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

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

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  1. 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

  2. Presentation outline • Introduction: Why explore mental disorder in injured patients? • Objectives • Methods • Results/discussion • Limitations • Conclusion

  3. Mental health • Injury Risk factors Depression 2% of DALYs (no. 10) Interpersonal violence 6.5% of DALYs (no. 2) Influences SA Burden of disease

  4. 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)

  5. Why explore mental disorder in injured patients? - 2

  6. Part of the picture

  7. 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

  8. 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

  9. 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

  10. Results: prevalence of mental disorders South Africa *includes suicidality High risk group

  11. Three logistic regression models AOD and mental disorder

  12. Current mental disorder

  13. 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

  14. 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

  15. Limitations • Generalisable? • Convenience sampling • Mental disorders under-sampled • Self-report, hospital data

  16. Conclusion - 1 Injured EC patients are an at-risk group: - mental disorder - lifetime trauma - witnessed violence

  17. Conclusion - 2 Targeted psychosocial interventions Decrease mental health Rx gap Injury prevention

  18. Conclusion - 3 Investigation and intervention required in many settings EC research and intervention

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

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