Violence Related Injuries in the Emergency Room: Alcohol, Depression, and Conduct Problems

Abstract

Objective. The aim of this study was to obtain epidemiological measures of the association between alcohol consumption and emergency room (ER) attendance due to violence, compared to the general population in the city of Pachuca, Mexico, during October–November, 1996 and June–July, 1997. Method. The study was a population-based case-control design. Intervention and Measurements: Data consisted of an interviewer-administered questionnaire, collected on a 24-h basis, during the entire week. Setting and Participants: Cases were 127 patients (78% male) admitted to the ER because of an injury that was the result of violence (being in a fight or being attacked by someone). A sample of residents from Pachuca (n = 920) was the comparison group. Results. Patients reporting drinking within 6 h compared to nondrinkers were more likely to suffer a violence-related injury [34.0 (17.5–66.2)] and alcohol dependent patients were more likely to be involved in a violence-related injury [7.4 (3.5–15.6)] compared to noncurrent drinkers. When both alcohol prior and alcohol dependence were considered simultaneously in multiple models among current drinkers, patients with violence-related injuries were more likely to report alcohol prior but not to be positive for alcohol dependence. Depressive symptoms, but not conduct problem behavior, were also associated with violent injury in simultaneous regressions that included alcohol variables. Conclusions. In the city of Pachuca, Mexico, a large relationship between drinking prior to the event and violence-related injury, regardless of alcohol dependence, was found. Depression was also related to violence, suggesting the need for more comprehensive intervention with these patients.

• Violence
• Injuries
• Emergency room
• Alcohol
• Depression

Resumen

Objetivo. El objetivo de este estudio fue obtener medidas epidemiológicas de la asociación entre el consumo de alcohol y el ingreso a los servicios de urgencias (SU) por una violencia, comparado con la población general de la ciudad de Pachuca, México, durante el período de octubre–noviembre de 1996 hasta junio–julio de 1997. Método. Este es un estudio de casos y controles de base poblacional. Mediciones: Los datos consisten de un cuestionario aplicado por un entrevistador, recolectados durante las 24 horas, todos los días de la semana. Escenario y Participantes: Los casos fueron 127 pacientes (78% varones) admitidos a los SU debido a un traumatismo resultado de una violencia (por haber estado en un pleito, o haber sido atacado por alguien). Una muestra de la población de Pachuca (n = 920) sirvió como grupo de comparación. Resultados. Los pacientes que reportaron consumo de alcohol seis horas antes, comparados con los no-bebedores tuvieron mayores probabilidades de sufrir un traumatismo por violencias [34.0 (17.5–66.2)] y los pacientes con síndrome de dependencia al alcohol tuvieron mayores probabilidades de sufrir un traumatismo por violencias [7.4 (3.5–15.6)] comparados con los no-bebedores. Cuando el consumo previo y la dependencia al alcohol se consideraron simultáneamente en un modelo múltiple aplicado a los bebedores actuales, los pacientes con una violencia tuvieron mayores probabilidades de reportar alcohol antes del evento, pero no tuvieron mayores probabilidades de reportar dependencia al alcohol. Los síntomas depresivos, pero no los trastornos de conducta, también se asociaron con la violencia independientemente del consumo de alcohol. Conclusiones. En la ciudad de Pachuca, México, se encontró una fuerte relación entre el consumo de alcohol antes del evento y los ingresos por violencias en los servicios de urgencias, independientemente de la dependencia al alcohol. Los síntomas depresivos también se relacionaron con la violencia, lo cual sugiere que son necesarias medidas de intervención de un amplio espectro.

Résumé

Objectif. Le but de cette étude était d’obtenir des mesures épidémiologiques sur l’association de la consommation d’alcool et de la prise en charge de personnes par les services d’urgence (SU) suite à une cause violente, et de comparer ces mesures à la population de la ville de Pachuca, Mexique, durant la période de octobre–novembre 1996 à juin–juillet 1997. Méthode. Cette étude est une étude de cas et contrôles basée sur la population. Mesures: Les données consistent en un questionnaire appliqué par un interviewer, récolté tous les jours de la semaine, 24 heures pour jour. Lieu et personnes prises en comte: Les cas furent 127 patients (78% de sexe masculin) admis aux services d’urgences suite à un traumatisme dû à une violence (une bagarre, victime d’une agression). Un échantillon de la population de Pachuca (n = 920) a été utilisé comme groupe de comparaison. Résultats. Les patients qui ont mentionné avoir consommé de l’alcool six heures auparavant, comparés à aux qui n’en avaient pas consommé eurent de plus grandes probabilité de souffrir d’un traumatisme à cause de violence [34.0 (17.5–66.2)] et les patients souffrant du syndrome de dépendance à l’alcool eurent de plus grandes probabilité de souffrir d’un traumatisme à cause de violence [7.4 (3.5–15.6)] comparés à aux qui n’en avaient pas consommé. Quand la consommation antérieure et la dépendance à l’alcool sont pris en compte simultanément dans un modèle multiple appliqué aux consommateurs actuels, les patients avec violence eurent de plus grands probabilités de reporter une consommation d’alcool antérieure à l’événement mais ils n’eurent pas une grand probabilité de reporter une dépendance à l’alcool. Les symptômes dépressifs, mais non les troubles de conduite, ont aussi été associés à la violence indépendamment de la consommation d’alcool. Conclusions. Dans la ville de Pachuca, Mexique, on a observé une forte relation entre la consommation d’alcool avant l’événement et la prise en charge de personnes, suite à une violence, par les services d’urgences, indépendamment de la dépendance à l’alcool. Les symptômes dépressifs ont aussi été liés avec la violence, ce qui implique que de mesures d’intervention d’une large amplitude sont nécessaires.

Additional information

Notes on contributors

G. Borges

Guilherme Borges, Doctor in Science in Epidemiology, is a professor at the Universidad Autonoma Metropolitana and researcher at the National Institute of Psychiatry Ramon de la Fuente, in Mexico. He was affiliated during a doctoral fellowship at the Department of Mental Hygiene in Johns Hopkins University and has been a postdoctoral fellow at the Department of Health Care Policy, Harvard Medical School. His main topics of interest are the consequences of alcohol and substance use and abuse, especially injuries and suicide. He is also interested in methodological problems of psychiatric epidemiology.

C. J. Cherpitel

Cheryl Cherpitel, Ph.D., is a Senior Scientist at the Alcohol Research Group, Associate Director of the National Alcohol Research Center, and lecturer in the Division of Public Health Biometry and Epidemiology at the University of California School of Public Health, Berkeley. She has a B.S. degree in nursing from the University of California Medical Center, San Francisco, and a Ph.D. in epidemiology and biostatistics from the University of California School of Public Health, Berkeley. She has been a scientist at the Alcohol Research Group for the last 15 years, where her area of research has focused on studies of drinking patterns and problems and the identification of alcohol use disorders in emergency room and primary care settings and the general population, with a special emphasis on gender, ethic, and regional differences, including cross-cultural comparisons.

M. E. Medina-Mora

María Elena Medina-Mora, Ph.D., a Clinical Psychologist with doctoral studies at the Universidad Nacional Autonoma de Mexico, is the head of the Division of Epidemiological and Psychosocial Research in the National Institute of Psychiatry Ramon de la Fuente, in Mexico. She is a senior researcher in Mexico and is the responsible for conducting several national surveys in the country, such as the National Addiction Survey of 1988, 1995, 1998, and currently the 2002 survey (in process). She is also responsible for the new national mental survey in Mexico, which is part of the World Mental Health Surveys, a global project from the World Health Organization. She is interested in several aspects of the epidemiology of alcohol and substance use disorders and mental health disorders.

L. Mondragón

Liliana Mondragón has a Bachelor's in Psychology from the Universidad Nacional Autonoma de Mexico and Master's in Social Psychology from the Universidad Autonoma Metropolitana, and is a researcher at the Division of Epidemiological and Psychosocial Research in the National Institute of Psychiatry Ramon de la Fuente, in Mexico. Her areas of interest are methodological, psychosocial, and epidemiological issues as they relate to addictions and mental health. The research line that she has been working on during the last years is the relationship between alcohol and suicide.