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Children hospitalized for injuries at risk for mental health concerns
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Children who sustain unintentional injuries that require hospitalization are more likely to be given a mental health diagnosis or prescription for psychotropic medication after treatment, according to research published in The Journal of Pediatrics.
According to the researchers, this risk is increased for young children treated for burns and all children with a head injury.
“We expect children to show a certain amount of stress and discomfort as a result of spending time in the hospital for an injury,” Julie Leonard, MD, MPH, associate director of the Center for Pediatric Trauma Research and principal investigator in the Center for Injury Research and Policy at Nationwide Children’s Hospital, said in a press release. “When we look back at medical records, it is clear that there are often serious mental health concerns after children go home.”
To assess whether children who sustain an injury requiring hospitalization have increased rates of mental health diagnoses and related prescriptions following injury, the researchers conducted an investigation of children 18 years of age and younger who were treated between 2005 and 2015 at a pediatric trauma center. Upon admission, children who were hospitalized were insured through a managed-Medicaid program and presented for any health care services at least once in the year before hospitalization.
Once data were collected, Leonard and colleagues evaluated the rates of mental health diagnoses, as well as the rate in which psychotropic prescriptions were made 1 year before and 1 year after injury using Poisson regression models.
Before injury, the mental health diagnosis rate of the 2,208 children included in the investigation was 95.9 per 1,000 person-years. When rates of mental health diagnoses were assessed after injuries were sustained, the researchers observed an increase to 156.7 per 1,000 person-years (RR = 1.63; 95% CI, 1.39-1.92).
Mental health diagnoses were more frequently given to children between the ages of 0 and 4 who had been treated for burns (adjusted RR = 8.56; 95% CI, 3.30-22.2). Additionally, children who sustained a head injury were more likely to receive subsequent mental health diagnoses, including children between the ages of 0 and 4 years (aRR = 2.87; 95% CI, 1.31-11.5), 5 and 9 years (aRR = 3.11; 95% CI, 1.27-7.59), 10 and 14 years (aRR = 2.17; 95% CI, 1.27-3.73) and 15 to 18 years (aRR= 5.37; 95% CI, 2.12-13.6).
According to the researchers, the three most commonly diagnosed conditions after injury were adjustment disorders (RR = 9.80; 95% CI, 1.23-78.3), learning and cognitive disorders (RR = 2.78; 95% CI, 1.84-4.19) and sleep disorders (RR = 2.31; 95% CI, 1.06-5.03).
When Leonard and colleagues examined the rate of prescribing psychotropic medications before injury, they observed a rate of 121.7 per 1,000 person-years. This rate also increased after children were hospitalized for an injury to 310.9 per 1,000 person-years (RR = 2.55; 95% CI, 2.26-2.89). The three classes of medications that children were most at risk of receiving after injury were antianxiety medications (RR = 4.28; 95% CI, 3.15-5.83), anticonvulsants (RR = 3.77; 95% CI, 2.37-6.00) and antidepressants (RR = 2.76; 95% CI, 2.01-3.80).
“We, as health care providers, need to do a better job assessing children for mental health needs, identifying high-risk children and referring them to mental health providers before sending them home,” Leonard said in the release. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
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