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The Relationship Between Severe Injury and Mental Health in a Pediatric Managed-Medicaid Population
Kylie M. Bushroe, BS3, Erinn M. Hade, PhD3, Tara A. McCarthy, BSPH1, Jeff Bridge, PhD2,3, Julie C., Leonard, MD, MPH1,3. 1Center for Injury Research and Policy, Columbus, The Research Institute at Nationwide Children's Hospital, OH, USA, 2Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA, 3The Ohio State University College of Medicine, Columbus, OH, USA.

Background: We compared mental health diagnoses before and after unintentional, non-fatal traumatic injuries in a managed-Medicaid population.

Methods: We investigated children (n=2208) ?18 years treated at a pediatric trauma center from 2005 to 2015 who were enrolled in a managed Medicaid program at hospital admission and for at least one healthcare visit the preceding year. We identified visits pre- and post-injury. Poisson regression models estimated rates of mental health diagnoses.

Results: The rate of mental health diagnoses pre-injury was 95.9 per 1000 person-years and increased to 156.7 per 1000 post-injury (unadjusted Rate Ratio (uRR), 95% confidence interval (CI): 1.6, 1.4-1.9). Diagnoses (uRR, CI) of adjustment (9.8, 1.2-78.3), disruptive behavior (2.0, 1.1-3.6), cognitive (2.8, 1.8-4.2), sleep (2.3, 1.1-5.0), and other disorders (2.0, 1.1-3.8) were more prevalent post-injury. The rate of post-injury diagnoses compared to pre-injury varied by age (uRR, CI): 0-4 years (2.9, 1.9-4.3); 5-9 years (1.4, 1.1-1.8); 10-14 years (1.1, 0.9-1.5); 15-18 years (2.1, 1.4-3.3). Adjusted for race/ethnicity, children ages 0-4 with burn injuries were more likely to have diagnoses post-injury (adjusted Rate Ratio (aRR), CI): 8.6 (3.3-22.2)), as were those ages 0-4 injured by other mechanisms (aRR: 1.8 (1.1-2.8)). Adjusted for race/ethnicity, children with head injuries were more likely to have diagnoses post-injury (aRR, CI): ages 0-4 years (3.9, 1.3-11.5); ages 5-9 (3.1, 1.3-7.6); ages 10-14 (2.2, 1.3-3.7); ages 15-18 (5.4, 2.1-13.6).

Conclusions: We identified a significant increase in the rate of mental health diagnoses after injury. Young age, burns, and head injury were highly associated with diagnoses post-injury.


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