Excess mortality associated with mental illness and substance use disorders among veteran clinic users with spinal cord injury

Patricia A. Findley, Ranjana Banerjea, Usha Sambamoorthi

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Purpose. 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 19992004 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.

Original languageEnglish
Pages (from-to)1608-1615
Number of pages8
JournalDisability and Rehabilitation
Volume33
Issue number17-18
DOIs
StatePublished - 2011

Keywords

  • Spinal cord injury
  • mental illness
  • mortality
  • substance abuse disorders
  • veterans

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