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

4. Why explore mental disorder in injured EC patients? What we know (HICs) 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) What we don’t know (LMICs) Mental disorders in EC ??? (substance use only) Past trauma and community violence??? Recurrent injuries???

5. Why explore mental disorder in injured patients? - 2 Data Majority of data from HICs LMIC very little data Need Mental health treatment gap High burden of injuries in LMICs EC visit ID and intervention for mental disorders Injury prevention

6. Part of the picture Society Community Family Individual Health Regional influences Justice Political environment Educa tion Global trends

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 DisordersIntentional injury Unintentional injury Any mental disorder82 (70%)44 (54%)30% (lifetime) Current mental disorder79 (67%)40 (49%)17% (12-month) Current depression or anxiety* 45 (38%)22 (27%) AOD dependence/abuse59 (50%)27 (33%)6% Mental disorder and AOD 39 (33%)9 (11%) *includes suicidality High risk group South Africa

11. Three logistic regression models Current mental disorder AOD AOD and mental disorder

12. Current mental disorder Variable Yes (%) Unadjusted OR (95% CI)Adjusted OR (95% CI) Age 18-25 38 (31.9) 1.00 25-40 51 (42.9) 0.844 (0.43-1.66)0.721 (0.34-1.54) >40 30 (25.2) 0.724 (0.34-1.53)0.668 (0.3-1.51) Gender Male 82 (68.9) 1.00 Female 37 (31.1) 0.809 (0.45-1.47)1.039 (0.52-2.08) Employed No 67 (56.3) 1.00 Yes 52 (43.7) 0.433 (0.24-0.77)*0.526 (0.28-1)* Injury presentation Unintentional 40 (33.3) 1.00 Intentional 79 (66.4) 2.127 (1.19-3.79)*1.284 (0.65-2.54) # prev intentional injuries (med, range) 1.571 (1.19-2.07)*1.460 (1.08-1.98)* Community violence (med, range) 1.155 (1.04-1.28) Lifetime trauma (THQ) None 15 (12.6) 1.00 1 to 10 44 (37) 0.933 (0.4-2.16)0.945 (0.38-2.35) 11 to 20 28 (23.5) 2.010 (0.75-5.36)1.667 (0.59-4.71) > 20 32 (26.9) 2.987 (1.08-8.26)*1.655 (0.54-5.08)

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 High frequencies of past trauma and witnessed community violence in this group Linked to mental disorders 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

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 Injury prevention Decrease mental health Rx gap

18. Conclusion - 3 Investigation and intervention required in many settings Society Community Family Individual EC research and intervention

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