Screening for Mental Illness in a Trauma Center: Rooting Out a Risk Factor for Unintentional Injury

Dicker, Rochelle; Mah, Jennifer; Lopez, Dahianna; Tran, Catherine; Reidy, Rosemary; Moore, Megan; Kreniske, Phil; Crane, Ian; Knudson, M. Margaret; Li, Moon; Menza, Rebecca; Shuway, Martha; Alvidrez, Jennifer

doi:10.1097/ta.0b013e318216f611

Cited by 27 publications

(29 citation statements)

References 12 publications

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“…Those seeking medical care for unintentional injuries may be more likely to have unrecognised mental health needs that may have either contributed to or resulted from their injuries. Brief alcohol and substance abuse screening, intervention and referral programmes have been used successfully in trauma centres nationwide to prevent recurrent traumatic injury 39. Longitudinal research is needed to clarify causal relationships and identify mediators of the association between psychological distress and unintentional injury and also to evaluate the potential of mental health screening and intervention as an injury prevention strategy.…”

Section: Discussionmentioning

confidence: 99%

Higher psychological distress is associated with unintentional injuries in US adults

et al. 2013

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Background Links between mental illness, self-inflicted injury, and interpersonal violence are well recognized, but the association between poor mental health and unintentional injuries is not well understood. Methods We used the 2010 National Health Interview Survey to assess the association between psychological distress and unintentional non-occupational injuries among U.S. adults. Psychological distress was measured by the Kessler Psychological Distress Scale, a symptom scale shown to identify community-dwelling persons with mental illness. Multivariable logistic regression was used to estimate adjusted odds ratios (AOR) and 95% confidence intervals. Results Of the 26,776 individuals analyzed, 2.5% reported a medically-attended unintentional injury in the past three months. Those with moderate and severe psychological distress had 1.5 [1.2-1.8] and 2.0 [1.4 -2.8] times higher odds of injury, respectively, as compared to those with low distress levels, after adjusting for age, sex, race, marital status, education level, alcohol use, physical functional limitation, medical comorbidity, employment status, and health insurance status. Psychological distress was significantly associated with falls [AOR 1.4 (1.1-1.9)] and sprain/strain injuries [AOR 2.0 (1.5-2.8)], but not transportation-related injuries [AOR 1.2 (0.7-1.9)] or fractures [AOR 1.1 (0.8-1.6)]. Conclusion Among community-dwelling U.S. adults, psychological distress is significantly associated with unintentional non-occupational injury, and the magnitude of association increases with severity of distress. The association between psychological distress and injury may be particularly strong for falls and sprain/strain injuries. These findings draw attention to a large group of at-risk individuals that may merit further targeted research, including longitudinal studies.

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Section: Discussionmentioning

confidence: 99%

Higher psychological distress is associated with unintentional injuries in US adults

et al. 2013

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“…Firstly, studies from high-income countries (HICs) suggest that injured patients presenting to ECs may represent an at-risk group for mental disorders. A number of these studies have found that patients presenting with an injury were more likely to meet criteria for a pre-existing mental disorder than their non-injured counterparts (Dicker et al, 2011; O'Donnell et al, 2009; Poole et al, 1997; Wan et al, 2006). For example, a Canadian study found that patients hospitalized for injury were over nine times more likely to have been hospitalized for a mental disorder prior to the injury admission, and over three times more likely to have submitted mental health physician claims than the matched non-injured cohort.…”

Section: Introductionmentioning

confidence: 99%

Prevalence and Predictors of Mental Disorders in Intentionally and Unintentionally Injured Emergency Center Patients

Westhuizen

Williams²,

Stein³

et al. 2014

Journal of Nervous &Amp; Mental Disease

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Little is known about the prevalence and predictors of mental disorders amongst injured emergency centre (EC) patients in low- and middle-income countries. Patients presenting with either an intentional or unintentional injury were recruited (n=200). Mental health, injury and psychological trauma histories were assessed. Descriptive statistics and logistic regressions were conducted and predictors for current mental disorder were identified. Diagnostic criteria for a current mental disorder, including substance use disorders, were met by 59.5% of participants. Compared to those with an unintentional injury, intentionally injured participants were more likely to be diagnosed with a current mental disorder (66.9% vs 48.8%; p=0.01). High frequencies of previous intentional injuries predicted for current mental disorder (OR = 1.460, 95% CI 1.08-1.98), while male gender and witnessed community violence predicted substance use disorder diagnoses. Findings indicate that injured EC patients, particularly those with intentional injuries, are at risk for mental disorders. Psychosocial interventions in the EC context can potentially make an important contribution in reducing the burden of mental disorders and injuries in low- and middle-income countries.

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“…Although many studies have looked at the impact of trauma on subsequent mental health, few studies have examined the impact of pre-existing mental health diagnoses on hospital resource use and cost after acute trauma. A study from San Francisco using medical records and registry data found similar rates of mental health diagnoses in cases of unintentional injury 16. These authors also found that patients with mental health diagnoses had longer lengths of stay and repeat admissions for injury 17…”

Section: Discussionmentioning

confidence: 94%

Deriving a prediction rule for short stay admission in trauma patients admitted at a major trauma centre in Australia

et al. 2013

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IntroductionThe aim of this study was to derive and internally validate a prediction rule for short stay admissions (SSAs) in trauma patients admitted to a major trauma centre. Methods A retrospective study of all trauma activation patients requiring inpatient admission at a single inner city major trauma centre in Australia between 2007 and 2011 was conducted. Logistic regression was used to derive a multivariable model for the outcome of SSA (length of stay ≤2 days excluding deaths or intensive care unit admission). Model discrimination was tested using area under receiver operator characteristic curve analyses and calibration was tested using the HosmerLemeshow test statistic. Validation was performed by splitting the dataset into derivation and validation datasets and further tested using bootstrap cross validation. Results A total of 2593 patients were studied and 30% were classified as SSAs. Important independent predictors of SSA were injury severity score ≤8 (OR 7.8; 95% CI 5.0 to 11.9), Glasgow coma score 14-15 (OR 3.2; 95% CI 1.8 to 5.4), no need for operative intervention (OR 2.2; 95% CI 1.6 to 3.2) and age < 65 years. (OR 1.7; 95% CI 1.2 to 2.6). The overall model had an area under receiver operator characteristic curve of 0.84 (95% CI 0.82 to 0.87) for the derivation dataset. After bootstrap cross validation the area under the curve of the final model was 0.83 (95% CI 0.81 to 0.84). Conclusions We report a prediction rule that could be used to establish admission criteria for a trauma short stay unit. Further studies are required to prospectively validate the prediction rule.

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Screening for Mental Illness in a Trauma Center: Rooting Out a Risk Factor for Unintentional Injury

Cited by 27 publications

References 12 publications

Higher psychological distress is associated with unintentional injuries in US adults

Higher psychological distress is associated with unintentional injuries in US adults

Prevalence and Predictors of Mental Disorders in Intentionally and Unintentionally Injured Emergency Center Patients

Deriving a prediction rule for short stay admission in trauma patients admitted at a major trauma centre in Australia

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