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Higher psychological distress is associated with unintentional injuries in US adults
  1. Jana McAninch1,
  2. Christina Greene1,
  3. John D Sorkin2,3,
  4. Marie-Claude Lavoie1,
  5. Gordon S Smith1,4
  1. 1Department of Epidemiology and Public Health, University of Maryland Baltimore School of Medicine, Baltimore, Maryland, USA
  2. 2Baltimore VA Medical Center, Geriatrics Research, Education, and Clinical Center, Baltimore, Maryland, USA
  3. 3University of Maryland School of Medicine Claude D. Pepper Older Americans Independence Center, Baltimore, Maryland, USA
  4. 4Shock, Trauma and Anesthesiology Research (STAR)—Organized Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
  1. Correspondence to Dr Jana McAninch, Department of Epidemiology and Public Health, University of Maryland Baltimore School of Medicine, 7102 Poplar Avenue, Takoma Park, Baltimore, MD 20912, USA; jana.mcaninch{at}


Background Links between mental illness, self-inflicted injury and interpersonal violence are well recognised, but the association between poor mental health and unintentional injuries is not well understood.

Methods We used the 2010 National Health Interview Survey to assess the association between psychological distress and unintentional non-occupational injuries among US adults. Psychological distress was measured by the Kessler Psychological Distress Scale, a symptom scale shown to identify community-dwelling persons with mental illness. Multivariable logistic regression was used to estimate adjusted ORs (AOR) and 95% CIs.

Results Of the 26 776 individuals analysed, 2.5% reported a medically attended unintentional injury in the past 3 months. Those with moderate and severe psychological distress had 1.5 (1.2 to 1.8) and 2.0 (1.4 to 2.8) times higher odds of injury, respectively, as compared to those with low distress levels, after adjusting for age, sex, race, marital status, education level, alcohol use, physical functional limitation, medical comorbidity, employment status and health insurance status. Psychological distress was significantly associated with falls (AOR 1.4 (1.1 to 1.9)) and sprain/strain injuries (AOR 2.0 (1.5 to 2.8)), but not transportation-related injuries (AOR 1.2 (0.7 to 1.9)) or fractures (AOR 1.1 (0.8 to 1.6)).

Conclusions Among community-dwelling US adults, psychological distress is significantly associated with unintentional non-occupational injury, and the magnitude of association increases with severity of distress. The association between psychological distress and injury may be particularly strong for falls and sprain/strain injuries. These findings draw attention to a large group of at-risk individuals that may merit further targeted research, including longitudinal studies.

  • Risk/Determinants
  • Injury Diagnosis

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