Factors associated with risk of falling among younger inpatients in a mental health setting-A systematic review.

AIM: To synthesise evidence related to risk factors of falls among younger mental health inpatients age ≤65 years old. BACKGROUND: Hospitalised patients with mental illness are at increased risk of falling. Specific risk factors for falls for younger inpatients are poorly understood. DESIGN: Systematic review. METHODS: Medline, CINAHL, APA PsycINFO, Scopus and Web of Science were searched for studies published in English till December 2022. The review followed the 2020 PRISMA checklist. Odds ratios and P values of significant risk fall factors and the frequency of factors related to circumstances of falls were extracted. RESULTS: Nine studies were included and 95 risk factors, across seven categories were extracted. These categories included socio-demographic, fall-related factors, functional status, health and mental status, psychiatric diagnosis and assessment, medication, and staff related factors. Factors related to medication, health and mental status are most reported. Majority of the patients sustained minor or no injury from the fall and circumstances of fall vary across studies. CONCLUSION: Factors strongly associated with risk of falls were dizziness, use of psychotropics and antihypertensive drugs. A meta-analysis of risk factors was not possible due to different dependent variables studied, controlled confounding variables and control groups used. RELEVANCE TO CLINICAL PRACTICE: Fall prevention is relevant to all patients in mental health settings. Approaches to fall risk assessment and management need to be better tailored to younger mental health patients in the psychiatric setting. PATIENT AND PUBLIC CONTRIBUTION: Patient or public contribution was not possible because of the study design.

Exposure to traumatic events, prevalence of posttraumatic stress disorder and alcohol abuse in Aboriginal communities.

INTRODUCTION: Generations of Aboriginal people have been exposed to strings of traumatic events with devastating psychosocial health consequences, including psychiatric morbidities and mortalities, and medical complications. Posttraumatic Stress Disorder (PTSD) is a psychiatric morbidity directly linked to traumatic events. Despite research findings indicating traumatic exposure and resultant PTSD in Indigenous communities, little attention has been given to this condition in mental healthcare delivery. Consequently, clinical and psychosocial interventions are misguided and failed to deliver positive outcomes. The objective of this study is to explore the relationship between exposure to traumatic events, prevalence of PTSD and alcohol abuse in remote Aboriginal communities in Western Australia. METHODS: A combination of structured clinical interview and multiple survey questionnaires - Composite International Diagnostic Interview (CIDI), and Impact of Events Scale (IES), Alcohol Use Disorder Identification Test (AUDIT) and Indigenous Trauma Profile (ITP) - were administered to 221 Indigenous participants aged 18 to 65 years. RESULTS: The overwhelming majority, 97.3% (n=215) of participants were exposed to traumatic events. Analysis of CIDI results using DSM-IV diagnostic criteria shows a life time prevalence of 55.2% (n=122) for PTSD, 20% (n=44) for major depression (recurrent) and 2.3% (n=5) for a single episode. A total of 96% (n=212) participants reported consuming a drink containing alcohol and 73.8% (n=163) met diagnostic criteria for alcohol use related disorders, abuse and dependence. Of participants who met the PTSD diagnostic criteria, 91% (n=111) met diagnostic criteria for alcohol use related disorders. Other impacts of trauma such as other anxiety disorders, dysthymic disorder and substances abuses were also identified. CONCLUSION: The rate of exposure to traumatic events and prevalence of PTSD are disproportionately higher in the communities studied than the national average and one of the highest recorded in survivors of specific traumatic events in the world. A very high rate of alcohol abuse and dependence in participants who met diagnostic criteria for PTSD demonstrates correlation between alcohol abuse and PTSD. It also suggests that alcohol is used as self-medication.