Prevalence and predictors of mental disorders in an injured emergency centre population: a...
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Prevalence and predictors of mental disorders in an injured emergency
centre population: a cross-sectional study
Claire van der Westhuizen, Dan J. Stein, Gail Wyatt, John Williams, Katherine
Sorsdahl
Presentation outline
• Introduction: Why explore mental disorder in injured patients?
• Objectives• Methods• Results/discussion• Limitations• Conclusion
SA Burden of disease
Mental health Injury
Risk factors
Interpersonal violence 6.5% of DALYs (no. 2)
Depression 2% of DALYs (no. 10) Influences
Why explore mental disorder in injured EC patients?
What we know (HICs)• Injured patients = at-risk
group for mental disorder, especially intentional injuries (Dicker et al, 2011; O’Donnell et al, 2009)
• EC patients ++ past trauma and community violence (Cunningham et al, 2006)
• Recurrent injury HIC (Sims et al, 1989; Worrell et al, 2006)
What we don’t know (LMICs)• Mental disorders in
EC ??? (substance use only)
• Past trauma and community violence???
• Recurrent injuries???
Why explore mental disorder in injured patients? - 2
Data• Majority of data from HICs• LMIC very little data
Need
•Mental health treatment gap•High burden of injuries in LMICs
EC visit •ID and intervention for mental disorders•Injury prevention
Part of the picture
Society
Individual
Health
Regional influences
Justice
Political environment
Education
Global trends
Objectives
• To determine the prevalence of mental disorders in intentionally and unintentionally injured ambulant emergency centre patients• To determine the sociodemographic,
injury and psychological predictors of mental disorder in this group
Methods - 1
• Sites: Elsies River CHC and Khayelitsha Hospital• N=200 injured patients, convenience sample• Intentional: assault injuries• Unintentional: included road traffic, burns, falls
etc• Exclusion criteria: <18 years old, self-inflicted
injuries, serious injury, unable to give informed consent
Methods - 2
• Sociodemographics and injury/violence history• Structured psychiatric diagnostic interview (MINI)• Trauma History Questionnaire (THQ)• Analysis: – Prevalence of mental disorders– Chi-square test: differences between intentionally
injured and unintentionally injured groups– Logistic regression: predictors of mental disorder
Results: prevalence of mental disordersDisorders Intentional
injuryUnintentional injury
Any mental disorder 82 (70%) 44 (54%) 30% (lifetime)
Current mental disorder 79 (67%) 40 (49%) 17% (12-month)
Current depression or anxiety*
45 (38%) 22 (27%)
AOD dependence/abuse 59 (50%) 27 (33%) 6%
Mental disorder and AOD
39 (33%) 9 (11%)
*includes suicidality
High risk group
South Africa
Three logistic regression models
Current mental
disorderAOD
AOD and mental disorder
Current mental disorderVariable Yes (%) Unadjusted OR (95% CI) Adjusted OR (95% CI)Age
18-25 38 (31.9) 1.00 1.00
25-40 51 (42.9) 0.844 (0.43-1.66) 0.721 (0.34-1.54)
>40 30 (25.2) 0.724 (0.34-1.53) 0.668 (0.3-1.51)
GenderMale 82 (68.9) 1.00 1.00
Female 37 (31.1) 0.809 (0.45-1.47) 1.039 (0.52-2.08)
EmployedNo 67 (56.3) 1.00 1.00
Yes 52 (43.7) 0.433 (0.24-0.77)* 0.526 (0.28-1)*
Injury presentationUnintentional 40 (33.3) 1.00 1.00
Intentional 79 (66.4) 2.127 (1.19-3.79)* 1.284 (0.65-2.54)
# prev intentional injuries (med, range) 1.571 (1.19-2.07)* 1.460 (1.08-1.98)*
Community violence (med, range) 1.155 (1.04-1.28)
Lifetime trauma (THQ)
None 15 (12.6) 1.00 1.00
1 to 10 44 (37) 0.933 (0.4-2.16) 0.945 (0.38-2.35)
11 to 20 28 (23.5) 2.010 (0.75-5.36) 1.667 (0.59-4.71)
> 20 32 (26.9) 2.987 (1.08-8.26)* 1.655 (0.54-5.08)
Logistic regression models
• Substance use disorders: male, high levels of witnessed community violence• Comorbid substance and other
mental disorder: high levels of witnessed community violence
FindingsSimilar
• High frequencies of past trauma and witnessed community violence in this group
• Linked to mental disorders
Different• Recurrent intentional injury
predicted current mental disorder
• Community violence plays a role in adult patients (mostly studied in adolescents)
• Witnessed community violence is a stronger predictor than cumulative trauma burden
Limitations
• Generalisable?• Convenience
sampling• Mental disorders
under-sampled• Self-report,
hospital data
Conclusion - 1
Injured EC patients are an at-risk group:
- mental disorder- lifetime trauma- witnessed violence
Conclusion - 2
Targeted psychosocial interventions
Injury prevention
Decrease mental health Rx gap
Conclusion - 3
Investigation and intervention required in many settings
Society
Individual
EC research and intervention
Thank you
• Staff of Elsies River and Khayelitsha facilities
• Katherine Sorsdahl• Phodiso
programme• Today’s audience