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Depressive symptoms as a risk factor for unintentional injury: a cohort study in a rural county
  1. H M Tiesman1,2,
  2. C Peek-Asa2,3,
  3. P Whitten,
  4. N L Sprince2,3,
  5. A Stromquist4,
  6. C Zwerling2,3
  1. 1Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
  2. 2The University of Iowa Injury Prevention Research Center, Iowa City, IA, USA
  3. 3Department of Occupational and Environmental Health, College of Public Health, The University of Iowa, Iowa City, IA, USA
  4. 4Keokuk County Rural Health Study, Great Plains Center for Agricultural Health, The University of Iowa, Iowa City, IA, USA
  1. Correspondence to:
 MsH Tiesman
 The University of Iowa College of Public Health, Department of Occupational and Environmental Health, 100 Oakdale Blvd. #100 IREH, Iowa City, IA 52242-5000, USA; hope-tiesman{at}


Objective: The authors used data from a population based prospective cohort study to determine if depressive symptoms predicted incidence of unintentional injury.

Methods: The Keokuk County Rural Health Study, based in Iowa, is a prospective cohort study of health status that includes injury outcomes. Depressive symptoms were measured using the 11-item Center for Epidemiologic Studies Depression Scale at the beginning of the study on 1493 participants. Quarterly follow up phone calls were made to measure injury incidence.

Results: 471 injuries were reported for an overall injury rate of 9.8 per 100 person-years. Crude injury rates were significantly higher for those with depressive symptoms (p = 0.0003). Those with depressive symptoms had a 41% increased risk for injury after controlling for antidepressant medication use, gender, prior injury, income, and sleepiness (RR = 1.41, 95% CI 1.10 to 1.80). Depressive symptoms remained a risk factor for injury regardless of current antidepressant medication use (no medication use, RR = 1.43, 95% CI 1.09 to 1.88; medication use, RR = 1.31, 95% CI 0.76 to 2.26).

Conclusions: Depressive symptoms were found to be risk factors for unintentional injury. Medical practitioners should consider talking about safety with their patients, especially those reporting symptoms of depression, and recognize that an increased risk for injury remains until the depressive symptoms subside.

  • CES-D, Center for Epidemiologic Studies Depression Scale
  • KCRHS, Keokuk County Rural Health Study
  • depression
  • rural population
  • prospective studies

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  • Competing interests: none.