269674 Mental Illness and Unintentional Injury: Who's Fault is It?

Tuesday, October 30, 2012

Rochelle Dicker, MD, FACS , San Francisco Injury Center & Department of Surgery, University of California, San Francisco, San Francisco
Catherine Tran, BS , Department of Surgery, University of California, San Francisco, San Francisco, CA
Martha Shumway, PhD , Department of Psychiatry, University of California, San Francisco, San Francisco, CA
BACKGROUND: Previously, through a validated screening instrument administered at our trauma center, we prospectively found that mental illness is an independent risk factor for unintentional injury. Currently, our aim is to understand causality per patient perception. The purpose of this 1-year follow up study is to compare perceptions of causality after the index injury in subjects with psychiatric diagnosis versus those without. We hypothesize that the preexisting presence of psychiatric illness in injured individuals increases the likelihood of perceived patient-related unsafe circumstances contributing to injury. METHODS: We prospectively screened for psychiatric illness at our Level I Trauma Center with unintentional injury over 17 months. We conducted chart reviews and follow up interviews 1 year after index injury. Subjects were asked their impressions of contributors to the injury incident. Logistic regression was used to analyze causality. RESULTS: Follow up interviews were conducted in 141 (positive response rate of 64%) subjects. Subjects with comorbid conditions of substance abuse and mental illness had a higher likelihood of expressing patient-related causality. This group reported greater than twice the likelihood of multiple patient-related reasons for the injury incident (see figure in summary text). CONCLUSIONS: The trauma center can screen for psychiatric illness and unroof details of causality and holes in psychiatric care and case management. Subjects with comorbid conditions are not receiving appropriate substance abuse resources. Subjects were not inclined to blame others for the injury. Treatment programs and mental health care could reduce risky behavior and prevent injury.

Learning Areas:
Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related research
Social and behavioral sciences

Learning Objectives:
Demonstrate that people with mental illness are at greater risk for unintentional injury and have a tendency to blame themselves.

Keywords: Mental Illness, Injury Prevention

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the Principal Investigator for all facets of this investigation into the link between mental illness and unintentional injury.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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