This article is more than 5 years old. Information may no longer be current.
Major trauma may increase risk for mental health diagnoses, suicide
Patients who experienced a major traumatic injury were at increased risk for mental health conditions or completing suicide in the years after their injury, according to a population-based analysis published in CMAJ.
“It was important for us to conduct this research as we, trauma physicians and surgeons, have long focused our efforts on the initial resuscitation and surgical management of patients suffering serious injuries,” Christopher C.D. Evans, MD, MSc, FRCPC, assistant professor in the department of emergency medicine at Queen’s University, Ontario, Canada, told Healio Psychiatry. “The trauma systems we work in have evolved to very effectively reduce the rates of death and even severe disability following major trauma, but have not consistently focused on the mental health side of the recovery from injury."
In this population-based, self-controlled, longitudinal cohort study, researchers examined the connection between major trauma and the development of a new mental health diagnosis or death by suicide.
The investigators used linked administrative data to examine patients treated for major trauma in Ontario between 2005 and 2010. The primary outcome was the difference in the composite rate of mental health diagnoses during inpatient admissions between the 5 years post-injury and the 5 years prior to injury and the secondary outcome was the rate of deaths by suicide among trauma survivors during the 5 years post-injury.
In total, 19,338 patients were included in the cohort. Analysis revealed that major trauma was linked to a 40% increased rate of hospital admission for one or more mental health diagnoses (IRR = 1.4; 95% CI, 1.11-1.18). Male gender, extremes of socioeconomic status, living in rural areas, experiencing unintentional injuries, and requiring surgery were all associated with a higher risk for hospital admission for a mental health diagnosis.
In addition, youth aged younger than 18 years had the greatest increase in rate of admissions with one or more mental health diagnosis after injury (IRR = 3.3; 95% CI 1.5-7.2). The most common mental health diagnoses included alcohol abuse, drug abuse disorders and major depressive disorder, according to the data.
Evans and colleagues found that the suicide rate was 70 per 100,000 patients each year. Prior hospital admission with a mood disorder diagnosis (HR = 4.3; 95% CI, 2.1-8.8) and self-inflicted injury (HR = 7.8; 95% CI, 3.9-15.4) were risk factors for completing suicide in the cohort.
“Clinicians caring for patients recovering from major trauma should be cognizant of their patients' heightened risks of developing mood disorders, substance abuse disorders, as well as their elevated risks of self harm, including suicide,” Evans said. "We would encourage all clinicians managing these patients in the months to years after their injury routinely screen for mental health diagnoses and offer appropriate mental health services to patients.” – by Savannah Demko
Disclosure: Evans reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.