title: Mental health: a cause or consequence of injury? A population-based matched cohort study.
abstract: BACKGROUND
  While a number of studies report high prevalence of mental health problems among injured people, the temporal relationship between injury and mental health service use has not been established. This study aimed to quantify this relationship using 10 years of follow-up on a population-based cohort of hospitalised injured adults.
  
  
  METHODS
  The Manitoba Injury Outcome Study is a retrospective population-based matched cohort study that utilised linked administrative data from Manitoba, Canada, to identify an inception cohort (1988-1991) of hospitalised injured cases (ICD-9-CM 800-995) aged 18-64 years (n = 21,032), which was matched to a non-injured population-based comparison group (n = 21,032). Pre-injury comorbidity and post-injury mental health data were obtained from hospital and physician claims records. Negative Binomial regression was used to estimate adjusted rate ratios (RRs) to measure associations between injury and mental health service use.
  
  
  RESULTS
  Statistically significant differences in the rates of mental health service use were observed between the injured and non-injured, for the pre-injury year and every year of the follow-up period. The injured cohort had 6.56 times the rate of post-injury mental health hospitalisations (95% CI 5.87, 7.34) and 2.65 times the rate of post-injury mental health physician claims (95% CI 2.53, 2.77). Adjusting for comorbidities and pre-existing mental health service use reduced the hospitalisations RR to 3.24 (95% CI 2.92, 3.60) and the physician claims RR to 1.53 (95% CI 1.47, 1.59).
  
  
  CONCLUSIONS
  These findings indicate the presence of pre-existing mental health conditions is a potential confounder when investigating injury as a risk factor for subsequent mental health problems. Collaboration with mental health professionals is important for injury prevention and care, with ongoing mental health support being a clearly indicated service need by injured people and their families. Public health policy relating to injury prevention and control needs to consider mental health strategies at the primary, secondary and tertiary level.
authors.affiliation: School of Medicine, Griffith University, Meadowbrook, Australia. cate.cameron@griffith.edu.au
authors.forename: Cate M
authors.initials: CM
authors.lastname: Cameron
authors.forename: David M
authors.initials: DM
authors.lastname: Purdie
authors.forename: Erich V
authors.initials: EV
authors.lastname: Kliewer
authors.forename: Rod J
authors.initials: RJ
authors.lastname: McClure
mesh_terms: D000293:Adolescent; D000328:Adult; D000359:Aftercare / Q000706:statistics & numerical data; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D007358:Insurance, Psychiatric / Q000706:statistics & numerical data; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015599:Trauma Severity Indices; D014947:Wounds and Injuries / Q000150:complications / Q000453:epidemiology*