BACKGROUND: Mental health conditions can increase the risk for injury, including intentional self–harm related injuries as well as increase risk factors that may indirectly result in unintentional injuries. Many population surveys have worked to ascertain either the burden of mental health conditions or the experience of an injury, but the two issues are rarely analyzed together. This work looks to expand the body of information about mental illness as a risk factor for injuries.
METHODS: New York inpatient hospitalizations and outpatient emergency department data were analyzed with SAS 9.4. Cases were limited to injuries (ICD-9CM codes 800-999, and any E-code) identified during the 2014 calendar year. Any mental health condition (ICD-9CM code 290-319) identified in any of the 24 diagnostic fields were identified and grouped based on mental health condition type. Demographics were assessed and risk ratios (RRs) were calculated for specific injury outcomes occurring with specific mental health conditions, compared to all other injuries.
RESULTS: Dementia among adults aged 65+ was documented in 16,628 (23%) of injury-related hospitalizations and 12,631 (7%) of emergency department visits. Unintentional falls were the leading cause of injury among patients documenting dementia, resulting in a higher risk of being treated for a fall (p<.01) compared to other types of injuries. Schizophrenia was recorded in 4,604 (3%) of all injury-related hospitalizations and 4,202 (<1%) of emergency department visits. Cases with schizophrenia had a higher risk of being treated at a hospital for assault, and both unintentional poisoning/overdose and intentional poisoning/overdose. Personality disorders including antisocial, dependent, obsessive compulsive, affective, and other disorder types were recorded in 2,898 (2%) injury-related hospitalizations and 1,298 (<1%) emergency department visits. Cases with personality disorders had higher risks for seeking hospital treatment for self-inflicted poisoning/overdose, accounting for 41% of their injury cases, and cutting/piercing which accounted for 13%. Episodic Mood Disorders including bipolar/manic disorders and depression were documented in 12,198 (8%) injury-related hospitalizations and 11,330 (1%) injury related emergency department visits. They were disproportionately treated at a hospital for self-inflicted injuries including cutting/piercing and intentional poisoning/overdose, as well as unintentional poisoning/overdose. Among those injured, there were significant differences by race and gender of comorbid mental health conditions.
CONCLUSIONS: Mental health conditions are frequently coded with injuries, and may provide additional information for injury prevention purposes. Health care providers should recognize patients with these mental health conditions are potentially at higher risk for specific types of injuries.