People who experience major injuries requiring hospital admission, such as car crashes and falls, are at substantially increased risk of being admitted to hospital for mental health disorders, found a study in CMAJ (Canadian Medical Association Journal). As well, they are at much higher risk of suicide than people without such injuries.

"Major trauma was associated with a 40% increased rate of hospital admission for 1 or more mental health diagnoses," writes Dr. Christopher Evans, Department of Emergency Medicine, Queen's University, Kingston, Ontario, with coauthors. "The most common mental health diagnoses were alcohol abuse, other drug abuse disorders and major depressive disorders."

There is little evidence on the link between major injury and later mental health issues. This large study, based on more than 19 000 patients in Ontario, contributes to the literature on this important topic. Most participants who had experienced major trauma were male (70.7%), lived in urban areas (82.6%) and had accidental (89%) rather than intentional injuries.

Male sex, low socioeconomic status, rural residence, accidental injuries and surgery for these injuries were associated with higher admissions for mental health issues. Researchers found that children and youth under 18 years of age had the largest increase in admissions for 1 or more mental health issues after injury. Suicide is also higher in people with major physical injury, with 70 suicides per 100 000 patients per year compared to 11.5 suicides per 100 000 patients in the general population.

"Patients who suffer major injuries are at significant risk of admissions to hospital with mental health diagnoses in the years after their injury and of having high suicide rates during this period," write the authors.

The authors urge that mental health supports should be offered to all trauma victims, with special attention to high-risk patients, including children and youth.

"Mental health outcomes after major trauma in Ontario: a population-based analysis" is published November 12, 2018.

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