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APHA Scientific Session and Event Listing

Lucinda Z. Frost, PsyD, Susan Y. Chao, MS, and James Leonard, MPH. USAF Medical Support Agency, Population Health Support Division, 2509 Kennedy Circle, Brooks City-Base, TX 78235, 210-536-3875, lucinda.frost@brooks.af.mil

An association between behavioral health and injury diagnoses was previously identified using a cohort of US Air Force active duty members. To further evaluate whether behavioral health is a risk factor for injury, a study design emphasizing temporality (the suspected factor must have occurred or been present before the effect) was developed. Methods for grouping behavioral health-related and injury-related diagnoses were used. The study cohort consisted of 338,458 US Air Force members in 2003. Based on medical data, the cohort was divided into two groups: those with at least one behavioral health-related diagnosis (BH) and those without (Non-BH). Both groups were followed for up to one year. Washout periods were established to screen out individuals with related diagnoses prior to follow-up. Of the 313,130 individuals remaining in the cohort, 12% and 88% were in BH and Non-BH, respectively. Of the individuals in BH, 22% had a diagnosis of depression and 11% had anxiety. The percentages of individuals injured during the study period were 29.6% and 22.1% for BH and Non-BH, respectively. “Sprain-strains” accounted for nearly half of the injuries in both groups. Cox proportional hazards modeling with adjustment on gender, age and race showed that the one-year risk of injury for individuals in BH was significantly higher than for Non-BH (HR 1.40, 1.37-1.43). Elevated risk was consistently found in the top 5 diagnostic subgroups within BH (e.g individuals with depression [HR 1.53, 1.44-1.62]; anxiety [HR 1.35, 1.24-1.46]; adjustment disorder [HR1.48, 1.30-1.68]; alcohol [HR 1.35, 1.22-1.49]; and psychopysiological [HR 1.65, 1.51-1.80]).

Learning Objectives: After viewing the presentation, the audience will be able to evaluate the relationship behavioral health and one-year risk of injury using medical claims encounter data in a cohort of active duty Air Force personnel. The participant in this session will also be able to

• recognize the relationship between specific types of behavioral health and injury diagnoses;
• know how to develop a retrospective cohort study design and how to apply survival analysis on medical encounter data; and,
• assess the elevated risk associated with diagnosed behavioral health problems.

Keywords: Injury Risk, Mental Health

Presenting author's disclosure statement:

Not Answered