Factors Associated with the Development of Mental Health Comorbidity Subsequent to Elbow Trauma.
Katherine M. Connors, M.D., George A Beyer, MD, MS, Adam Wolfert, MD, David H. Mai, MD, MPH and Jennifer Hashem, MD, State University of New York (SUNY) Downstate Medical Center, Brooklyn, NY
Elbow trauma and its often-arduous recovery can cause a lasting impact on a patientâ€™s ability to use their upper extremity. The psychological effects of the limitations experienced by elbow trauma patients are not well elucidated. We hypothesize that patients suffering from elbow trauma have an increased incidence of subsequent mental health diagnoses.
Methods: The Statewide Planning and Research Cooperative System (SPARCS) database was queried by International Classification of Disease 9th Revision (ICD9) codes from 2000-2014 to identify all patients with an acute diagnosis of elbow trauma (elbow dislocation, radial head fracture, coronoid fracture, medial epicondyle fracture, or lateral epicondyle fracture). Psychiatric comorbidities diagnosed across all patientsâ€™ preceding, initial, and subsequent visits were identified. Factors associated with developing a psychiatric condition after elbow trauma were assessed including gender, age, race, insurance, and whether the patient was discharged to a facility or home. Univariate analysis compared demographics between patients with and without psychiatric comorbidities among all patients who had elbow trauma.
Results: A total of 13,413 patients with elbow trauma were identified. 4,370 had a mental health diagnosis (MHD) at the time of presentation for elbow trauma. 1,259 patients had a history of mental health diagnosis prior to the presentation for elbow trauma. 2,355 patients were identified who presented with elbow trauma and subsequently developed a MHD (17.6%). Female patients (OR =0.67, 95% CI 0.59-0.76) were less likely while patients discharged to a facility (OR = 1.21, 95% CI 1.06-1.38) were more likely to develop MHD after elbow trauma. Overall, there was a significant association between race and MHD (p<0.0001); Non-Hispanic Black patients had the highest proportion of incidence of subsequent development of MHD (161 patients, 9.6%) while Asian patients had lowest (12 patients, 3.5%). Age was also significantly associated with development of MHD (p<0.0001). Patients < 50 years old had the highest incidence later developing MHD (554, or 9.4%), while patients >80 years old had the lowest (5.4%). There was a significant association between insurance type and MHD (p<0.0001); patients with Medicaid (183, 13.7%) and Medicare (319, 8.12%) had the highest incidence of developing MHD as compared to non-federal insurance.
Patients who are younger than 50, male, black, insured by Medicare or Medicaid, or those discharged to a facility may be more at risk for developing mental health diagnoses after elbow trauma.
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