Trauma Mental Health Screening Prior Incarceration Disclosure and Post-Traumatic Stress Disorder Service Exclusion Among Nigerian Emergency Department Survivors: A Multilevel Analysis of Institutional Trust Barriers

Emergency departments in Nigeria are the first point of contact for many survivors of traumatic injury, yet post-traumatic stress disorder frequently goes unrecognised and untreated in this setting. Drawing on a multilevel conceptual framework that integrates patient-level disclosure decisions, clinician-level screening practices, and institutional-level trust dynamics, the analysis synthesises existing scholarship on trauma care in Nigeria, prison health, stigma, and health-seeking behaviour. Institutional trust is positioned as the key mediator of this disclosure decision, shaped by prior experiences of carceral and healthcare systems. The contribution is a theoretically grounded account of how trust barriers produce systematic PTSD service exclusion among a stigmatised survivor population, with implications for screening protocol design and institutional reform in Nigerian emergency care.