Facial fractures and the long-term risk of mental health complications

The psychosocial implications of facial fractures are unclear. The aim of the study was to identify any association between facial fractures and the long-term risk of hospitalization for mental health disorders. The study followed a cohort of 64,089 patients aged ≥10 years who were hospitalized for facial fractures between 1989 and 2023 in Quebec, Canada. Patients with facial fractures were matched to 318,520 controls based on age, sex, and year, and facial fractures were classified by site, type, and cause. The outcomes were hospitalizations for psychiatric disorders, substance use disorders, and suicide attempts up to 34 years later. Stratified Cox regression models were used to estimate adjusted hazard ratio (HR) and 95% confidence interval (CI) for the association between facial fractures and mental health hospitalization. Compared with matched controls, patients with facial fractures were 1.58 times more likely to be hospitalized for a mental health disorder over time (95% CI 1.55-1.61). Mandible (HR 1.89, 95% CI 1.81-1.96), open (HR 1.75, 95% CI 1.63-1.88), and assault-related facial fractures (HR 2.43, 95% CI 2.33-2.54) were most strongly associated with subsequent mental health hospitalization. Patients with facial fractures were at risk of admission for psychiatric disorders (HR 1.35, 95% CI 1.32-1.38), substance use disorders (HR 2.12, 95% CI 2.07-2.18), and suicide attempts (HR 1.69, 95% CI 1.58-1.80). Risk of mental health admission was greatest within 5 years of injury but persisted throughout follow-up. Overall, this study suggests that facial fractures are associated with the long-term risk of hospitalization for mental health disorders.