Childhood psychiatric disorder and unintentional injury: findings from a national cohort study.

OBJECTIVE We set out to examine the relationship between unintentional injury and common child psychiatric disorders, including both internalizing and externalizing diagnoses. METHODS The 1999 British Child and Adolescent Mental Health Survey provided a nationally representative sample of over 10,000 children aged 5-15 years. Measures included assessment of diagnoses of psychiatric disorder from the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, unintentional injury, and a range of potentially related psychosocial factors. RESULTS Children with psychiatric disorders had higher rates of unintentional injury. After accounting for psychosocial risk factors and comorbid psychopathology, oppositional defiant disorder (ODD) was independently associated with burns and poisoning. Attention deficit hyperactivity disorder (ADHD) was related to fractures, and depression and anxiety also showed independent links to some injury types. CONCLUSIONS ODD and ADHD, rather than conduct disorder, appear to be the externalizing disorders associated with unintentional injury. We discuss possible models of the relationships between internalizing disorders and unintentional injury.

[1]  H. Meltzer,et al.  Mental health of children and adolescents in Great Britain , 2003, International review of psychiatry.

[2]  H. Meltzer,et al.  The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[3]  J. Dunn,et al.  Distribution of Accidents, Injuries, and Illnesses by Family Type , 2000, Pediatrics.

[4]  O. Gureje,et al.  The validity of two versions of the GHQ in the WHO study of mental illness in general health care , 1997, Psychological Medicine.

[5]  A. Wazana.  Are There Injury-Prone Children? A Critical Review of the Literature , 1997, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[6]  A. Pickles,et al.  Child psychiatric symptoms and psychosocial impairment: relationship and prognostic significance , 2001, British Journal of Psychiatry.

[7]  P. Raina,et al.  Childhood behavior disorders and injuries among children and youth: a population-based study. , 2003, Pediatrics.

[8]  S. Hinshaw,et al.  Academic underachievement, attention deficits, and aggression: comorbidity and implications for intervention. , 1992, Journal of consulting and clinical psychology.

[9]  E. Fombonne,et al.  Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health , 2003, International review of psychiatry.

[10]  D. Schwebel,et al.  Unintentional injury in preschool boys with and without early onset of disruptive behavior. , 2002, Journal of pediatric psychology.

[11]  B. Ewigman,et al.  Judgments regarding appropriate child supervision to prevent injury: the role of environmental risk and child age. , 1993, Child development.

[12]  E. Costello,et al.  Toward establishing an empirical basis for the diagnosis of oppositional defiant disorder. , 1996, Journal of the American Academy of Child and Adolescent Psychiatry.

[13]  M. Rutter,et al.  A prospective study of children with head injures: III. Psychiatric sequelae , 1981, Psychological Medicine.

[14]  Stephen Scott,et al.  Multicentre controlled trial of parenting groups for childhood antisocial behaviour in clinical practice , 2001, BMJ : British Medical Journal.

[15]  Tx Station.  Stata Statistical Software: Release 7. , 2001 .

[16]  D. Schwebel,et al.  Social and temperamental influences on children's overestimation of their physical abilities: links to accidental injuries. , 1997, Journal of experimental child psychology.

[17]  Richard Rowe,et al.  Conduct disorder and oppositional defiant disorder in a national sample: developmental epidemiology. , 2004, Journal of child psychology and psychiatry, and allied disciplines.

[18]  I. Goodyer,et al.  Depression in 11-16-year-old girls: the role of past parental psychopathology and exposure to recent life events. , 1993, Journal of child psychology and psychiatry, and allied disciplines.

[19]  P. Bijur,et al.  Child behavior and accidental injury in 11,966 preschool children. , 1986, American journal of diseases of children.

[20]  P. Scheidt,et al.  The effects of recall on estimating annual nonfatal injury rates for children and adolescents. , 1994, American journal of public health.

[21]  A Pickles,et al.  The influence of genetic factors and life stress on depression among adolescent girls. , 1999, Archives of general psychiatry.

[22]  M. Monuteaux,et al.  Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. , 2002, The American journal of psychiatry.

[23]  M. Pembrey,et al.  ALSPAC--the Avon Longitudinal Study of Parents and Children. I. Study methodology. , 2001, Paediatric and perinatal epidemiology.

[24]  Lawrence M. Baldwin,et al.  THE McMASTER FAMILY ASSESSMENT DEVICE , 1983 .

[25]  P. Silva,et al.  Child behavior and accidents. , 1983, Journal of pediatric psychology.

[26]  L. Davidson,et al.  Hyperactivity in school-age boys and subsequent risk of injury. , 1992, Pediatrics.

[27]  J. Garbarino.  Preventing childhood injury: developmental and mental health issues. , 1988, The American journal of orthopsychiatry.

[28]  B. Erens,et al.  The health of minority ethnic groups '99 , 2001 .

[29]  M. Rutter,et al.  Antisocial behavior by young people. , 1998 .

[30]  P. Bijur,et al.  Behavioral predictors of injury in school-age children. , 1988, American journal of diseases of children.

[31]  I. Goodyer.  Developmental Psychopathology: The Impact of Recent Life Events in Anxious and Depressed School-Age Children , 1994, Journal of the Royal Society of Medicine.