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

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.