Abstract
<title>Abstract</title> <p>Injuries represent a major global public health challenge, particularly in low- and middle-income countries (LMICs), where the burden of injury is high and access to comprehensive post-injury care remains limited. Preexisting or emerging healthcare needs are common in injured patients and may hinder physical recovery and long-term rehabilitation. However, mental health needs are often overlooked within injury care systems in LMICs. This study explored stakeholder perspectives on mental health needs of injured patients in Sindh province, Pakistan. We conducted a qualitative study involving four focus group discussions with 30 purposively selected injured patients, community members and healthcare workers from urban and rural settings. Discussions were audio-recorded, transcribed and analysed thematically using a hybrid inductive-deductive approach. Participants recognised that injuries often lead to persistent psychological consequences particularly among individuals with severe injuries or long-term disabilities. Mental health services were perceived as limited and poorly integrated within injury care pathways, especially in rural areas. Limited access to mental healthcare professionals was important barrier, along with low mental health literacy, stigma and financial constraints. Informal sources of support and coping practices, including family support, religious practices and spiritual healing, were commonly used, often in place of formal mental health services. The unmet mental health needs of injured patients in Sindh reflect not only a gap in post-injury care, but also wider health-system challenges around service integration, referral coordination, financial protection, and community engagement. Drawing on a health-systems perspective, the findings suggest that injury care pathways in Pakistan and similar LMIC settings should move beyond survival-focused acute care to include psychological screening, structured referral mechanisms, community-based psychosocial support, and culturally appropriate links with informal sources of care to strengthen continuity, equity, and responsiveness across the broader health system.</p>