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Claire van der Westhuizen , Dan J. Stein, Gail Wyatt, John Williams, Katherine Sorsdahl PowerPoint Presentation
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Prevalence and predictors of mental disorders in an injured emergency centre population: a cross-sectional study. Claire van der Westhuizen , Dan J. Stein, Gail Wyatt, John Williams, Katherine Sorsdahl. Presentation outline.

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Presentation Transcript
slide1

Prevalence and predictors of mental disorders in an injured emergency centre population: a cross-sectional study

Claire van der Westhuizen, Dan J. Stein, Gail Wyatt, John Williams, Katherine Sorsdahl

presentation outline
Presentation outline
  • Introduction: Why explore mental disorder in injured patients?
  • Objectives
  • Methods
  • Results/discussion
  • Limitations
  • Conclusion
sa burden of disease

Mental health

  • Injury

Risk factors

Depression 2% of DALYs (no. 10)

Interpersonal violence 6.5% of DALYs (no. 2)

Influences

SA Burden of disease
why explore mental disorder in injured ec patients
Why explore mental disorder in injured EC patients?

What we know (HICs)

What we don’t know (LMICs)

Mental disorders in EC ??? (substance use only)

Past trauma and community violence???

Recurrent injuries???

  • Injured patients = at-risk group for mental disorder, especially intentional injuries (Dicker et al, 2011; O’Donnell et al, 2009)
  • EC patients ++ past trauma and community violence (Cunningham et al, 2006)
  • Recurrent injury HIC (Sims et al, 1989; Worrell et al, 2006)
objectives
Objectives
  • To determine the prevalence of mental disorders in intentionally and unintentionally injured ambulant emergency centre patients
  • To determine the sociodemographic, injury and psychological predictors of mental disorder in this group
methods 1
Methods - 1
  • Sites: Elsies River CHC and Khayelitsha Hospital
  • N=200 injured patients, convenience sample
  • Intentional: assault injuries
  • Unintentional: included road traffic, burns, falls etc
  • Exclusion criteria: <18 years old, self-inflicted injuries, serious injury, unable to give informed consent
methods 2
Methods - 2
  • Sociodemographics and injury/violence history
  • Structured psychiatric diagnostic interview (MINI)
  • Trauma History Questionnaire (THQ)
  • Analysis:
    • Prevalence of mental disorders
    • Chi-square test: differences between intentionally injured and unintentionally injured groups
    • Logistic regression: predictors of mental disorder
results prevalence of mental disorders
Results: prevalence of mental disorders

South Africa

*includes suicidality

High risk group

three logistic regression models
Three logistic regression models

AOD and mental disorder

logistic regression models
Logistic regression models
  • Substance use disorders: male, high levels of witnessed community violence
  • Comorbid substance and other mental disorder: high levels of witnessed community violence
findings
Findings

Similar

Different

Recurrent intentional injury predicted current mental disorder

Community violence plays a role in adult patients (mostly studied in adolescents)

Witnessed community violence is a stronger predictor than cumulative trauma burden

  • High frequencies of past trauma and witnessed community violence in this group
  • Linked to mental disorders
limitations
Limitations
  • Generalisable?
  • Convenience sampling
  • Mental disorders under-sampled
  • Self-report, hospital data
conclusion 1
Conclusion - 1

Injured EC patients are an at-risk group:

- mental disorder

- lifetime trauma

- witnessed violence

conclusion 2
Conclusion - 2

Targeted psychosocial interventions

Decrease mental health Rx gap

Injury prevention

conclusion 3
Conclusion - 3

Investigation and intervention required in many settings

EC research and intervention

thank you
Thank you
  • Staff of Elsies River and Khayelitsha facilities
  • Katherine Sorsdahl
  • Phodisoprogramme
  • Today’s audience