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Screening for Mental Illness in a Trauma Center: Rooting Out a Risk Factor for Unintentional Injury

Dicker, Rochelle A. MD; Mah, Jennifer BS; Lopez, Dahianna MSN, MPH; Tran, Catherine BA; Reidy, Rosemary BS; Moore, Megan BA; Kreniske, Phil BA; Crane, Ian BA; Knudson, M. Margaret MD; Li, Moon NP; Menza, Rebecca NP; Shuway, Martha PhD; Alvidrez, Jennifer PhD

Journal of Trauma-Injury Infection & Critical Care:
doi: 10.1097/TA.0b013e318216f611
Original Article
Abstract

Background: Injury prevention and screening efforts have long targeted risk factors for injury recurrence. In a retrospective study, our group found that mental illness is an independent risk factor for unintentional injury and reinjury. The purpose of this study was to administer a standard validated screening instrument and psychosocial needs assessment to admitted patients who suffer unintentional injury. We aimed to prospectively measure the prevalence of mental illness. We hypothesize that systematic screening for psychiatric disorders in trauma patients is feasible and identifies people with preexisting mental illness as a high-risk group for unintentional injury.

Methods: In this prospective study, we recruited patients admitted to our Level I trauma center for unintentional injury for a period of 18 months. A bedside structured interview, including the Mini International Neuropsychiatric Interview, and a needs assessment were performed by lay research personnel trained by faculty from the Department of Psychiatry. The validated needs assessment questions were from the Camberwell Assessment of Need Short Appraisal Schedule instrument. Psychiatric screening and needs assessment results, as well as demographic characteristics are reported as descriptive statistics.

Results: A total of 1,829 people were screened during the study period. Of the 854 eligible people, 348 were able to be approached by researchers before discharge with a positive response rate of 63% (N = 219 enrolled). Interviews took 35 minutes ± 12 minutes. Chi-squared analysis revealed no difference in mechanism in those with mental illness versus no mental illness. Men were significantly more likely to be found to have a mental health disorder but when substance abuse was excluded, no difference was found. Four-way diagnostic grouping revealed the prevalence of mental illness detected.

Conclusions: This inpatient pilot screening program prospectively identified preexisting mental illness as a risk factor for unintentional injury. Implementation of validated psychosocial and mental health screening instruments is feasible and efficient in the acute trauma setting. Administration of a validated mental health screening instrument can be achieved by training college-level research assistants. This system of screening can lead to identification and treatment of mental illness as a strategy for unintentional injury prevention.

Author Information

From the University of California, San Francisco, California; and the San Francisco Injury Center, San Francisco, California.

Submitted for publication October 5, 2010.

Accepted for publication February 22, 2011.

Presented at the 69th Annual Meeting of the American Association for the Surgery of Trauma, September 22–25, 2010, Boston, Massachusetts.

Supported by the Centers for Disease Control and Prevention, Injury Center grant (R49 CE001178-04).

Address for reprints: Rochelle A. Dicker, MD, San Francisco General Hospital, 1001 Potrero Avenue, Ward 3A, San Francisco, CA 94143-0807; email: dickerr@sfghsurg.ucsf.edu.

© 2011 Lippincott Williams & Wilkins, Inc.