Abstract
BackgroundUnintentional injuries are a leading cause of morbidity and mortality in children of all ages. Prevention strategies require knowledge of risk factors, and behavior and psychiatric disorders have been suggested to influence the risk of injury during childhood. While externalizing disorders have been found to increase the risk for injuries, results are mixed regarding internalizing disorders, such as affective and anxiety conditions, and Autism Spectrum Disorders (ASD). There is a need for large scale studies relying on robust data sources. The aim of the present study was to examine the association between psychiatric disorders and injuries requiring medical attention, in a large population-based cohort of 350,000 children and adolescents in Sweden.MethodsData were obtained from the regional health care database Vega. Psychiatric diagnoses and injury diagnoses obtained during 2014–2018 for individuals aged 0–17 years in 2016 were extracted. Descriptive statistics were used to examine differences in 5-year injury prevalence between children with and without different psychiatric diagnoses. Logistic regression was used in age-stratified models to test the association between psychiatric diagnoses and injuries requiring medical attention.ResultsThe results show an increased risk for concurrent injuries in general, but the patterns vary by age and psychiatric disorder. Externalizing disorders and anxiety conditions were associated with concurrent injuries, while individuals with ASD had a lower risk for most injuries included. Affective disorders were associated with an increased risk for wounds, concussion, complications and poisoning, while the risk for fractures was decreased. Self-inflicted injury was more common in all psychiatric conditions investigated during adolescence, except for ASD. Children and adolescents with many types of psychiatric disorders were also at increased risk for a concurrent maltreatment diagnosis.ConclusionsA general pattern of increased risk for concurrent injuries in children and adolescents with most psychiatric diagnoses was found, but the associations vary by age and type of psychiatric disorder. The results add to the literature on risk factors for injuries in children and adolescents, supporting diagnosis specific patterns. Several psychiatric diagnoses were associated with a marked increase in injury risk, indicating a high burden of disease for affected individuals.
Highlights
Unintentional injuries are a leading cause of morbidity and mortality in children of all ages
Unintentional injuries were more common in children and adolescents with psychiatric disorders than those without, with the biggest difference noted for concussion
Large differences were noted for oppositional defiant disorder (ODD)/Conduct Disorder (CD) where 45.4% of 13–17-year-olds with an ODD or CD diagnosis had sought medical attention for an injury compared to 27.1% without these diagnoses
Summary
Unintentional injuries are a leading cause of morbidity and mortality in children of all ages. The aim of the present study was to examine the association between psychiatric disorders and injuries requiring medical attention, in a large populationbased cohort of 350,000 children and adolescents in Sweden. Child behavior and associated psychiatric disorders have been brought to light as risk factors for unintentional injuries in children and adolescents. Smaller studies have indicated that children with ADHD are less likely to perceive consequences of hazardous situations [6] and that impulsivity as a trait is associated with risk behaviors such as initiating physical fights [7] which in turn could increase the risk for injuries. In a large populationbased cohort, Rowe et al found ODD to be associated with unintentional injuries after controlling for comorbid psychopathology, while no association was found for conduct disorder (CD) [10]. Conduct problems were shown to be associated with hospital admission due to unintentional injury [11]
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