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Chui Z, Leightley D, Jones M, Landau S, McCrone P, Hayes RD, Wessely S, Fear NT, Goodwin L. Mental health problems and admissions to hospital for accidents and injuries in the UK military: A data linkage study. PLoS One 2023; 18:e0280938. [PMID: 36693079 PMCID: PMC9873160 DOI: 10.1371/journal.pone.0280938] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/12/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Accidents are the most common cause of death among UK military personnel. It is a common misconception in the general public that accidental injuries are always the result of random events, however research suggests that mental health problems and the increased levels of risky behaviour in military personnel may play a role. The objective of this study was to further our understanding of injuries and deaths not related to deployment by examining the associations of mental health, alcohol misuse and smoking with inpatient admission to hospital for accidents and injuries, and attendance to accident and emergency (A&E) departments. METHODS Data on all hospital admissions for accidents and injuries and A&E attendance at NHS hospitals in England, Scotland and Wales were linked to data on self-reported mental health problems, alcohol misuse and smoking from a large, representative UK military cohort of serving and ex-serving personnel (n = 8,602). Logistic regression was used to examine the associations between having a hospital admission for an accident or injury with self-reported mental health problems, alcohol misuse and smoking. Cox proportional-hazards regression was then conducted to assess the associations of mental health problems, alcohol misuse and smoking with time to hospital admission for an accident or injury. Finally, negative binomial regression was used to examine associations between the number of A&E attendances with mental health problems, alcohol misuse and smoking. RESULTS Personnel reporting symptoms of common mental disorder (CMD) or probable post-traumatic stress disorder (PTSD) were more likely to have an admission to hospital for an accident or injury (fully adjusted odds ratio 1.39, 95% confidence interval [CI] 1.05-1.84), than those who did not report these symptoms, and also had more attendances to A&E (fully adjusted incidence rate ratio [IRR] 1.32, 95% CI 1.16-1.51). A&E attendances were also more common in personnel who were smokers (fully adjusted IRR 1.21, 95% CI 1.09-1.35) following adjustment for demographic, military and health characteristics. CONCLUSIONS The findings suggest that accidents and injuries among military personnel are not always random events and that there are health and behavioural factors, including poor mental health and smoking, which are associated (with small effect sizes) with an increased risk of being involved in an accident. Clinicians treating individuals attending hospital after an accident should consider their healthcare needs holistically, including issues related to mental health and health damaging behaviours.
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Affiliation(s)
- Zoe Chui
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- * E-mail:
| | - Daniel Leightley
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Margaret Jones
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Sabine Landau
- Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Faculty of Education and Health, University of Greenwich, London, United Kingdom
| | - Richard D. Hayes
- Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Simon Wessely
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Nicola T. Fear
- King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
- Academic Department of Military Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Laura Goodwin
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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Yeh HH, Westphal J, Hu Y, Peterson EL, Williams LK, Prabhakar D, Frank C, Autio K, Elsiss F, Simon GE, Beck A, Lynch FL, Rossom RC, Lu CY, Owen-Smith AA, Waitzfelder BE, Ahmedani BK. Diagnosed Mental Health Conditions and Risk of Suicide Mortality. Psychiatr Serv 2019; 70:750-757. [PMID: 31185853 PMCID: PMC6718299 DOI: 10.1176/appi.ps.201800346] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Although mental health conditions are risk factors for suicide, limited data are available on suicide mortality associated with specific mental health conditions in the U.S. population. This study aimed to fill this gap. METHODS This study used a case-control design. Patients in the case group were those who died by suicide between 2000 and 2013 and who were patients in eight health care systems in the Mental Health Research Network (N=2,674). Each was matched with 100 general population patients from the same system (N=267,400). Diagnostic codes for five mental health conditions in the year before death were obtained from medical records: anxiety disorders, attention deficit-hyperactivity disorder (ADHD), bipolar disorder, depressive disorders, and schizophrenia spectrum disorder. RESULTS Among patients in the case group, 51.3% had a recorded psychiatric diagnosis in the year before death, compared with 12.7% of control group patients. Risk of suicide mortality was highest among those with schizophrenia spectrum disorder, after adjustment for age and sociodemographic characteristics (adjusted odds ratio [AOR]=15.0) followed by bipolar disorder (AOR=13.2), depressive disorders (AOR=7.2), anxiety disorders (AOR=5.8), and ADHD (AOR=2.4). The risk of suicide death among those with a diagnosed bipolar disorder was higher in women than men. CONCLUSIONS Half of those who died by suicide had at least one diagnosed mental health condition in the year before death, and most mental health conditions were associated with an increased risk of suicide. Findings suggest the importance of suicide screening and providing an approach to improve awareness of mental health conditions.
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Affiliation(s)
- Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Joslyn Westphal
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Yong Hu
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Edward L Peterson
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - L Keoki Williams
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Deepak Prabhakar
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Kirsti Autio
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Farah Elsiss
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Frances L Lynch
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Beth E Waitzfelder
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Yeh, Westphal, Hu, Autio, Elsiss, Ahmedani), Department of Public Health Sciences (Peterson), Department of Internal Medicine (Williams), Department of Behavioral Health Services (Frank), Henry Ford Health System, Detroit; Outpatient Services, Sheppard Pratt Health System, Baltimore (Prabhakar); Kaiser Permanente Washington Health Research Institute, Seattle (Simon); Institute for Health Research, Kaiser Permanente Colorado, Denver (Beck); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); HealthPartners Institute, Minneapolis (Rossom); Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); School of Public Health, Georgia State University, and Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta (Owen-Smith); Center for Health Research, Kaiser Permanente Hawaii, Honolulu (Waitzfelder)
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