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Mental and physical health disorders following paediatric traumatic injury: a population-based longitudinal study in
Rae Spiwak1,2, Justin P Gawaziuk1, Dominic Chung3
1Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
Children who survive traumatic injuries face higher rates of mental and physical health disorders. Early intervention is crucial for these pediatric patients following hospitalization.
Area of Science:
- Public Health
- Pediatric Medicine
- Trauma Surgery
Background:
- Paediatric traumatic injury (PTI) is a significant cause of childhood hospitalization.
- Limited understanding exists regarding long-term mental and physical health outcomes post-injury, especially when considering pre-existing conditions.
Purpose of the Study:
- To compare mental and physical disorders in pediatric injury survivors versus an uninjured matched cohort.
- To investigate the hypothesis that injured youth experience increased mental and physical disorders post-injury.
Main Methods:
- Retrospective longitudinal cohort study utilizing linked administrative health data.
- Involved pediatric patients hospitalized for injury (n=9551) and matched uninjured controls (n=47,755) in Manitoba, Canada.
- Assessed mental (anxiety, depression, substance use) and physical disorders (arthritis, cancer, diabetes, etc.) two years pre- and post-injury.
Main Results:
- Injured youth exhibited significantly higher rates of all mental disorders (anxiety, depression, substance use) both pre- and post-injury compared to controls.
- Increased rates of physical disorders including arthritis, cancer, gastrointestinal issues, and hypertension were observed in the injured cohort post-injury.
- Greater injury severity correlated with a two-fold increase in mental health disorders and a three-fold increase in suicide rates among injured survivors.
Conclusions:
- Pediatric survivors of traumatic injury demonstrate elevated relative rates of mental and physical health disorders.
- Findings underscore the need for targeted interventions for this vulnerable population, commencing at the time of hospital admission.
Importance:
Paediatric traumatic injury (PTI) is a leading cause of hospitalisation among children. Little is known about subsequent mental and physical health disorders while accounting for pre-injury health.
Objective:
To compare pre-injury and post-injury mental and physical disorders in survivors of PTI with an uninjured matched cohort from the general population. This study hypothesised injured youth will have increased rates of mental and physical disorders relative to matched uninjured youth in the post-injury period.
Design:
Retrospective longitudinal cohort study using linked administrative health data to examine paediatric patients hospitalised for injury between 1 January 2004 and 31 December 2016, measured 2 years pre-injury and 2 years post-injury.
Setting:
Population-based study in Manitoba, Canada.
Participants:
Youth<18 years old who survived to discharge after an injury requiring hospitalisation in the study period (n=9551) were matched 1:5 (age, sex and region) to youth from the general uninjured population (n=47 755).
Exposures:
PTI that required hospitalisation.
Main Outcomes And Measures:
Mental disorders (anxiety, depression and substance use) and physical disorders (arthritis, cancer, diabetes, gastrointestinal, hypertension and total respiratory morbidity) were measured at physician visits and hospitalisations 2 years pre-injury and post-injury. Generalised estimating equations were used to estimate adjusted rate ratios (ARR).
Results:
This study examined 9551 in the injured cohort and 47 755 matches in the uninjured cohort. Injured individuals had increased ARRs for all mental disorders (p<0.0006) pre-injury (anxiety=1.30 (95% CI, 1.16 to 1.47); depression=2.00 (95% CI, 1.73 to 2.32); substance use=4.99 (95% CI, 3.08 to 5.20); any mental disorder=1.50 (95% CI, 1.37 to 1.66)) and post-injury (anxiety=1.66 (95% CI, 1.51 to 1.82); depression=2.87 (95% CI, 2.57 to 3.21); substance use=3.25 (95% CI, 2.64 to 3.99); any mental disorder=1.90 (95% CI, 1.76 to 2.04)). For physical disorders, injured individuals had increased ARRs (p<0.0006) pre-injury for arthritis (1.50 (95% CI, 1.39 to 1.60)), cancer (1.97 (95% CI, 1.35 to 2.88)), gastrointestinal (1.12 (95% CI, 1.06 to 1.18)) and any physical disorder (1.14 (95% CI, 1.11 to 1.18)). Post-injury, the injured had higher ARRs (p<0.0006) for arthritis (2.02 (95% CI, 1.91 to 2.15)), cancer (1.97 (95% CI, 1.35 to 2.88)), diabetes (1.76 (95% CI, 1.33 to 2.32)), gastrointestinal (1.19 (95% CI, 1.12 to 1.27)), hypertension (2.36 (95% CI, 1.83 to 3.06)) and any physical disorder (1.33 (95% CI, 1.29 to 1.37)). Comparing the pre-injury and post-injury periods, ARRs for injured showed a difference over time for all mental disorders except substance use and all physical disorders except gastrointestinal and total respiratory morbidity compared with matched uninjured. Greater injury severity was associated with two times greater ARR for developing any mental health disorder, and the injured had three times the ARR for dying by suicide (p<0.0006).
Conclusions And Relevance:
Child survivors of traumatic injury had increased relative rates of mental and physical disorders compared with a matched uninjured cohort. These findings support targeted intervention strategies for this population at the time of hospitalisation.
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