Worldwide, injuries such as those caused by road traffic crashes, falls, interpersonal violence and self-harm represent a serious public health challenge [1]. Although the burdens represented by injuries are declining in Norway, in 2015, 5.5% of all deaths were caused by injuries, and injuries caused 9.5% of years lost [2]. In terms of Disability Adjusted Life Years (DALYs), the loss from injuries amounted to 7.6% [2].

Injuries are usually painful for the individual, impose burdens on health- and welfare services, and lead to loss of productive worktime [3]. These are the immediate (often also long-term), and most tangible costs. Injuries may, however, also have consequences in terms of increased levels of psychological distress, reduced social functioning, and reduced wellbeing. This kind of possible effects of injuries are addressed in the present study.

Many studies of the relationship between being injured and aspects of distress and quality of life have focussed on patients with specific diagnoses. Serious limitation of daily functioning, high levels of distress, and low levels of health-related quality of life have been found in groups of patients, for instance after traumatic brain injuries [4], hip fractures [5], and traumatic pelvic injuries [6].

Studies among broader groups of injured patients confirm these findings [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. Post-injury scores are often compared with pre-injury scores obtained retrospectively during post-trauma interviews. Levels of distress have been shown to be higher and levels of subjective quality of life to be lower after injuries, and multiple injuries are associated with stronger associations with outcomes (dose–response) [7,8,9,10,11,12,13]. Prospective, longitudinal studies among patients being treated for injuries in health care settings have showed improvements in scores as a function of time after the first post-injury data collection [11, 14, 18,19,20, 24,25,26], although also other patterns of change have been observed [27,28,29].

A serious methodological challenge in studies where post-injury scores are compared with pre-injury scores obtained retrospectively, is the retrospective measurement of pre-injury levels of distress and quality of life. Retrospective measurement is based on the assumption that scores are similar to those that would have been obtained with actual measurements before injury. This is not necessarily the case[30].

In other studies, distress and subjective quality of life scores among injured people are compared with normative data. Higher levels of distress and lower levels of subjective quality of life are found among the injured [7, 14,15,16,17,18,19,20,21,22,23]. Scores less favourable than in normative data have been found long after the injury took place, after 12 months [11, 12, 15, 17, 22], 24 months, [9, 15, 19, 31], and after five to six years [20, 23]. Serious challenges in these studies are to find data from sufficiently relevant normative populations and data collections taking place sufficiently close in time to the data collections among injured.

In a recent systematic review of twenty-nine studies, it was found that being injured was associated with lower health-related quality of life compared to not being injured. Most studies documented improvements in health-related quality of life over time since shortly after the injury event, but without full return to pre-injury levels [32]. Improvements tend to be fastest during the first period after injury, and less fast or not at all during subsequent months.

There is a large literature on consequences of injuries which is beyond the scope of this study to cover. One example is a study by Andelic and associates, which describes disability and quality of life 20 years after traumatic brain injury [33].

Exposure to violence is associated with deteriorations in health and well-being [34,35,36]. Studies of consequences of intimate partner violence among women have shown exposure to violence to be associated with long-term negative psychological effects and increased risks of suicide [37]. Effects of violence on outcomes such as health is well documented [36].

In a study among women in Finland, it was found that exposure to violence in close relationships was associated with lower mean scores on quality of life [34]. Two Danish cross-sectional studies provided evidence for an association between exposure to physical violence and reduction in health-related quality of life [35].

Abused women in Norway were in one study found to have lower scores than national normative data on all dimensions of the SF-36 scale (physical health, role-physical, bodily pain, general health, vitality, social functioning, role-emotional, mental health) at a first data collection (while staying in women’s shelter). One year later, mean scores had improved markedly, except for vitality scores [16].

Studies of effects of violence are, however, not the same as studies of effects of injuries caused by violence. In a study from Australia, it was reported that adults exposed to physical violence and serious injury exhibited lower levels of health-related quality of life. Exposure to injuries was measured independently from exposure to violence. The injuries reported were therefore, however, not necessarily caused by violence [38].

Studies with relevant designs and sufficient power on associations between functional impairment due to injuries and distress and quality of life indicators were not found.

The purpose of the present study was to examine associations between a set of three injury-related predictors and a selection of outcome variables related to distress and subjective quality of life.