Dissertations & Theses (Open Access)

Date of Award

Fall 12-2018

Degree Name

Doctor of Philosophy in Nursing (PhD)


Rebecca L. Casarez, PhD

Second Advisor

Janet C. Meininger, PhD

Third Advisor

John B. Holcomb, M.D.


Background: Traumatic injury is a major health problem and has been linked to mental and physical disability following injury. Although it is the leading cause of disability in the United States (US) for adolescents and young adults, there is a paucity of evidence in the literature regarding association(s) of perceived stress on the outcomes of anxiety and depressive symptoms and the moderating role of resilience and social support in which to develop prevention and treatment interventions for this patient population.

Purpose: The purpose of this study was to examine the effect of perceived stress on anxiety and depressive symptoms in adolescents and young adults who have been hospitalized for treatment following traumatic injury at one point in time on the trauma floor at a Level I in-patient trauma center. The moderating effect of resilience and social support in the relationship between perceived stress and anxiety and depressive symptoms was also explored.

Methods: Face to face interviews were conducted in this cross-sectional research design for subjects admitted to an in-patient trauma unit. Data were collected via the Perceived Stress Scale (PSS), the Mood and Anxiety Symptom Questionnaire (MASQ), the 10-item Connor-Davidson Resilience Scale (CDRISC-10), and the Medical Outcomes Study-Social Support Scale (MOS-SSS). Multiple linear regression in the form of the general linear model was utilized to test 5 variables to describe the population and associations among the psychosocial factors.

Results: A total of 68 candidates were enrolled into the study after exclusions. The results for arousal anxiety (AA) suggested that perceived stress, gender, and ethnicity are significantly associated with arousal anxiety. The results indicated that males had higher AA scores than females (p = .023), African Americans and Caucasians had higher AA scores than Hispanics (p = .021), and higher perceived stress was associated with higher AA scores (p = .001), suggesting an increase in stress was significantly associated with higher anxiety. Anhedonic depression and perceived stress as well as the moderating roles of resilience and social support were non-significant.

Conclusion: The current study revealed significance with perceived stress and anxiety as well as perceived stress between ethnicity and gender in adolescents and young adults who experienced physical trauma. Early identification, treatment and referral are possible solutions to address mental health issues associated with physical traumatic injury in adolescents and young adults and may ultimately contribute to prevention of untoward long-term patient outcomes. Health care may benefit from further study in the adolescent-young adult population focusing on treatment and intervention and evidenced based practice in the clinical setting.


Traumatic injury, stress resilience, adolescents, young adults, social support

Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.