Mental health outcomes after major trauma in Ontario: a population-based analysis
Mental health outcomes after major trauma in Ontario: a population-based analysis
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DOI：
10.1503/cmaj.180368
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发表时间：
2018-11-12
影响因子：
14.6
通讯作者：
Hall, Stephen
中科院分区：
文献类型：
--
作者：
Evans, Christopher C. D.;DeWit, Yvonne;Hall, Stephen
背景技术背景：重大创伤仍然是发病率和死亡率的常见来源;改善重大创伤幸存者的功能恢复需要更好地了解这一人群可能发生的心理健康结果。我们评估了重大创伤和一个新的精神健康诊断或死亡的发展之间的关联suicid.METHODS：我们完成了一个人口为基础的，自我控制，纵向队列分析使用关联的行政数据，在安大略重大创伤治疗的患者在2005年和2010年之间。所有幸存者均被纳入，并使用Poisson回归和广义估计方程，比较受伤后5年和受伤前5年住院期间精神健康诊断的复合率。计算受伤后5年的自杀发生率。采用考克斯比例风险回归分析计算自杀的危险因素。结果：分析包括19338例患者，主要是男性（70.7%），来自城市地区（82.6%），意外（89%），钝伤（93.4%）。总体而言，创伤与创伤后精神健康诊断率增加40%相关（发病率比[IRR] 1.4，95% [置信区间] CI 1.1至1.8）。每年每10万名病人中有70人自杀，大大高于人口平均水平。完成自杀的危险因素是先前住院诊断的情绪障碍（风险比[HR] 4.3，95%CI 2.1至8.8）和自我伤害（HR 7.8，95%CI 3.9至15.4）。解释：重大创伤的幸存者在受伤后的几年内发展心理健康状况或自杀死亡的风险增加。患有预先存在的精神健康障碍或正在从自我伤害中恢复的患者风险特别高。
BACKGROUND: Major injury continues to be a common source of morbidity and mortality; improving the functional recovery of survivors of major trauma requires a better understanding of the mental health outcomes that may occur in this population. We assessed the association between major trauma and the development of a new mental health diagnosis or death by suicide.METHODS: We completed a population based, self-controlled, longitudinal cohort analysis using linked administrative data on patients treated for major trauma in Ontario between 2005 and 2010. All survivors were included and composite rates of mental health diagnoses during inpatient admissions were compared between the 5 years after injury and the 5 years before injury, using Poisson regression with generalized estimating equations. The incidence of suicide was calculated for the 5 years after injury. Risk factors for suicide were calculated using Cox proportional hazard regression analyses.RESULTS: The analysis included 19 338 patients, predominantly men (70.7%) from urban areas (82.6%), with unintentional (89%), blunt injuries (93.4%). Overall, trauma was associated with a 40% increase in the post-injury rate of mental health diagnoses (incidence rate ratio [IRR] 1.4, 95% [confidence interval] CI 1.1 to 1.8). The suicide rate was 70 per 100 000 patients per year, substantially higher than the population average. Risk factors for completing suicide were prior inpatient diagnosis of mood disorder (hazard ratio [HR] 4.3, 95% CI 2.1 to 8.8) and self-inflicted injury (HR 7.8, 95% CI 3.9 to 15.4).INTERPRETATION: Survivors of major trauma are at a heightened risk of developing mental health conditions or death by suicide in the years after their injury. Patients with pre-existing mental health disorders or who are recovering from a self-inflicted injury are at particularly high risk.