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

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