Research Reports - Risk and outcomes for traumatic brain injury in patients with mental disorders

J Neurol Neurosurg Psychiatry. 2012 Dec;83(12):1186-92

Liao CC, Chiu WT, Yeh CC, Chang HC, Chen TL

OBJECTIVE: To investigate the risk of traumatic brain injury (TBI) and
post-injury mortality in patients with mental disorders.
BACKGROUND: Patients with mental disorders are at higher risk of injuries.
However, the association between mental disorders and TBI is still not
understood. We conducted case-control studies to investigate whether people with
pre-existing mental disorders are at higher risk of TBI and post-injury
mortality.
METHODS: Using reimbursement claims, we analysed 16,635 patients with TBI and
66,540 controls with adjustment of covariates to study the association of mental
disorders and TBI. A nested case-control study was also conducted to analyse
contributory factors for post-injury mortality.
RESULTS: People with mental disorders were at increased risk of TBI (odds ratio
(OR) 1.94, 95% confidence interval (CI) 1.86 to 2.02). Men, older age, living in
highly urbanised areas and patients on low income had a higher risk of TBI and
post-injury mortality. Psychiatric medication intensity and frequency of
psychiatric visits was significantly correlated with TBI in a severity dependent
relationship (p for trend <0.0001). Patients receiving advanced psychiatric
healthcare had an increased risk of TBI (OR 2.98, 95% CI 2.67 to 3.33) and
post-injury mortality (OR 1.92, 95% CI 1.34 to 2.77). A history of receiving
psychiatric related outpatient care (OR 1.77, 95% CI 1.70 to 1.85),
hospitalisation (OR 3.21, 95% CI 2.79 to 3.70) or emergency visits (OR 3.53, 95%
CI 3.15 to 3.94) were highly associated with subsequent TBI.
CONCLUSIONS: Patients with mental disorders have an increased risk of TBI.
Intensity of psychiatric medication is associated with increased post-injury
mortality. Special attention to prevent TBI among this disabled population is
mandatory.

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