Article

Among veterans with traumatic spinal cord injury (SCI) or disease
aetiologies, examine the association between diagnosed mental illness (MI) and
substance use disorders (SUD) on mortality after controlling for demographic and
socioeconomic factors, SCI severity, injury duration and chronic physical
illnesses. METHOD: Longitudinal analysis of Veteran Health Administration(VHA)
administrative data and Medicare claims for FY 1999-2004 matched with Spinal Cord
Dysfunction-Registry (SCD-R) of VHA clinic users (N = 8334) with SCI. SCI was
identified through SCD-R; individual MIs (anxiety, bipolar, depressive disorders,
psychoses, post-traumatic disorder and schizophrenia) and SUDs (tobacco, alcohol
and/or drug) were identified through ICD-9-CM codes. Cox-proportional hazards
regressions were used to examine association between MI and SUD and time to death
in years. RESULTS: Among veterans with SCI, 17% died by the end of FY 2004.
Veterans with psychosis (35%), depression (22%) and alcohol and/or drug use (20%)
had significantly higher rates of mortality compared to those without these
diagnoses. After adjusting for other independent variables in the study, hazards
ratios for psychosis was 1.47 (95%CI = 1.24, 1.75), for alcohol and/or drug use
was 1.30 (95% CI = 1.11, 1.53). CONCLUSIONS: Some types of MI and SUD were
associated with excess mortality among veterans with SCI. Care for MI and SUD
needs to be routinely integrated into SCI management. Future research is needed
to determine whether depression and SUD treatment provides opportunity to improve
survival.

Langue : ANGLAIS