Psychiatric disorders and accidental injury

A Fuzzy DEMATEL Analysis of Cultural Variables in Traffic Rules Violation

Traffic rules violation stems from numerous causes such as the lack of appropriate traffic rules training, non-institutionalization of respect to the rights of others especially pedestrians, and more importantly self-preference. There is a need for accidents prevention and deeper analysis of the multi-attributes which lead to unwanted accidents and lethal crashes resulting in death. Most of these elements are cultural variables. In this study, the cultural variables affecting traffic rules violation are investigated. From among many cultural variables, 6 most important factors were examined. For this aim, 10 traffic officers who have more than 10 years' experience and 10 citizens with master's degree and at least 6 years driving experience, participated in this research. For determining the cause and effect relations between them, fuzzy DEMATEL is applied. Findings show that unawareness of traffic rules has the greatest importance because it is the premier causal factor from one hand and on the other hand, it has the maximum relation with the other cultural variables.

Tourette syndrome increases risk of bone fractures: a population-based cohort study

This study assesses the risk of fractures among children with Tourette syndrome (TS), and identifies the effects of comorbidities and antipsychotics. We randomly sampled the claims data of 1 million enrollees in the National Health Insurance program of Taiwan, and identified 1258 children with TS diagnosed between 2000 and 2010. Additionally, 12,580 children without TS who were frequency matched for sex, age, residential area, parental occupation, and index year were identified for comparison. The children's cases were followed until December 31, 2010, or censored to ascertain incident fractures cases and associations with comorbidities of attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) and treatments with antipsychotics, antidepressants, or clonidine. The TS cohort had a 1.27-fold higher incidence of fractures than did the comparison cohort (190.37 vs. 149.94 per 10,000 person-years), with an adjusted hazard ratio (HR) of 1.28 [95% confidence interval (CI) 1.06-1.55] based on multivariable Cox regression analysis. This increased risk of fractures was apparent for fractures of the skull, neck, and spine. Comorbid ADHD and OCD did not result in an additional risk of fractures. The children without both ADHD and OCD were also at a higher risk of fractures, indicating that TS alone increases the risk of fractures. The children taking antipsychotics had a reduced risk of fractures, and the adjusted HR decreased to 1.17 (95% CI 0.90-1.52). Children with TS have an increased risk of fractures. ADHD and OCD do not increase the risk further.

Stress Vulnerability, Coping and Risk-Taking Behaviors during Simulated Driving

112 college students participated in a study of simulated driving. The aim of the study was to investigate how coping related to both subjective stress responses and objective indices of risk-taking behavior. Dispositional coping (i.e., typical coping style) predicted task-induced stress responses, including increased distress and loss of task engagement. Consistent with the transactional model of driver stress, the effect of dispositional coping was mediated by the situational strategies adopted in response to the specific situation. Task-focused coping appeared to be more adaptive than emotion-focused coping. Drivers were afforded opportunities to pass other traffic in risky circumstances. Dispositional coping factors, especially a confrontive coping dimension, predicted risk-taking behaviors, such as frequent passing. These effects were not mediated by situational coping, suggesting that emotions during driving may shape habitual behavioral styles that operate irrespective of current mood and coping strategy. Implications of the findings for countermeasures to driver stress are discussed.

Psychological-behavioral characteristics and fractures in children are closely related

This work aimed to study the relationship between psychological-behavioral characteristics and fractures in children to provide a basis for development of preventive strategies. The study included 84 children hospitalized for fractures (fracture group) and 78 children without fractures (control group). The following questionnaires were utilized: temperament questionnaire, Eysenck Personality Questionnaire, and the Achenbach Child Behavior Checklist (CBCL). There were more children with problem behaviors in the fracture group than in the control group (P<0.01). Furthermore, level of activity and attention dispersion showed a significant relationship with fractures (P<0.05). Scores for the psychoticism, extroversion, and neuroticism subscales of the Eysenck Personality Questionnaire were higher for the fracture group than the control group (P<0.05 or <0.01). For the Achenbach Child Behavior Checklist, the average score for boys and/or girls was higher in the fracture group than the control group in 4-5-year and/or 6-11-year olds. In addition, in 6-11-year olds, boys in the fracture group had higher scores for restlessness, aggression, and violation of discipline and girls in the fracture group had higher scores for aggression and depression than those in the control group (P<0.05). Children with fractures had more psychological and behavioral problems. Psychological intervention measures could be adopted to reduce the occurrence of fractures in children.

Unintentional injury, psychological distress and depressive symptoms: is there an association for rural Australians?

PURPOSE

To investigate the association between unintentional injury and mental health in Australian rural communities.

METHODS

Using cross-sectional baseline data for a longitudinal study from randomly selected adults in nonmetropolitan Australia, we fitted logistic regression models for the outcomes of domestic or public setting injury and injury in high-risk settings, using prior depression and demographic factors. OR and 99% CI were reported and also calculated for current mental health including psychological distress, depressive symptoms and risky alcohol consumption, comparing those injured with those not.

FINDINGS

Of 2,639 participants who completed the injury component, 364 (13.8%) reported injury requiring treatment from a doctor or a hospitalization in the previous 12 months. Of those requiring treatment or hospitalization, 147 (40.4%) reported being injured in a domestic or public setting and 207 (56.9%) in a high-risk setting. The most common types and mechanisms of injury were sprains and strains, and falls, trips and slips, respectively. Preinjury depression was independently associated with unintentional injury in a domestic or public setting. Being injured in this setting was associated with double the odds of experiencing current depressive symptoms. The likelihood of a high-risk setting injury was significantly associated with male gender. High-risk setting injury was associated with current psychological distress and higher levels of alcohol usage.

CONCLUSIONS

This study supports the hypothesis that pre-existing depression is associated with unintentional injury in a rural sample and indicates the important role of prior depression in management of injury, given the high rate of injury in rural communities. Mechanisms by which prior depression increases likelihood of unintentional injury will be further investigated using longitudinal data.

Development and validation of a self-report measure of bus driver behaviour

There are likely to be individual differences in bus driver behaviour when adhering to strict schedules under time pressure. A reliable and valid assessment of these individual differences would be useful for bus companies keen to mitigate risk of crash involvement. This paper reports on three studies to develop and validate a self-report measure of bus driver behaviour. For study 1, two principal components analyses of a pilot questionnaire revealed six components describing bus driver behaviour and four bus driver coping components. In study 2, test-retest reliability of the components were tested in a sub-sample and found to be adequate. Further, the 10 components were used to predict bus crash involvement at three levels of culpability with consistently significant associations found for two components. For study 3, avoidance coping was consistently associated with celeration variables in a bus simulator, especially for a time-pressured drive. STATEMENT OF RELEVANCE: The instrument can be used by bus companies for driver stress and fatigue management training to identify at-risk bus driver behaviour. Training to reduce the tendency to engage in avoidance coping strategies, improve evaluative coping strategies and hazard monitoring when under stress may improve bus driver safety.

Psychiatric risk factors in pediatric hand fractures

BACKGROUND

Various psychopathologies are becoming more commonly recognized as a cause of violence in the pediatric population. In this study, we aimed to investigate (1) the link between the pediatric hand fractures and psychopathology and (2) the prevalence of repeated hand injuries in the same population.

METHOD

We retrospectively reviewed 208 patients treated at a level 1 trauma center and recorded age, sex, past medical and psychiatric history as well as type, etiology, and treatment of hand fractures for analysis. A mental health professional has confirmed psychiatric diagnosis. Fisher exact tests and independent samples t tests were performed for analysis.

RESULTS

Metacarpal fractures were the most common hand fracture seen in patients with a psychiatric history (P=0.05). More than half (52.9%, n=18) of the patients with a positive psychiatric history had a subsequent injury whereas only 14.6% (n=29) of patients negative for psychiatric issues had a subsequent injury (P<0.001). The most common psychiatric disorders were attention-deficit hyperactivity disorder, depression, and substance abuse. Psychiatric diagnosis was significantly more frequent in those sustaining an injury due to punching compared with other mechanisms (38% vs. 8%, P<0.001). Twenty one (38%) of the 55 children whose injuries were due to punching had a documented psychiatric diagnosis. Of the 55 injuries due to a punching mechanism, 39 (68.4%) sustained metacarpal fractures and 18 (31.6%) sustained another type of hand fracture (P<0.001).

CONCLUSIONS

The high rate of repeated hand injuries in children with punching may require in depth psychiatric assessment due to its high association with mental illness.

LEVEL OF EVIDENCE

IV.

Vehicle automation: a remedy for driver stress?

The present study addressed the effects of stress, vehicle automation and subjective state on driver performance and mood in a simulated driving task. A total of 168 college students participated. Participants in the stress-induction condition completed a 'winter' drive, which included periodic loss of control episodes. Participants in the no-stress-induction condition were not exposed to loss of control. An additional, independent manipulation of vehicle speed was also conducted, consisting of two control conditions requiring manual speed regulation and a third in which vehicle speed was automatically regulated by the simulation. Stress and automation both influenced subjective distress, but the two factors did not interact. Driver performance data indicated that vehicle automation impacted performance similarly in the stress and no-stress conditions. Individual differences in subjective stress response and performance were also investigated. Resource theory provides a framework that partially but not completely explains the relationship between vehicle automation and driver stress. Implications for driver workload, safety and training are discussed.

An investigation of the prevalence of depressive symptoms in soldiers during military training

OBJECTIVES

A cross-sectional study was conducted to determine the prevalence of depressive symptoms in soldiers during military training in Chinese army and to identify associations between depressive symptoms and socio-demographic characteristics.

METHODS

The self-rating depression scale (SDS) was used to assess self-reported experiences of depression among 1107 young adult males during military training. The following socio-demographic variables are considered as independent variables: age, service time, settlement type, education, levels of family income, family type, education of parents, health status, history of negative accidents, social support status and hobby status. A logistic regression model was used to estimate the association of these variables with depressive symptoms.

RESULTS

25.20% (n = 279) of the servicemen had depressive symptoms. The soldiers who had high education level (OR = 1.74; 95%CI: 1.37-2.12), come from city or town (OR = 1.39; 95%CI: 1.18-1.61), have served in army for a shorter time (OR = 1.63; 95%CI: 1.43-1.88), had head ache during training course (OR = 1.39; 95%CI: 1.12-2.09), had abdomen ache or diarrhea during training course (OR = 1.85; 95%CI: 1.47-2.13) and had training injury during training course (OR = 1.67; 95%CI: 1.29-1.83) are associated with depressive symptoms.

CONCLUSIONS

There was a high prevalence rate of depressive symptoms among soldiers during military training. Special attention should be paid to avoiding depressive symptoms in those who have high education level, come from city or town, have served in army for a shorter time and have health problems during training course.

Depression and Occupational Injury: Results of a Pilot Investigation

OBJECTIVE

Even mild clinical depression can cause decreased vigilance, attention span, increased irritability, and insomnia-all well-known precursors to occupational injury. This pilot project explores the relationship between occupational injury and depression.

METHOD

One hundred twenty-one individuals with recent work-related injuries and 140 without work-related injuries completed a self-administered depression screening instrument (PHQ-9). We compared the two groups using bivariate analyses. The impact of depression on injury was examined using logistic regression analysis controlling for employment history, marital status, age, and sex.

RESULTS

Overall, injured workers in this study were not more likely to be depressed than a comparison group of uninjured workers. However, injured women had significantly higher depression scores than non-injured women (P = 0.04); no such difference was found for men.

CONCLUSIONS

These data suggest that depression may serve as a precursor to occupational injury for women.

Driving and riding avoidance following motor vehicle crashes in a non-clinical sample: psychometric properties of a new measure

Three studies were conducted to assess the reliability and validity of a measure that we developed using a non-clinical sample of university undergraduates, the Driving and Riding Avoidance Scale (DRAS). Study 1 indicated that the scale was internally consistent (alpha=0.92) and that a four-factor model (general avoidance, avoidance of traffic and busy roads, avoidance of weather or darkness, and riding avoidance) provided the best fit to the data in a sample of 386 crash survivors. This study also revealed that survivors who received medical treatment for their crash-related injuries reported significantly greater avoidance than people who were uninjured or injured and not medically treated. Study 2 revealed that the DRAS possessed acceptable test-retest reliability (r=0.83) over a 4-week interval in a sample of 67 crash survivors. Using a sample of 118 survivors, study 3 examined the instrument's convergent and divergent validity through correlations with the Accident Fear Questionnaire (AFQ), the Mobility Inventory (MI), the Fear Survey Schedule-II (FSS-II), and the Fear Questionnaire (FQ). The strongest relationships were observed between the DRAS and the AFQ and with a driving subscale created from the MI items. The DRAS exhibited significantly weaker relationships with the FQ subscales that assessed other kinds of phobic avoidance.

Personality and behavioral predictors of traffic accidents: testing a contextual mediated model

A contextual mediated model was proposed to distinguish the distal (i.e. personality factors) and proximal (i.e. aberrant driving behaviors) factors in predicting traffic accident involvement. Turkish professional drivers (N=295) answered a questionnaire including various measures of personality factors, driver behaviors, and accident history. Results of the latent variable analysis with LISREL indicated that latent variables in the distal context (i.e. psychological symptoms, sensation seeking, and aggression) predicted at least one of the proximal elements (i.e. aberrant behaviors, dysfunctional drinking, and preferred speed) with relatively high path coefficients. While aberrant driver behaviors yielded a direct effect on accident involvement, psychological symptoms yielded an indirect effect mediated by driver behaviors. Further analyses revealed that personality factors had an impact on road accidents via their effects on actual driving-related behaviors although the path coefficients in predicting accidents were relatively weaker than those predicting risky driving behaviors and habits. Results were discussed considering the implications for classifying the accident correlates in a contextual framework and binominal-poisson distribution of self-reported accidents.

Psychiatric consequences of motor vehicle accidents

Psychiatric complaints are frequent following motor vehicle accidents and may be major predictors of persistent pain and other complaints. Outcomes are not related closely to the nature or severity of any medical injury. Psychiatric problems often are unrecognized and untreated. There is a need for more behaviorally inferred routine care, early recognition of complications, and the use of psychological and pharmacological interventions.

Epidemiology of unintentional adult injury in a rural population

BACKGROUND

The purpose of this study was to describe the frequency, characteristics, and risk factors of unintentional adult injury in a rural population.

METHODS

We interviewed 1,644 adults representing an all-rural county in Iowa. Analyses used bivariate and multivariable logistic regression.

RESULTS

Participants' mean age was 53 years, and 54% were women. Twenty-three percent (n = 380) of participants reported an injury during the past 12 months, of which four fifths were treated. Overexertion (25%) and falls (22%) caused nearly half the injuries. Women with high levels of depression symptoms had 1.57 times (95% confidence interval, 1.05-2.33) the prevalence of injury occurrence as did women with low levels of depression symptoms. Men with a CAGE score of 2 or more had between 0.98 and 2.56 times (according to the range of values of the relevant odds ratio 95% confidence interval) the prevalence of injury episode of men without this exposure.

CONCLUSION

The association of injury occurrence with alcohol problems is consistent with prior research, but the increased prevalence of injury associated with high levels of symptoms of depression requires further study and explanation.

Illicit drugs and fitness to drive: assessment in Spanish Medical Driving Test Centres

This study investigated the incidence of problems related to illicit drugs and fitness to drive among 8043 Spanish drivers assessed in 25 Medical Driving Test Centres at national level. In accordance with Spanish and European Union legislation, driving licences cannot be issued or renewed to people suffering from illicit drug-related problems. A small percentage (0.3%; n=24) of drivers interviewed had problems relating to drug use (abuse, dependence and induced disorders) and half of them (n=12) were also diagnosed as having problems with alcohol. Drivers with illicit drug-related problems were more often involved in road accidents and committed more traffic infractions during the last year (33.3%, n=8, and 79.2%, n=19, respectively) than those without problems related to illegal drug taking (12.3%, n=986, and 9.3%, n=748, respectively). Of drivers with drug problems 70.8% (n=17) were considered fit to drive. The results show that the incidence of drug-related problems is rare among Spanish drivers, and that in three out of four cases drivers with drug-related problems were considered fit to drive.

Psychological consequences of road traffic accidents

Although accident-induced psychopathology was formerly considered as being associated with secondary gain, subsequent reports have refuted this contention. More recent studies have shown that road traffic accident-induced psychopathology can be a persistent and chronic disability, irrespective of whether the victim seeks compensation. This study describes the psychological assessment of 50 potential road traffic accident litigants referred by solicitors. They were all assessed within a hospital setting approximately three weeks after the receipt of the request for a psychological report. All participants completed measures of depression, anxiety, post-traumatic stress and subjective distress, and information was obtained about injuries sustained. The results suggest that the potential litigants who sustained an injury presented with significantly higher post-traumatic distress intrusion and avoidance scores, and that these scores are also influenced by the delay between the accident and the assessment. Furthermore, the sample showed intrusion, avoidance and perceived stress scores above normal population data. Reducing the delay between the accident and assessment has important clinical implications. However, it appears that solicitors rather than general practitioners initiate these referrals. Some implications for assessment prior to treatment are discussed.