Elsevier

Journal of Psychiatric Research

Volume 92, September 2017, Pages 101-107
Journal of Psychiatric Research

Association of physical injury and mental health: Results from the national comorbidity survey- adolescent supplement

https://doi.org/10.1016/j.jpsychires.2017.03.022Get rights and content

Abstract

Nonfatal injury is common among adolescents in the U.S., but little is known about the bi-directional associations between injury and mental health. Utilizing a nationally representative sample of U.S. adolescents, we examined 1) associations between lifetime mental health history and subsequent injury; 2) concurrent associations between injury and mental health; and 3) associations between injury and subsequent mental disorders. Data were drawn from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A), a national survey of adolescents aged 13 through 17 years (N = 10,123). Twelve-month prevalence of nonfatal injury requiring medical attention was assessed along with lifetime, 12-month, and 30-day prevalence of DSM-IV depressive, anxiety, behavior, substance use, and bipolar disorders. We used Poisson regression to examine associations between 1) lifetime history of mental disorders and 12-month exposure to injury; 2) concurrent associations between 12-month exposure to injury and 12-month prevalence of mental disorders; and 3) 12-month exposure to injury and 30-day prevalence of mental disorders. A total of 11.6% of adolescents experienced an injury requiring medical attention in the year before the survey. Lifetime history of mental disorders was not associated with past-year injury. Behavior and bipolar disorders were concurrently associated with past-year injury. Past-year injury occurrence predicted increased risk for past-month anxiety disorders and decreased risk of past-month depressive disorders. Our findings reveal reciprocal associations between injury and mental disorders and highlight the need for systematic assessment, prevention, and treatment of mental disorders among injured youth.

Introduction

Nonfatal injury accounts for 10–16% of all disability worldwide (Haagsma et al., 2016, Murray et al., 2013, World Health Organization, 2010) and is common among children and adolescents (Centers for Disease Control and Prevention (CDC) - National Center for Injury Prevention and Control, 2014). In 2014 nonfatal injuries in children and adolescents accounted for over 8 million emergency department visits in the U.S. alone, with the highest rates among adolescents across both unintentional (i.e., struck, fall, overexertion) and intentional (i.e., assault) injuries (CDC - National Center for Injury Prevention and Centers for Disease Control and Prevention, 2014). Although substantial research has investigated physical disability outcomes post-injury (World Health Organization, 2013, World Health Organization, 2011), few studies have examined associations between a broad range of injury types and mental disorders in adolescents. The present study aimed to address this gap in the literature by examining the bi-directional associations between nonfatal injury and mental disorders in a nationally representative sample of U.S. adolescents.

Numerous studies have assessed the association between mental health and nonfatal traumatic injury requiring hospitalization in adult samples (Bryant, 2011, Schweininger et al., 2015, Wiseman et al., 2013, Zatzick et al., 2008, Zatzick et al., 2007). However, adolescents are at heightened risk for injury occurrence relative to children and adults and the majority of adolescent injuries require medical attention without the need for hospitalization (CDC - National Center for Injury Prevention and Control, 2014). Prior research examining associations between injury occurrence and youth mental disorders have typically focused on either a specific injury type or cause, such as traumatic brain injury (Mackelprang et al., 2014, Rivara et al., 2012) and motor vehicle crashes (Bryant et al., 2004, Williams et al., 2015), or a specific mental health outcome. Whether injury exposure, regardless of severity, contributes to mental disorder onset or exacerbation among adolescents warrants further attention.

Existing research among children and adolescents suggests that the associations between injury and mental disorders are bi-directional, although little research has examined a wide range of mental health outcomes as predictors and consequences of injury. Behavioral (Brehaut et al., 2003, Davidson, 1987, DiScala et al., 1998, Rowe et al., 2004) and substance use (Cho et al., 2007, Hingson et al., 2000, Mo et al., 2006) disorders are associated with increased risk of injury occurrence among children and adolescents; however, these conditions have infrequently been examined as post-injury outcomes in this age group (Rowe et al., 2007). Anxiety disorders and symptoms have been found to both increase (Rowe et al., 2007) and decrease (Jokela et al., 2009) risk for subsequent injury whereas depressive disorders and symptoms have been associated with increased risk for injury (Asbridge et al., 2014, Patten, 2010, Tiesman et al., 2006). With regard to consequences of injury, elevations in anxiety disorders and symptoms have been shown following injury and motor vehicle crashes (Bryant et al., 2004, Rowe et al., 2007); however, associations between injury occurrence and depressive disorders are inconsistent with some finding an association between injury and depression (Patten, 2010, Zatzick et al., 2006) and others findings no association (Rowe et al., 2007). While associations between injury and bipolar disorder have been rarely studied in adolescents, population-based studies of non-U.S. adults observed strong associations of bipolar disorder with rates of traumatic brain injury (Mortensen et al., 2003, Orlovska et al., 2014) and mortality due to both intentional and unintentional injury (Crump et al., 2013). Overall, no studies have investigated the bi-directional associations among a broad spectrum of both mental health disorders and injury exposures in a nationally representative sample of U.S. adolescents.

We examined the association of injury with mental disorders in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a nationally representative sample of U.S. adolescents. The NCS-A dataset includes systematic assessments of mental disorder onset and persistence across the lifespan, which we used to understand the reciprocal associations between nonfatal injury and mental disorders. The objectives of this study were to examine: 1) associations between mental health history and subsequent risk for nonfatal injury; 2) concurrent associations between injury and mental health; and 3) associations between injury occurrence and presence of subsequent mental disorders. Given the high degree of diagnostic comorbidity within the NCS-A sample (Kessler et al., 2012b), we examined associations between nonfatal injury occurrence and comorbidity of mental health disorders across these three study aims. Finally, we conducted sensitivity analyses adjusting for lifetime mental illness across all models examining the associations between injury and concurrent and subsequent risk for mental disorders.

Section snippets

Sample

The NCS-A was based on a national dual-frame household and school sample of adolescents aged 13 through 17 years, and is described in detail elsewhere (Kessler et al., 2009a, Kessler and Merikangas, 2004). Between February 2001 and January 2004, data were collected via in-person interviews with adolescents, and self-administered questionnaires (SAQs) given to one parent or guardian of each adolescent. Written informed adolescent assent was only obtained after consent was given by parents. Both

Sociodemographics and injury characteristics

A total of 11.6% of adolescents had an injury requiring medical attention in the year before the survey. Compared to uninjured adolescents, those with history of past-year injury were more likely to be male, older, and white as shown in Table 1. Poverty, urbanicity and family structure were unrelated to injury. Table 2 highlights characteristics of adolescent-reported injuries that occurred within the last 12-months. Most injuries were unintentional (89%), and the most common resulting

Discussion

Although injury is a common occurrence among adolescents, little is known about the interplay between injury and mental health. This is the first study examining associations between injury and a wide range of mental disorders among a nationally representative sample of U.S. adolescents. Nearly 12% of adolescents in our sample reported sustaining an injury in the past year that required medical attention. Although lifetime history of mental disorders did not predict subsequent injury occurrence

Acknowledgements

We would like to thank Drs. Janessa M. Graves and Jennifer M. Whitehill for their consultation on this study's design during its most preliminary phases.

References (52)

  • M. Asbridge et al.

    Elevated depressive symptoms and adolescent injury: examining associations by injury frequency, injury type, and gender

    BMC Public Health

    (2014)
  • J.C. Brehaut et al.

    Childhood behavior disorders and injuries among children and youth: a population-based study

    Pediatrics

    (2003)
  • B. Bryant et al.

    Psychological consequences of road traffic accidents for children and their mothers

    Psychol. Med.

    (2004)
  • R.A. Bryant

    Mental disorders and traumatic injury

    Depress. Anxiety

    (2011)
  • Centers for Disease Control and Prevention - National Center for Injury Prevention and Control

    Web-based Injury Statistics Query and Reporting System (WISQARS)

    (2014)
  • E.A. Crone et al.

    Annual Research Review: neural contributions to risk-taking in adolescence–developmental changes and individual differences

    J. Child. Psychol. Psychiatry

    (2016)
  • C. Crump et al.

    Comorbidities and mortality in bipolar disorder: a Swedish national cohort study

    JAMA Psychiatry

    (2013)
  • P. Cummings

    The relative merits of risk ratios and odds ratios

    Arch. Pediatr. Adolesc. Med.

    (2009)
  • L.L. Davidson

    Hyperactivity, antisocial behavior, and childhood injury: a critical analysis of the literature

    J. Dev. Behav. Pediatr.

    (1987)
  • C. DiScala et al.

    Injuries to children with attention deficit hyperactivity disorder

    Pediatrics

    (1998)
  • A. Dudani et al.

    Childhood behavior problems and unintentional injury: a longitudinal, population-based study

    J. Dev. Behav. Pediatr.

    (2010)
  • J.A. Haagsma et al.

    The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013

    Inj. Prev. Inj.

    (2016)
  • R.W. Hingson et al.

    Age of drinking onset and unintentional injury involvement after drinking

    Jama

    (2000)
  • C. Johnston et al.

    Incremental validity in the psychological assessment of children and adolescents

    Psychol. Assess.

    (2003)
  • M. Jokela et al.

    Childhood problem behaviors and injury risk over the life course

    J. Child. Psychol. Psychiatry

    (2009)
  • R.C. Kessler et al.

    Design and field procedures in the US national comorbidity survey replication adolescent supplement (NCS-A)

    Int. J. Methods Psychiatr. Res.

    (2009)
  • Cited by (14)

    • Occupational injury and psychological distress among U.S. workers: The National Health Interview Survey, 2004–2016

      2020, Journal of Safety Research
      Citation Excerpt :

      Our findings were consistent with previous studies that examined risk of distress or depression following injury events. Results from population-based studies conducted in the United States and Australia showed that depression, anxiety, and stress disorders developed at 6 or 12 months after traumatic injury in hospitalized patients (Jenness, Witt, Quistberg, & Johnston, 2017; Wiseman, Curtis, Lam, & Foster, 2014; Zatzick et al., 2007). A Canadian study found that injured patients have mental health issues in the year following the event, compared to the non-injured (Cameron, Purdie, Kliewer, & McClure, 2006).

    • Meta-analysis: Exposure to Early Life Stress and Risk for Depression in Childhood and Adolescence

      2020, Journal of the American Academy of Child and Adolescent Psychiatry
      Citation Excerpt :

      We used STATA 14 to conduct statistical analyses. A total of 57 studies reported on the diagnosis of MDD in childhood or adolescence as a function of ELS (Table 1,22-83 with additional details presented in Table S1, available online), with a wide range of ORs (Figure 2). The random-effects meta-analysis indicated that individuals who experienced ELS were more likely to develop depression in childhood or adolescence than were children without a history of ELS (OR = 2.50, 95% CI = 2.08, 3.00), an effect that differed significantly from zero (Z = 9.87, p < .001).

    • Serious physical injury and depressive symptoms among adolescents aged 12–15 years from 21 low- and middle-income countries

      2020, Journal of Affective Disorders
      Citation Excerpt :

      Although the previous studies are of particular interest, they display some important limitations. These studies used clinical samples and often lacked a control group (Ellis et al., 1998; Han et al., 2011; Sabin et al., 2006; Zatzick et al., 2008), while only a few had a large sample size (Jenness et al., 2017; Kepple et al., 2012; Kostev et al., 2019; Williams et al., 2015). In addition, all of this research was conducted in high-income countries and there are no studies specifically on this topic from LMICs.

    View all citing articles on Scopus
    View full text