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 postinjury 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.
This is a particularly useful study of the relationship between physical trauma and mental health admission because it was carefully done and used a 5 year baseline and a 5 year follow up. Because the authors cautiously used only inpatient admission, they probably underestimated the association between major physical trauma and mental health problems. This article should alert us all to the increased risk of mental health problems after physical trauma.
This thorough study shows that people who suffer major traumatic injuries are at a higher risk of developing mental disorders. It seems, then, quite surprising the low incidence of PTSD in this sample. I agree with authors that including patients with self-inflicted injuries might have inflated the strength of the association between major injury and the development of a mental disorder. A segmented analysis might have been quite illustrative.
This outstanding piece of research should be widely dispersed. Its value rests in the formal identification of substantive sequelae secondary to traumatic injury. While this is reasonably well-known and has profound implications clinically, it also in my opinion has significant relevance economically and politically. Well done and thank you!