title: Screening for mental illness in a trauma center: rooting out a risk factor for unintentional injury.
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.
authors.affiliation: University of California, San Francisco, California, USA. dickerr@sfghsurg.ucsf.edu
authors.forename: Rochelle A
authors.initials: RA
authors.lastname: Dicker
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mah
authors.forename: Dahianna
authors.initials: D
authors.lastname: Lopez
authors.forename: Catherine
authors.initials: C
authors.lastname: Tran
authors.forename: Rosemary
authors.initials: R
authors.lastname: Reidy
authors.forename: Megan
authors.initials: M
authors.lastname: Moore
authors.forename: Phil
authors.initials: P
authors.lastname: Kreniske
authors.forename: Ian
authors.initials: I
authors.lastname: Crane
authors.forename: M Margaret
authors.initials: MM
authors.lastname: Knudson
authors.forename: Moon
authors.initials: M
authors.lastname: Li
authors.forename: Rebecca
authors.initials: R
authors.lastname: Menza
authors.forename: Martha
authors.initials: M
authors.lastname: Shuway
authors.forename: Jennifer
authors.initials: J
authors.lastname: Alvidrez
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D015601:Injury Severity Score; D007297:Inpatients; D007406:Interview, Psychological; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D010865:Pilot Projects; D016012:Poisson Distribution; D015995:Prevalence; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D014193:Trauma Centers / Q000458:organization & administration*; D014947:Wounds and Injuries / Q000209:etiology*