166709 Emergency care must include a focus on psychiatric consequences of injury

Wednesday, November 7, 2007: 1:06 PM

Therese Richmond, PhD, CRNP, FAAN , School of Nursing, University of Pennsylvania, Philadelphia, PA
Theiman Ackerson, MSW , School of Nursing, University of Pennsylvania, Philadelphia, PA
Justine Shults, PhD , School of Medicine, Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, PA
Wensheng Guo, PhD , School of Medicine, Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, PA
Vicente Gracias, MD , School of Medicine, Division of Traumatology & Surgical Critical Care, University of Pennsylvania, Philadelphia, PA
Judd Hollander, MD , School of Medicine, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
Keith Robinson, MD , School of Mediicne, Department of Physical Medicine & Rehabilitation, University of Pennsylvania, Philadelphia, PA
Jay Amsterdam, MD , School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphioa, PA
Background: Increasing attention should be paid to the consequences of minor injuries since they constitute the largest portion of the injury pyramid annually and disabling psychological consequences of injury are unrelated to injury severity. Purpose: To identify individuals at risk for developing mood and related psychiatric disorders in the year following minor injury. Methods: A longitudinal cohort design of 275 randomly selected patients who visited an ED for minor injury, excluding those with current major depression or psychotic disorders. Structured psychiatric interviews were obtained at 2 weeks, 3, 6, and 12 months post-injury and disorders were diagnosed using DSM IV criteria. Stepwise logistic regression was used to examine factors present at the time of injury or soon thereafter that predicted risk for post-injury disorders. Results: The sample (N=248) had women (50.4%) and men (40.7%), was black (56%) and white (40.7%) with a mean age of 41.4 years (SD 17.1). Forty-five participants (18%) had a mood disorder diagnosed. 7 (2.8%) had anxiety disorder, 9 (3.6%) had substance abuse disorder, 1 had an adjustment disorder. Four had more than one Axis 1 disorder. Five factors predicted an increased likelihood of a mood disorder: current psychiatric disorder at time of injury (OR 6.1, 95%CI 2.4 15.9), anticipation of problems (OR 4.4, 95% CI 1.8 11.1), increasing number of bed days in month prior to injury (OR 1.3 95%CI 1.1 1.5), and lower pre-injury social interaction (OR .97 95% CI .95 - .99) and reported quality of life (OR .89, 95% CI .83-.96). Findings are similar for all Axis I disorders are added to mood as the dependent variable. Conclusion: More than 1 in 5 patients meet diagnostic criteria for a psychiatric disorder following minor injury. This has policy implications for the design, delivery, and payment of services. Funder: RO1MH63818, NIMH

Learning Objectives:
Examine the risk factors for developing psychiatric disorders after physical injury. Consider the clinical, economic, and public policy implications of psychiatric consequences following injury.

Keywords: Injury, Depression

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

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