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Pre-existing mental disorder, clinical profile, inpatient services and costs in people hospitalised following traumatic spinal injury: a whole population record linkage study
  1. Lisa Nicole Sharwood1,2,3,
  2. Taneal Wiseman4,
  3. Emma Tseris5,
  4. Kate Curtis4,6,7,8,
  5. Bharat Vaikuntam1,
  6. Ashley Craig1,
  7. Jesse Young9,10,11,12
  1. 1Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3Faculty of Engineering and Risk, University of Technology Sydney, Sydney, NSW, Australia
  4. 4Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Faculty of Arts and Social Sciences, Sydney School of Education and Social work, University of Sydney, Sydney, New South Wales, Australia
  6. 6Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia
  7. 7Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
  8. 8The George Institute for Global Health, Newtown, New South Wales, Australia
  9. 9Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
  10. 10School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
  11. 11Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, VIC, Australia
  12. 12National Drug Research Institute, Curtin University, Perth, WA, Australia
  1. Correspondence to Dr Lisa Nicole Sharwood, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia; lisa.sharwood{at}


Background Risk of traumatic injury is increased in individuals with mental illness, substance use disorder and dual diagnosis (mental disorders); these conditions will pre-exist among individuals hospitalised with acute traumatic spinal injury (TSI). Although early intervention can improve outcomes for people who experience mental disorders or TSI, the incidence, management and cost of this often complex comorbid health profile is not sufficiently understood. In a whole population cohort of patients hospitalised with acute TSI, we aimed to describe the prevalence of pre-existing mental disorders and compare differences in injury epidemiology, costs and inpatient allied health service access.

Methods Record linkage study of all hospitalised cases of TSI between June 2013 and June 2016 in New South Wales, Australia. TSI was defined by specific International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) codes. Mental disorder status was considered as pre-existing where specific ICD-10-AM codes were recorded in incident admissions.

Results 13 489 individuals sustained acute TSI during this study. 13.11%, 6.06% and 1.82% had pre-existing mental illness, substance use disorder and dual diagnosis, respectively. Individuals with mental disorder were older (p<0.001), more likely to have had a fall or self-harmed (p<0.001), experienced almost twice the length of stay and inpatient complications, and increased injury severity compared with individuals without mental disorder (p<0.001).

Conclusion Individuals hospitalised for TSI with pre-existing mental disorder have greater likelihood of increased injury severity and more complex, costly acute care admissions compared with individuals without mental disorder. Care pathway optimisation including prevention of hospital-acquired complications for people with pre-existing mental disorders hospitalised for TSI is warranted.

  • spinal cord injury
  • burden of disease
  • costs
  • mental health
  • trauma systems
  • socioeconomic status
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  • Twitter @lisanicole70, @jtyoung_edu

  • Collaborators James; Middleton.

  • Contributors LNS conceived the study. LNS and JY wrote the manuscript, and all authors critically reviewed and edited the manuscript. All authors contributed to the final review and approval of the manuscript.

  • Funding This study was funded by Insurance & Care NSW.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Cancer Institute NSW, Population and Health Services Research Ethics Committee: AU RED Reference: HREC/16/CIPHS/19, Cancer Institute NSW reference number: 2016/07/647.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data were provided by the Centre for Health Record Linkage NSW.

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