Psychiatric morbidity among patients with facial injury at Moi Teaching and Referral Hospital

Abstract

Background: Psychiatric morbidity is the presence of clinically significant disturbance in an individual’s cognition, emotion regulation or behavior and is diagnosed using the fifth edition of Diagnostic Statistical Manual criteria by American Psychiatric Association. A disfigured face resulting from a facial injury is a source of both objective and subjective stigma which predisposes one to psychiatric morbidity. Patients with facial injury in surgical units get inadequate psychological care. This complicates surgical care outcome and increases the cost of care. The burden of psychiatric disorders among patients with facial injury at Moi teaching and referral hospital is not known. Objectives: To determine the prevalence of psychiatric morbidity, establish the pattern of psychiatric morbidity and assess the associations between socio-demographic/clinical characteristics and psychiatric morbidity among patients with facial injury at Moi Teaching and Referral Hospital (MTRH). Methods: The study was a descriptive and analytical cross-sectional in which the mini international neuropsychiatric interview questionnaire was administered to diagnose the presence of psychiatric morbidity and a researcher-designed questionnaire was used to collect socio-demographic and clinical characteristics. The study was done at the surgical unit of MTRH where 90 consenting patients were interviewed from January to December 2017. Categorical data were summarized with frequency tables and percentages. Association between categorical variables was analyzed by chi-square and Fisher’s exact test. Logistic regression was used to measure the association between psychiatric morbidity and sociodemographic/clinical variables. Results: Ninety participants were evaluated, 77% were male. The mean age of the patients evaluated was 32±11 years. Seventy-one percent resided in rural areas. The commonest cause of facial injuries were road traffic accidents 51(57%), followed by interpersonal injuries 27(30%) and burns 11(12%). The prevalence of psychiatric morbidity among patients with facial injury at MTRH was 61.1%, of this 47.3% were diagnosed with more than one disorder. Twenty-five participants (28%) had alcohol use disorder: others included anxiety disorders 23(25.6%), depression 18(20%), other substance use disorder 13(14%), psychotic disorders 9(10%), attempted suicide 4(4%), and antisocial personality disorder 3(3%). The prevalence of alcohol use disorder among males was 35% compared to 5% among females (p=0.007). Compared to patients with facial burns patients with maxillary/ orbital fractures had 87.5% reduced odds of being diagnosed with psychiatric morbidity (AOR 0.125, P = 0.034 95%CI, 0.039, 0.859). Age, marital status, level of education, as well as cause and duration of injury were not statistically significantly associated with psychiatric morbidity. Conclusion: The prevalence of psychiatric morbidity among patients with facial injury at MTRH is high with alcohol use, anxiety, with depressive disorder being the leading and often goes undiagnosed and untreated. Recommendation: Routine screening for psychiatric morbidity among patients with facial injury should be initiated and comprehensive care offered. Prevention strategies for alcohol and other substance use disorders should be initiated targeting particularly males.