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Traumatic injury in teens ups psychiatric diagnosis.

ATLANTA -- A single, traumatic injury is associated with more psychiatric diagnoses and more psychotropic medication prescriptions among adolescents than among those uninjured, according to a large, prospective, cohort study.

Researchers studied 20,507 patients aged 10-19 years who were treated at Group Health, a large health maintenance organization based in Seattle. Dr. Doug Zatzick and his associate studied the 6,116 teenagers (30%) who experienced a single traumatic injury in the index year of 2001 and looked for mental health diagnoses and psychotropic prescriptions in these patients for 2002, 2003, or 2004. They compared these factors with the group of 14,391 teens (70%) who were not injured.

"Yes, a single event in 2001 was associated with increased risk for broad range of psychopathology," Dr. Zatzick said at the annual meeting of the International Society for Trauma Stress Studies.

Injury during the index year was significantly and independently associated with an increased likelihood of any psychiatric diagnosis (odds ratio, 1.23) in this population-based study, said Dr. Zatzick, of the psychiatry and behavioral science departments at the University of Washington, Seattle.

Specifically, injured teenagers were more likely to have an anxiety diagnosis (OR, 1.19) or an acute stress disorder (OR, 1.21), compared with the noninjured adolescents, according to adjusted regression analyses. As an example, a significantly higher percentage of injured children had an anxiety diagnosis in 2002, 6.5%, compared with 4.8% of the noninjured group.

A total 6.2% of the injured adolescents were subsequently diagnosed with a disruptive behavior disorder, compared with 4.6% of their noninjured peers, Dr. Zatzick said.

A secondary aim of the study was to look at prevalence of traumatic brain injury (TBI). Of the 30% of the kids who were injured, "only 1% had a traumatic-brain related injury, so it's not that common," Dr. Zatzick said.

A greater percentage of the injured group (15%) received a prescription for a psychotropic medication, compared with the noninjured group (9%). There was an increased odds ratio of 1.35 for psychotropic drug use by the injured teenagers.

"We randomly approach injured adolescents on our trauma ward. About 40% have four or more lifetime trauma [events] when they present, and so do about 50% of their parents--a common story at level 1 trauma centers," said Dr. Zatzick said, a self-described "front-line, trauma center clinician" at Harborview Injury Prevention and Research Center in Seattle. He is director of Attending Consult Services at Harborview.

Misclassification bias of psychiatric diagnosis is a potential limitation of the study, Dr. Zatzick said.

"Injury surveillance would be good way to pick up these kids in general practice," Dr. Zatzick said. "There could be screening on pediatrician charts for one injury, two injuries, etc."

Dr. Zatzick had no conflicts of interest.

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Title Annotation:MENTAL HEALTH
Comment:Traumatic injury in teens ups psychiatric diagnosis.(MENTAL HEALTH)
Author:McNamara, Damian
Publication:Family Practice News
Article Type:Clinical report
Geographic Code:1USA
Date:Jan 1, 2010
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