The Relationship Between Social Problems And Injuries: Implications
For Policy And Practice
Angus H Thompson, PhD.Alberta Centre for Injury Control & Research
University of Alberta
Canadian Conference on Injury Prevention & Safety Promotion. Ottawa, Canada, November 24, 2003
ACKNOWLEDGEMENTS
Kathy L Belton
Co-DirectorAlberta Centre For Injury Control & Research
Kim Borden
Data AnalystAlberta Centre For Injury Control & Research
Source: Thompson AH, Borden K, Belton KL. (2003). The Relationship Between Unintentional & Intentional Injuries Across Alberta’s Health Regions. Unpublished manuscript.
DO UNINTENTIONAL AND INTENTIONAL INJURIES BELONG
TOGETHER?
Unintentional and intentional injuries involve very different contexts and interventions
“Traditional public health injury control does not apply to violence.”
L.Fisher
ARGUMENTS AGAINST
“Whatever the form, in the end an injury is a health problem”
B. Pless
“... the evidence on shared risk factors among intentional and unintentional infant deaths warrants ‘convergence’ of effort rather than the compartmen-talization engendered by separation.”
Overpeck and McLoughlin
ARGUMENTS FOR
• SII predicts later mortality due to natural causes, unintentional injuries, & violence
• Common parental factors exist for a variety of infant injury deaths, regardless of intent
• There is a relationship between falls, suicidal behaviour, & disease
• There is an overlap among predictors of death by suicide, accidents & natural causes.
EVIDENCE FOR
THE
CANADIAN SOCIAL
PROBLEM INDEX
(SPI)
MurderAttempted Murder
AssaultSexual assault
SuicideRobberyDivorce
Alcoholism
SPI COMPONENTS
SOCIAL PROBLEM INTERCORRELATIONS ACROSS PROVINCES: 1971/1981
Att.Murder Assault Rape Robbery Divorce Suicide
Alco-Holism
Homicide .91/.90 .47/.50 .58/.69 .71/.61 .65/.66 .47/.81 .43/.82
AttemptedMurder .36/.24 .58/.44 .80/.61 .56/.48 .38/.79 .43/.59
Assault .23/.73 .26/.00 .76/.54 .41/.30 .17/.63
Rape .84/.35 .71/.68 .68/.34 .76/.83
Robbery .72/.67 .63/.66 .75/.65
Divorce .77/.70 .68/.77
Suicide .79/.66
80
100
120
140
160S
PI
BC AB SK MN ON PQ NB NS PEI NF
SPI VALUES FOR CANADIAN PROVINCES: 1956, 1976, & 1996
1956 1976 1996
Source: Thompson AH, Howard AW, Yin J (2001). A social problem index for Canada. Canadian Journal of Psychiatry 46, 45-51
Social Problem Index Values For
Alberta RHA’s in Comparison to
Canadian 1956 Values
1991 1997
1. Chinook 160 151
2. Palliser 155 147
3. Headwaters 152 150
4. Calgary 148 145
5. RHA #5 152 148
6. David Thompson 156 151
7. East Central 148 143
8. WestView 158 149
9. Crossroads 168 152
10. Capital 153 146
11. Aspen 159 157
12. Lakeland 155 161
13. Mistahia 165 151
14. Peace 159 153
15. Keeweetinok 203 177
16. Northern Lights 173 161
17. Northwestern 192 174
Alcohol Abuse
Drug Abuse Divorce
Unem- ployment
Suicide attempt Felony
Spouse Abuse
Child Abuse
Schizophrenia
Mania
Depression
Dysthymia
Phobia
Panic Disorder
Obsessive Compulsive
Antisocial Personality
OR < 5 OR 5 - 9.9 OR 10+
THE ASSOCIATION BETWEEN SOCIAL PROBLEMS AND PSYCHIATRIC DIAGNOSES IN THE EDMONTON AREA EPIDEMIOLOGICAL STUDY OF PSYCHIATRIC DISORDERS
Source: Thompson A & Bland RC (1995). Social dysfunction and mental illness in a community sample. Canadian Journal of Psychiatry 40, 15 – 20.
ECOLOGICAL EVIDENCE FROM
ALBERTA’S HEALTH REGIONS
METHOD
• Comparison of injury rates (hospitalizations) across Alberta’s 17 health regions (in 1999)
•Analysis of the level of association among intentional and unintentional injuries
• Principal components analysis to search for an independent intentional injury factor
Unintentional InjuriesAdverse Effects (Medical)Adverse Effects (Drug)FallsMotor Vehicle CrashOverexertion /StrainLate Injury EffectsPoisonStruck Object /PersonNatural /Env. CausesSports RelatedCutting/PiercingSuffoc'n Foreign Body
MachineryFire/ Scalding Bike - Non-TrafficUndetermined IntentPedestrian - Non TrafficDrowningFirearm (Unintentional)Legal InterventionOther InjuryOther Transp. RelatedUnspec.Cause of InjuryIntentional InjuriesSuicide AttemptAssault
ALBERTA INJURY GROUPINGS
Unintentional InjuriesAdverse Effects (Medical)Adverse Effects (Drug)FallsMotor Vehicle CrashOverexertion /StrainLate Injury EffectsPoisonStruck Object /PersonNatural /Env. CausesSports RelatedCutting/PiercingSuffoc'n Foreign Body
MachineryFire/ Scalding Bike - Non-TrafficUndetermined IntentPedestrian - Non TrafficDrowningFirearm (Unintentional)Legal InterventionOther InjuryOther Transp. RelatedUnspec.Cause of InjuryIntentional InjuriesSuicide AttemptAssault
ALBERTA INJURY GROUPINGS
Unintentional InjuriesAdverse Effects (Medical)Adverse Effects (Drug)FallsMotor Vehicle CrashOverexertion /StrainLate Injury EffectsPoisonStruck Object /PersonNatural /Env. CausesSports RelatedCutting/PiercingSuffoc'n Foreign Body
MachineryFire/ Scalding
Other InjuryOther Transp. RelatedUnspec.Cause of InjuryIntentional InjuriesSuicide AttemptAssault
ALBERTA INJURY GROUPINGS
Unintentional InjuriesAdverse Effects (Medical)Adverse Effects (Drug)FallsMotor Vehicle CrashOverexertion /StrainPoisonStruck Object /PersonNatural /Env. Causes
Sports RelatedCutting/PiercingSuffoc'n Foreign Body MachineryFire/ Scalding
Intentional InjuriesSuicide AttemptAssault
RETAINED INJURY GROUPINGS(91.7% of Injury Hospitalizations)
INTERCORRELATIONS OF THE RETAINED INJURY GROUPINGS
Suic Att MVCs Falls Poison Asslt Suffoc Fire
Nat /Env
AdvEff Medic.
AdvEff Drugs Mach Struck Cut Sport
Motor Vehicle
Falls
Poison .60+ p < .01
Assault .47-.59 p < .05
Suffocat’n/Foreign Body .30-.46
Fire/Scalding
Natural/Environmental
Adverse Effect-Medical
Adverse Effect-Drugs
Machinery
Struck Object/Person
Cutting/Piercing
Sports Related
Overexertion/Strain
Note: 48 of 105 comparisons were significant at p < 5%
(r = 0.81)
PRINCIPLE COMPONENTS ANALYSIS
Factor1 2 3
Eigenvalue 6.9 2.6 1.4
Variance 45.8% 17.2% 9.6%
Suicide .85 -.20 -.24
Motor Vehicle .67 .16 -.39
Falls .87 -.31 .16
Poison .77 .49 .04
Assault .74 -.53 .00
Suffocation/Foreign Body .48 -.30 .06
Fire/Scalding .59 .59 -.34
Natural/Environmental .89 .19 .33
Adverse Effects-Medical .51 -.40 -.11
Adverse Effects-Drugs .48 -.10 .77
Machinery .76 .03 -.37
Struck Object/Person .83 -.09 .17
Cutting/Piercing .50 -.55 -.25
Sports Related .42 .79 -.14
Overexertion/Strain .48 .57 .37
SOCIAL PROBLEMS AND INJURIES
Suicide 0.72Assault 0.89
Falls 0.75Adverse Effects-Medical 0.65
Cutting/Piercing 0.51Struck Object /Person 0.50
Motor Vehicle 0.49Machinery 0.46
Natural /Env. Causes 0.43Poison 0.23
Fire/ Scald 0.22Suffoc'n Foreign Body 0.17Adverse Effects-Drugs 0.14
Overexertion /Strain -0.16 Sports Related -0.19
CORRELATIONS BETWEEN THE SPI AND THE RETAINED INJURY GROUPINGS
SPI AlcoholismSexual Assault
Child Negl/Abuse
Suicide Attempt 0.72 0.82 0.75 0.76Assault 0.89 0.83 0.83 0.66
Falls 0.75 0.73 0.69 0.49Adverse Effects-Medical 0.65 0.41 0.65 0.50
Cutting/Piercing 0.51 0.49 0.54 0.25Struck Object /Person 0.50 0.52 0.44 0.40
Motor Vehicle 0.49 0.78 0.61 0.52Machinery 0.46 0.50 0.54 0.51
Natural /Env. Causes 0.43 0.63 0.38 0.36Poison 0.23 0.49 0.29 0.43
Fire/ Scald 0.22 0.33 0.24 0.56Suffoc'n Foreign Body 0.17 0.25 0.15 0.18Adverse Effects-Drugs 0.14 0.42 0.06 -0.09
Overexertion /Strain -0.16 0.21 -0.22 -0.22 Sports Related -0.19 0.10 -0.10 0.23
CORRELATIONS BETWEEN SELECTED SPI COMPONENTS AND RETAINED INJURY GROUPINGS
REVISITS TO THE EMERGENCY ROOM AFTER
SELF-INFLICTED INJURY
UTILIZATION OF THE EMERGENCY DEPARTMENT AFTER SELF-INFLICTED INJURY
Source: Colman I, Dryden DM, Thompson AH, Chahal AM, Borden K, Rowe BH, Voaklander DC. In press. Academic Emergency Medicine.
• Record-linkage study of individuals admitted to an Edmonton ER for SII in fiscal year 1995/96
• Comparison groups were those admitted for asthma and a random selection of the remaining patients
• Groups were matched on age and sex, and were of equal size (n = 478)
• Groups were compared on readmissions to any regional ER over the subsequent three years
PROPORTION RETURNING TO THE ER WHO WERE INITIALLY ADMITTED FOR EITHER SII, ASTHMA OR "OTHER" REASONS
0%
5%
10%
15%
20%
25%
30%
Self-inflicted Injury Unintentional Injury Assault
REASON FOR RETURN
SII Group
Asthma Group
Other
WHAT DOES IT MEAN?
• They do, at least at the ecological level.
• Proximal vs Distal: There may be less commonality in the proximal case, but this needs to be investigated.
• The association among social problems, mental illness, and injuries is suggestive of a common underlying, contributing cause.
DO INTENTIONAL AND UNINTENTIONAL INJURIES BELONG TOGETHER?
SOME POSSIBILITIES
1. Child Development
2. Child Development
3. Child Development
SOME POSSIBILITIES
• Parenting & Supervision
• Community Self-Efficacy
• Social Capital (Democracy)
The End
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