历史总是重演：精神疾病对人际暴力女性受害者再次暴力伤害和再次入院的影响。
History repeats itself: Impact of mental illness on violent reinjury and hospital reencounters among female victims of interpersonal violence.
机构信息
From the Department of Surgery (M.Y.N., T.M., D.S., L.A., S.E.S.), Boston Medical Center; Department of Surgery (M.Y.N., D.S., L.A., S.E.S.), Boston University School of Medicine; Undergraduate Program in Neuroscience (E.P.), Boston University College of Arts and Sciences, Boston, Massachusetts; and Department of Surgery (M.G.J.), University of Michigan, Ann Arbor, Michigan.
出版信息
J Trauma Acute Care Surg. 2023 Jul 1;95(1):143-150. doi: 10.1097/TA.0000000000003984. Epub 2023 Apr 17.
BACKGROUND
Violence-related reinjury impacts both patients and health care systems. Mental illness (MI) is prevalent among violently injured individuals. The relationship between preexisting MI and violent reinjury among women has not been fully characterized. Our objective was to determine if risk of hospital reencounter-violent reinjury and all-cause-was associated with preexisting MI at time of index injury among female victims of violence.
METHODS
All females (15-100 + years) presenting to a level I trauma center with violent injury (2002-2019) surviving to discharge were included (N = 1,056). Exposure was presence of preexisting MI. The primary outcome was hospital reencounters for violent reinjury and all-cause within one year (through 2020). The secondary outcome was the development of a new MI within one year of index injury. Odds of reencounter and development of new MI for those with and without preexisting MI were compared with multivariable logistic regression, stratified for interaction when appropriate.
RESULTS
There were 404 women (38%) with preexisting MI at time of index injury. Approximately 11% of patients with preexisting MI experienced violent reinjury compared to 5% of those without within 1 year ( p < 0.001). Specifically, those with MI in the absence of concomitant substance use had more than three times the odds of violent reinjury (adjusted Odds Ratio, 3.52 (1.57, 7.93); p = 0.002). Of those with preexisting MI, 64% had at least one reencounter for any reason compared to 46% of those without ( p < 0.001 ) . Odds of all-cause reencounter for those with preexisting MI were nearly twice of those without (adjusted Odds Ratio, 1.81 [1.36, 2.42]; p < 0.0001).
CONCLUSION
Among female victims of violence, preexisting MI is associated with a significantly increased risk of hospital reencounter and violent reinjury within the first year after index injury. Recognition of this vulnerable population and improved efforts at addressing MI in trauma patients is critical to ongoing prevention efforts to reduce violent reinjury.
LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
背景
与暴力相关的再受伤不仅影响患者，也影响医疗系统。精神疾病（MI）在遭受暴力伤害的人群中很常见。先前存在的 MI 与女性暴力再受伤之间的关系尚未完全明确。我们的目的是确定在女性暴力受害者的指数损伤时是否存在先前存在的 MI 与医院再就诊 - 暴力再受伤和全因 - 相关。
方法
所有在一级创伤中心因暴力受伤（2002-2019 年）并存活至出院的 15-100 岁及以上女性（N=1056）均被纳入研究。暴露是先前存在的 MI。主要结局是一年内（到 2020 年）因暴力再受伤和全因的医院再就诊。次要结局是指数损伤后一年内新发 MI。有和没有先前存在的 MI 的患者发生再就诊和新发 MI 的可能性通过多变量逻辑回归进行比较，当适合时进行交互作用分层。
结果
在指数损伤时，有 404 名女性（38%）存在先前存在的 MI。大约 11%的有先前存在的 MI 的患者在 1 年内发生暴力再受伤，而无 MI 的患者为 5%（p<0.001）。具体来说，没有伴随物质使用的 MI 患者发生暴力再受伤的可能性是没有 MI 的患者的三倍以上（调整后的优势比，3.52（1.57，7.93）；p=0.002）。在有先前存在的 MI 的患者中，有 64%的患者至少有一次因任何原因就诊，而没有 MI 的患者为 46%（p<0.001）。有先前存在的 MI 的患者发生全因再就诊的可能性几乎是没有 MI 的患者的两倍（调整后的优势比，1.81（1.36，2.42）；p<0.0001）。
结论
在女性暴力受害者中，先前存在的 MI 与指数损伤后第一年发生医院再就诊和暴力再受伤的风险显著增加相关。认识到这一脆弱人群，并努力改善创伤患者的 MI 治疗，对于减少暴力再受伤的持续预防工作至关重要。
证据水平
预后和流行病学；IV 级。
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