Background: People who experience physical trauma face a range of psychosocial outcomes. These may be overlooked by busy clinicians. While some risk factors are understood, our understanding of the psychological effects of violent injury remains limited. Furthermore, there has been little research on the effect of facial trauma. Although changes to appearance can be distressing, the effects of these have not been studied in traumatic injury patients. Aims: To establish the prevalence and persistence of psychological distress and appearance concerns following injury. To compare the psychological outcomes in i) violent and accidental injury and ii) facial and other injury, and iii) to identify explanatory risk factors for psychological distress. Methods: Participants were adults admitted to the Royal London Hospital with traumatic injuries. Two hundred and twenty five participants (225) completed questionnaires in hospital. Follow up was at three months (N = 100) and six months (N = 112). Standardised measures were used to assess symptoms of post-traumatic stress (PTSS) (Acute Stress Disorder Scale, PTSD Checklist), depression and anxiety (Hospital Anxiety and Depression Scale), and appearance concern (Derriford Appearance Scale). Explanatory measures were collected, including history of mental health. Data were analysed in logistic and linear regressions, using multilevel models. Results: PTSS and depressive symptoms affected 28% and 33% respectively at baseline. At six months, 27% and 31% respectively reported these symptoms. After adjusting for demographic factors, violent injury was associated with increased PTSS (OR 6.44, CI 1.75 to 23.75), depressive symptoms (OR 4.78, CI 1.41 to 16.18) and appearance concern (2.78, CI 0.09 to 5.47). A history of mental health problems increased distress. Conclusions: There were high levels of psychological distress in this sample. Violent injury was associated with a complex interaction of social and psychological factors. People vulnerable to distress may benefit from psychological support. Hospital admission provides a unique opportunity to engage them in interventions.