centre population a crosssectional study Claire van der Westhuizen Dan J Stein Gail Wyatt John Williams Katherine Sorsdahl Presentation outline Introduction Why explore mental disorder in injured patients ID: 432671
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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 SorsdahlSlide2
Presentation outlineIntroduction: Why explore mental disorder in injured patients
?ObjectivesMethodsResults/discussionLimitationsConclusionSlide3
SA Burden of disease
Mental health
Injury
Risk factors
Interpersonal violence 6.5% of DALYs (no. 2)
Depression 2% of DALYs (no. 10)
InfluencesSlide4
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)
M
ental disorders in EC ??? (substance use only)
P
ast trauma and community violence???
Recurrent injuries??? Slide5
Why explore mental disorder in injured patients? - 2Slide6
Part of the pictureSlide7
ObjectivesTo determine the
prevalence of mental disorders in intentionally and unintentionally injured ambulant emergency centre patientsTo determine the sociodemographic, injury and psychological predictors of mental disorder in this groupSlide8
Methods - 1Sites:
Elsies River CHC and Khayelitsha HospitalN=200 injured patients, convenience sampleIntentional: assault injuriesUnintentional: included road traffic, burns, falls etcExclusion criteria: <18 years old, self-inflicted injuries, serious injury, unable to give informed consentSlide9
Methods - 2Sociodemographics
and injury/violence historyStructured psychiatric diagnostic interview (MINI)Trauma History Questionnaire (THQ)Analysis: Prevalence of mental disordersChi-square test: differences between intentionally injured and unintentionally injured groupsLogistic regression: predictors of mental disorderSlide10
Results: prevalence of mental disorders
Disorders
Intentional injury
Unintentional 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 AfricaSlide11
Three logistic regression models
AOD and mental disorderSlide12
Current mental disorder
Variable
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)
Gender
Male
82 (68.9)
1.00
1.00
Female
37 (31.1)
0.809 (0.45-1.47)
1.039 (0.52-2.08)
Employed
No
67 (56.3)
1.00
1.00
Yes
52 (43.7)
0.433 (0.24-0.77)*
0.526 (0.28-1)*
Injury presentation
Unintentional
40 (33.3)1.001.00Intentional79 (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
)Slide13
Logistic regression modelsSubstance use disorders: male, high levels of witnessed community violence
Comorbid substance and other mental disorder: high levels of witnessed community violenceSlide14
Findings
SimilarHigh frequencies of past trauma and witnessed community violence in this groupLinked to mental disordersDifferent
Recurrent intentional injury predicted current mental disorderCommunity violence plays a role in adult patients (mostly studied in adolescents)Witnessed community violence is a stronger predictor than cumulative trauma burdenSlide15
Limitations
Generalisable?Convenience samplingMental disorders under-sampledSelf-report, hospital dataSlide16
Conclusion - 1
Injured EC patients are an at-risk group:- mental disorder- lifetime trauma- witnessed violence
Slide17
Conclusion - 2Targeted psychosocial interventions
Injury prevention
Decrease mental health Rx gapSlide18
Conclusion - 3
Investigation and intervention required in many settings
EC research and interventionSlide19
Thank youStaff of
Elsies River and Khayelitsha facilitiesKatherine SorsdahlPhodiso programmeToday’s audience