prevalence and predictors of mental disorders in an injured emergency centre population: a...
TRANSCRIPT
![Page 1: Prevalence and predictors of mental disorders in an injured emergency centre population: a cross-sectional study Claire van der Westhuizen, Dan J. Stein,](https://reader035.vdocument.in/reader035/viewer/2022062713/56649f515503460f94c74592/html5/thumbnails/1.jpg)
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
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Presentation outline
• Introduction: Why explore mental disorder in injured patients?
• Objectives• Methods• Results/discussion• Limitations• Conclusion
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SA Burden of disease
Mental health Injury
Risk factors
Interpersonal violence 6.5% of DALYs (no. 2)
Depression 2% of DALYs (no. 10) Influences
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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???
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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
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Part of the picture
Society
Individual
Health
Regional influences
Justice
Political environment
Education
Global trends
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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
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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
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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
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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
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Three logistic regression models
Current mental
disorderAOD
AOD and mental disorder
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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)
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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
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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
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Limitations
• Generalisable?• Convenience
sampling• Mental disorders
under-sampled• Self-report,
hospital data
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Conclusion - 1
Injured EC patients are an at-risk group:
- mental disorder- lifetime trauma- witnessed violence
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Conclusion - 2
Targeted psychosocial interventions
Injury prevention
Decrease mental health Rx gap
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Conclusion - 3
Investigation and intervention required in many settings
Society
Individual
EC research and intervention
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Thank you
• Staff of Elsies River and Khayelitsha facilities
• Katherine Sorsdahl• Phodiso
programme• Today’s audience