across encounters (mental health PC:MHPC versus acute illness/injury PC:AcutePC). A priori, we predicted the MHPC group would endorse a greater need for trauma-informed care (TIC) than the AcutePC group. Conversely, we predicted the AcutePC group would report greater informational/medical, and tangible/survival needs compared to the MHPC group. The sample consisted of 116 students who focused on their worst previous healthcare experience (48.9% White, 60.7% women); 90 endorsed an AcutePC; 26 endorsed a MHPC for their worst encounter. Participants also completed measures of HIB, trauma symptoms, and what was needed during their problematic healthcare experience. Via a needs assessment measure, three distinct need-based factors were found (Lathan et al., 2023): informational/medical (IN), tangible/survival (TN), and trauma-informed care (TICN). Independent samples t-tests compared the AcutePC and MHPC groups' reports of HIB, trauma symptoms, and 3 types of needs during their worst healthcare incident. The MHPC group reported experiencing significantly more HIB (M=3.81, SD=2.77; M= 2.35, SD= 2.35), t(121)=-2.74, p=.007, d=-.60, trauma symptoms (M=1.69, SD=1.89; M=.54, SD=1.06), t(29.99)=-2.96, p=.006, d= -.88, and TICN (M=31.81, SD=10.04; M=25.01, SD=10.62), t(112)=-2.90, p=.004, d=-.65 than the AcutePC group. No group differences were found for IN and TN. Young adults presenting with mental health indicators appear to be vulnerable to institutional betrayal and trauma-related experiences and needs during their problematic healthcare experiences. Widespread adoption of both trauma-informed care practices and personalized, indicator-specific, healthcare is critical.