Research Reports - The long-term psychiatric sequelae of severe injury

J Clin Psychiatry. 2016 Apr;77(4):e473-9. doi: 10.4088/JCP.14m09721.

O'Donnell ML(1), Alkemade N, Creamer MC, McFarlane AC, Silove D, Bryant RA,
Forbes D.

OBJECTIVE: The impact of mental health on disease burden associated with injury
represents a major public health issue, yet almost no information is available on
the associated long-term mental health outcomes. The primary aim of this study
was to assess the psychiatric outcomes 6 years after a severe injury and their
subsequent impact on long-term disability. The secondary aim was to investigate
the relationship between a mild traumatic brain injury (mTBI) and long-term
psychiatric disorder and its impact on disability.
METHODS: From April 2004 to February 2006, randomly selected injury patients
admitted to 4 hospitals across Australia were assessed during hospitalization and
at 72 months after trauma (N = 592). Injury characteristics, the presence of an
mTBI (ICD-9 criteria), and previous psychiatric history were assessed during
hospitalization. Structured clinical interviews for psychiatric disorders (DSM-IV
and DSM-5) and a self-report measure of disability (WHODAS II) were administered
at 72 months.
RESULTS: At 72 months after a severe injury, 28% of patients met criteria for at
least 1 psychiatric disorder, with 45% of those presenting with comorbid
diagnoses. The most prevalent psychiatric disorder was a major depressive episode
(11%) followed by substance use disorder (9%), agoraphobia (9%), posttraumatic
stress disorder (6%), and generalized anxiety disorder (6%). The presence of any
psychiatric disorder was found to increase the risk for disability (P < .001,
odds ratio = 6.04). An mTBI was found to increase the risk for having some
anxiety disorders but not to increase disability by itself.
CONCLUSIONS: The long-term psychiatric consequences of severe injury are
substantial and represent a significant contributor to long-term disability. This
study points to an important intersection between injury and psychiatric disorder
as a leading contributor to disease burden and suggests this growing burden will
impose new challenges on health systems. 

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