ATLANTA — A single traumatic injury is associated with more psychiatric diagnoses and more psychotropic medication prescriptions among adolescents than among those uninjured, according to a large, prospective, cohort study.
Researchers studied 20,507 patients aged 10-19 years who were treated at Group Health, a large health maintenance organization based in Seattle. Dr. Doug Zatzick and his associate studied the 6,116 teenagers (30%) who experienced a single traumatic injury in the index year of 2001 and looked for mental health diagnoses and psychotropic prescriptions in these patients for 2002, 2003, or 2004. They compared these factors with the group of 14,391 teens (70%) who were not injured.
“Yes, a single event in 2001 was associated with increased risk for a broad range of psychopathology,” Dr. Zatzick said at the annual meeting of the International Society for Trauma Stress Studies.
Injury during the index year was significantly and independently associated with an increased likelihood of any psychiatric diagnosis (odds ratio, 1.23) in this population-based study, said Dr. Zatzick, of the psychiatry and behavioral science departments at the University of Washington, Seattle. Dr. Zatzick conducted the study with Dr. David Grossman, a pediatrician at the Group Health Research Center in Seattle.
Specifically, injured teenagers were more likely to have an anxiety diagnosis (OR, 1.19) or an acute stress disorder (OR, 1.21), compared with the noninjured adolescents, according to adjusted regression analyses. As an example, a significantly higher percentage of injured teens had an anxiety diagnosis in 2002, 6.5%, compared with 4.8% of the noninjured group.
A total 6.2% of the injured adolescents were subsequently diagnosed with a disruptive behavior disorder, compared with 4.6% of their noninjured peers, Dr. Zatzick said.
A secondary objective of the study was to look at prevalence of traumatic brain injury in this population. Of the 30% of the patients who were injured, “only 1% had a traumatic brain-related injury, so it's not that common,” he said.
A greater percentage of the injured group (15%) received a prescription for a psychotropic medication, compared with the noninjured group (9%). There was an increased odds ratio of 1.35 for psychotropic drug use by the injured teenagers.
A total of 72% of the injured group versus 49% of the noninjured reported a history of previous injury. Although this study assessed only a single event, some adolescents present with a cumulative trauma burden.
“We randomly approach injured adolescents on our trauma ward. About 40% have four or more lifetime trauma [events] when they present, and so do about 50% of their parents—a common story at level 1 trauma centers,” said Dr. Zatzick said, a self-described “front-line, trauma center clinician” at Harborview Injury Prevention and Research Center in Seattle. He is director of Attending Consult Services at Harborview.
Misclassification bias of psychiatric diagnosis is a potential limitation of the study, Dr. Zatzick said. In addition, there is the possibility of increased injury visits associated with increased diagnoses, “but we don't think that is happening.”
In terms of the future, “injury surveillance would be good way to pick up these kids in general practice,” Dr. Zatzick said. “There could be screening on [their] charts for one injury, two injuries, etc.”
Disclosures: Dr. Zatzick and Dr. Grossman reported having no relevant conflicts of interest.