title: The long-term psychiatric sequelae of severe injury: a 6-year follow-up study.
abstract: The impact of mental health on disease burden associated with injury represents a major public health issue, yet almost no information is available on the associated long-term mental health outcomes. The primary aim of this study was to assess the psychiatric outcomes 6 years after a severe injury and their subsequent impact on long-term disability. The secondary aim was to investigate the relationship between a mild traumatic brain injury (mTBI) and long-term psychiatric disorder and its impact on disability.
  
  
  
  From April 2004 to February 2006, randomly selected injury patients admitted to 4 hospitals across Australia were assessed during hospitalization and at 72 months after trauma (N = 592). Injury characteristics, the presence of an mTBI (ICD-9 criteria), and previous psychiatric history were assessed during hospitalization. Structured clinical interviews for psychiatric disorders (DSM-IV and DSM-5) and a self-report measure of disability (WHODAS II) were administered at 72 months.
  
  
  
  At 72 months after a severe injury, 28% of patients met criteria for at least 1 psychiatric disorder, with 45% of those presenting with comorbid diagnoses. The most prevalent psychiatric disorder was a major depressive episode (11%) followed by substance use disorder (9%), agoraphobia (9%), posttraumatic stress disorder (6%), and generalized anxiety disorder (6%). The presence of any psychiatric disorder was found to increase the risk for disability (P < .001, odds ratio = 6.04). An mTBI was found to increase the risk for having some anxiety disorders but not to increase disability by itself.
  
  
  
  The long-term psychiatric consequences of severe injury are substantial and represent a significant contributor to long-term disability. This study points to an important intersection between injury and psychiatric disorder as a leading contributor to disease burden and suggests this growing burden will impose new challenges on health systems.
authors.affiliation: Phoenix Australia-Centre for Posttraumatic Mental Health, Level 3, Alan Gilbert Bldg, 161 Barry St, Carlton, VIC, 3053, Australia mod@unimelb.edu.au.
authors.forename: Meaghan L
authors.initials: ML
authors.lastname: O'Donnell
authors.forename: Nathan
authors.initials: N
authors.lastname: Alkemade
authors.forename: Mark C
authors.initials: MC
authors.lastname: Creamer
authors.forename: Alexander C
authors.initials: AC
authors.lastname: McFarlane
authors.forename: Derrick
authors.initials: D
authors.lastname: Silove
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
authors.forename: David
authors.initials: D
authors.lastname: Forbes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D001924:Brain Concussion / Q000453:epidemiology / Q000523:psychology*; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult