Unhealthy and unsafe practices associated with symptoms of depression among injured patients

Each year, some 20.9 million US adults suffer from a diagnosable depressive disorder (Kessler, Chiu, Demler & Walters, 2005). Greater numbers have subclinical depressive symptoms, which are associated with increased risk of major depression, physical disability, and medical illness (Kessler, Berglund, Demler, Jin & Walters, 2005; World Health Organization, 2004). Depression, a major contributing factor to deliberate self-harm (McLean, Maxwell, Platt, Harris, & Jepson, 2008), is also associated with increased unintentional injury risk (American Geriatrics Society [AGS], British Geriatrics Society, & American Academy of Orthopaedic Surgeons, 2001, Tiesman et al., 2006). Mood disorders are common in patients presenting for acute injury (Richmond Hollander, Ackerson, Robinson, Gracias, Shults & Amsterdam, 2007). The potential connection between depressive symptoms and poor health and safety practices, which may further contribute to risk of injury, disability and illness, has not been fully delineated (Cannella & Scoloveno, 2003; Yarcheski, Mahon, Yarcheski, & Cannella, 2004). Many studies investigating this relationship have focused solely on young people (Allgower, Wardle, & Steptoe, 2001; Babiss & Gangwisch, 2009; Mahon, Yarcheski, & Yarcheski, 2001; Melnyk et al., 2006; Yarcheski, Mahon, & Yarcheski, 2004), while those investigating adults have been limited by the practices assessed (i.e. physical activity alone) (Farmer, Locke, Moscicki, Dannenberg, Larson & Radloff, 1988) or their restricted study samples (Igna, Julkunen, Vanhanen, Keskivaara, & Verkasalo, 2008; Bonnet, Irving, Terra, Nony, Berthezene & Moulin, 2005; Gazmararian, Baker, Parker, & Blazer, 2000). Only one population-based study has examined a wide variety of health practices among a large sample of adults of all ages (Strine, Mokdad, Dube, Balluz, Gonzalez, Berry & Kroenke, 2008), finding positive associations between current or lifetime depression and smoking, physical inactivity, binge drinking, and heavy drinking. A similar, negative association between depression and safety behaviours (e.g., seat belt use), which are also important health-promoting practices, has been reported in a few studies of young people (Allgower et al., 2001; Mahon et al., 2001; Yarcheski, Mahon, & Yarcheski, 2004) and in one study of adult farm residents (Stallones & Beseler, 2004). However, there is little available evidence on the relationship between safety practices and depressive symptoms in the general adult population. Further, although studies have found that depressive symptoms are an important risk factor for acute injury (AGS et al., 2001; Cox, Kenardy, & Hendrikz, 2008; Richmond et al., 2007; Richmond et al., 2009; Stoddard & Saxe, 2001; Tiesman et al., 2006), we found no studies examining the association between safety or health practices and depression among trauma patients.