Injury & Mental Disorders

Name some data sources for burden of injury in NZ

• national surveys

• ACC claims database

• ZNHIS

• Agency databases

• Research publications and projects

In injury epidemiology why is the denominator used important?

using the whole population can lead to inaccuracies in interpreting injury data. its important that the denominator represents people who have been exposed to the same risk but didn’t have the outcome (e.g. drivers in a specific area, hours spent driving, etc)

Is exposure to risk of injury always constant

no it can be transient and intermittent

What is an intermittent and transient exposure?

• transient exposure happen for brief periods of time

• intermittent exposures are not continuous

Explain the epidemiological triad in the context of injuries

• host: who was affected by the injury and what happened to them

• agent: what caused the injury - the energy/force

• environmental: where the injury occurred

Give a simple definition of injury

physical or physiological harm caused by interaction of the body with energy that exceeds physical or physiological tolerances

How are injury classified

External causes of injury are classified by

• intentional

• non-intentional

• (Sometimes the purpose of the activity)

What are the 2 types of injuries that are the leading causes of injury related health loss in NZ?

• self inflicted

• transport injuries

What is the most common injury for older demographics?

falls

What are the four injuries that have the highest DALYs?

• self inflicted

• transport

• falls

• interpersonal

which two risk factors contribute about ¼ each to all injury related health loss?

• alcohol

• mental illness

_____ experience ____ the rate of injury related health loss compared to _____

Māori; twice; non-Māori

Health loss from ____ is 4 times higher in ____

assault; Māori

over half of all injuries occur in those under ____ years

35

injuries are the ___ most important cause of health loss in children and young people and ___ in all age groups

3rd; 5th

Which external causes of injury have the highest mortality rates?

1. road injuries

2. self harm

3. falls

Mortality by poisoning is higher in __________

low and middle income countries

____ are more at risk of death from injuries and violence

men

In which age group are road injuries the highest cause of mortality

15-29 years

What are the dimensions of the Haddon’s matrix - the rows

• pre event (primary)

• event (secondary)

• post event (tertiary)

What are the dimensions of the Haddon’s matrix - columns

• host (human) - person at risk of injury

• agent (vehicle)

• proximal environment (physical)

• distal environment (social-legal)

  

What are strengths and limitations of descriptive studies for answering research questions about injury control?

strengths: can identify the descriptive epidemiology and burden of injury

• describes the problem and the context in which it occurs

Limitations: describes factors associated with injury but not whether they are causal

What are strengths and limitations of cohort studies for answering research questions about injury control?

Strengths:

• can examine multiple exposures and multiple outcomes

• temporal relationship

• can use existing datasets with high risk populations

Limitations:

• most injuries are rare outcomes therefore need large samples

• loss to follow up - common in young people as they are more mobile

• expensive and long follow up

• Difficult to measure transient exposures

What are strengths and limitations of case control studies for answering research questions about injury control?

strengths

• info on transient risk factors

• no risk of loss to follow up

• good for measuring rare events

• controls come from the same source population as the cases

limitations

• recall bias

• misclassification of exposed and non-exposed

• no incidence rates just relative risk which is estimated by OR

• confounding

What are strengths and limitations of RCTs studies for answering research questions about injury control?

Strengths

• good for testing interventions

• no confounding

Limitations

• cannot randomise people to potentially harmful exposures or interventions - need equipoise

What are strengths and limitations of Ecological studies for answering research questions about injury control?

strengths

• useful in injury prevention policy evaluation

• acknowledges the contribution of the physical and social environment in injury

• differences between groups

Limitation

• ecological fallacy

• clues to cause but no causal association

• provides limited information on injury

What is an example of an intermittent exposure

driving

what are the downstream determinants of injury?

the factors relating to the individual and individual lifestyle factors

what are the upstream determinants of injury?

the causal factors outside the individual

most injuries are ____ and therefore ____

predictable; preventable

Provide two examples of intentional injuries

• family violence

• self inflicted harm

What is the prevalence of any ACEs for men and women?

ACEs are more prevalent in women (62%) compared to men (54%)

Who experiences more non-partner violence?

men

Who experiences more intimate partner violence?

women (54.7%) (men (49.9))

List 3 health consequences that are associated with the experience of intimate partner violence

• pain and discomfort

• increases risk of being diagnosed with mental disorders like depression and anxiety

• increases risk of chronic diseases like diabetes and CVD

What’s the difference between positive/good, tolerable and toxic stress

• good stress is good for motivating a person, there are mild elevations of stress hormone levels and a slight increase in heart rate

• tolerable stress is caused by a stressful event which results in a prolonged experience of stress but is buffered by supportive relationships

• toxic stress occurs as a result of prolonged activation of the stress response system without protective relationships to help

  

Describe the magnitude of intimate partner violence in NZ

• There is a high prevalence of IPV in both men and women

• women experience (62%) more IPV than men(49%)

• 54% of women reported experiencing any form of IPV while 11% of women reported experiencing 4 or more types of IPV

What is the relationship between IPV and health

There is a dose response effect - the more IPV events experienced, the poorer the health outcomes.

Describe the magnitude of child abuse in NZ

• 18% of adults reported experiencing physical abuse

• 18% of adults reported experiencing sexual abuse

• 29% of adult reported experiencing emotional abuse

• women experienced more ACEs than men

what are some of the mechanisms which contribute to the long-term health consequences of family violence

• developmental/physiological

• emotional

• behavioral

What is promotion and what is an example of how it is used in Family Violence?

promotion is about encouraging healthy relationships and norms. These can be though social marketing and campaigns

an example of this is the its not OK campaign for family violence

What are the three types of prevention methods and what are they for?

• indicative - individuals at high risk

• selective - subgroups at high risk

• universal - the general population

Parenting programmes, programmes for adolescents who may be at high risk are examples of which prevention method?

indicative

healthy teen dating educational campaigns are examples of which prevention method?

selective

child protection services, police involvement, treatment are examples of what?

response (to an event of violence. response refers to how the person is being supported)

strengthening anti-violence social norms, promoting gender equality and reducing poverty is an example of which type of prevention?

universal

Where can you access information on evidence based strategies to address violence?

• vine

• CDC

• Te Puna Aonui

____ are the _____ leading cause of unintentional injury deaths worldwide and the most common way to injure yourself in _________

falls; second; New Zealand

Describe fall mortality by HDI

higher in low and middle income countries

Falls are often severe in older adults. one in __ people over 65 injures themselves in a fall. This rises to one in _ people once you reach —

3; 2; 80

From which age do falls become the leading cause of injury deaths?

75

describe the magnitude of the health burden from falls in older adults in the future.

as our population continues to age, the burden of falls in older adults will likely increase and continue to be a large health burden.

what are some environmental (home and residential areas) interventions?

Which groups have the highest alcohol consumption?

• 18 - 24 year olds

• Māori

what determines patterns of drinking

speed and volume

How do patterns of drinking influence injury risk?

Drinking volume and speed determines how intoxicated becomes and depending on the context and situation they are in, their risk of injury could increase

What is classified as binge drinking for men and women?

• 6 or more standard drinks for men

• 4 or more standard drinks for women

What major types of injuries does alcohol contribute

• car crashes

• interpersonal violence (at home and with strangers)

• self harm

• boating

Describe the contribution of alcohol to car crashes and boating

• A high proportion of serious injury car crashes are attributed to car crashes

• as the fatality/seriousness of the car crash goes up, the probability that alcohol was a contributing factor also increases

• risk of boating fatality increases significantly with BAC (blood alcohol concentration)

List some interventions for reduction of alcohol related injury for which there is evidence of effectiveness

• taxing and pricing

• drink driving countermeasures and enforcement

• restrictions on alcohol promotion and advertisement

• limiting physical availability

  • outlets

  • times in which they can sell alcohol

  • distance of outlets from certain institutions

What are some interventions for reduction of alcohol related injury for which there is no evidence of effectiveness

• lowering the drinking age

• educational and persuasive approaches including warning labels (no sustained effect on drinking)

What are the prospects for control of alcohol related injury in different contexts?

road injuries

• random breath testing

• improving safety of cars

• airbags

Drowning

• teaching people to swim

Define ‘mental disorder’

a behavioural or psychological syndrome associates with clinically significant distress or disability (functional impairment)

A mental disorder must cause ______

clinically significant distress and disability

What is a challenge about mental health diagnosis?

there is no biological marker or test that can conclusively diagnose people. this is a point of a lot of criticisms

Mental disorders are defined by clusters of mostly ____ ____ symptoms some of which may not be _____ to ____

self reported; obvious; observers

What are the most common disorders?

• anxiety disorders as a group but depression as an individual disorder

You must have ___ out of ___ symptoms to be diagnosed with major depressive disorder

5/9

One of the diagnostic criteria for major depressive disorder is a ______ (sadness or emptiness) every day, most of the day, for at least _____

depressed mood; 2 weeks

one of the diagnostic criteria for major depressive disorder is ______ in activities you used to enjoy. What is another term for this?

reduced interest; anhedonia

one of the diagnostic criteria for major depressive disorder is having ____ disturbances

sleep → fatigue (another criteria)

one of the diagnostic criteria for major depressive disorder is _______ retardation or ____

psychomotor; agitation

one of the diagnostic criteria for major depressive disorder is weight _____

change

one of the diagnostic criteria for major depressive disorder is _______ concentrating, holding a conversation, and ________

difficulty; making decisions

one of the diagnostic criteria for major depressive disorder is feeling ________ or excessive ____

worthless; guilt

one of the diagnostic criteria for major depressive disorder is ______ thoughts or intentions

suicidal

Abnormally elevated mood or irritability is a symptom of which disorder?

Bipolar/ mania

Decreased need for sleep and an inflated self esteem are symptoms of which disorder?

bipolar/mania

excessive involvement in pleasurable but risky activities is associated with which disorder?

bipolar/mania

Why is hospital/health service data insufficient in measuring mental health epidemiology?

only tells you about the most severe cases and people who has sought help - this leaves out a lot of people

Why is it difficult to conduct mental health surveys

• there is a lot of stigma around mental health conditions which makes it difficult to get people to answer questions about it

• people might not know which mental disorder they have

what are the challenges of using cross sectional surveys for mental disorder prevelence?

• need a very large sample especially for rate disorders

• requires long interviews

• requires a high response rate to reduce bias

what are the challenges of using prospective surveys for mental disorder prevalence?

• usually smaller samples and restricted age ranges (limits generalisability)

What are the benefits of using prospective surveys for mental disorder prevalence?

good for measuring risk factors

What are the 3 methods/studies used to measure disorder prevalence?

• cross sectional surveys

• prospective surveys

• mental disorder assessment

What was the sample for the NZ mental health survey?

non institutionalized general adults (16+)