Preexisting mental disorder and mortality among people with traumatic spinal injury: a population-based retrospective cohort study - 14/04/26

Doi : 10.1016/j.rehab.2026.102129

Jesse T Young ^a,^b,^c,^d,^e,^f,^g,^⁎ , Alexander Charles Campbell ^a,^f, Craig Cumming ^e, Kym Coupe ^a, Bharat Vaikuntam ^h, Ashley Craig ^h,ⁱ, James W Middleton ^h,^i,^j, Lisa N Sharwood ^h,^k,^l

^a Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia

^b Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada

^c Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

^d Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia

^e School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia

^f Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, Victoria, Australia

^g Justice Health Group, Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia

^h John Walsh Centre for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District, Royal North Shore Hospital, St Leonards, New South Wales, Australia

ⁱ Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

^j Spinal Outreach Service, Royal Rehab, Ryde, New South Wales, Australia

^k School of Population Health, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia

^l School of Mechanical Engineering, Faculty of Engineering, University of Technology Sydney, Sydney, New South Wales, Australia

^⁎ Corresponding author. Dr Jesse T Young, The University of Melbourne; Level 3, 207 Bouverie Street, Carlton, VIC, 3010, Australia. Tel: +61 3 8344 4413; Fax: +61 3 9348 1174. The University of Melbourne Level 3, 207 Bouverie Street Carlton VIC 3010 Australia

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Tuesday 14 April 2026

Highlights

•	One-third of people with traumatic spinal injury have a preexisting mental disorder
•	Standardised mortality ratios are 4–17 in people with mental disorders after injury
•	External cause mortality is markedly elevated in people with substance use disorder
•	Mental disorders predict increased mortality risk after traumatic spinal injury
•	Health insurance is protective against mortality after traumatic spinal injury

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Abstract

Background

Both mental disorders and traumatic spinal injury are associated with premature mortality. However, relatively little is known about the impact of preexisting mental disorders on mortality risk following traumatic spinal injury (TSI).

Objectives

We aimed to evaluate the rates and relative risk of mortality after acute TSI by preexisting mental disorder status, compared to the general population, and stratified by age at injury.

Methods

Individuals with acute TSI were identified from hospital records in New South Wales, Australia, and linked with ambulance and emergency department records from 1 ^st June 2013 to 30 ^th June 2016. Death records were linked from 1 ^st June 2013 until 31 ^st December 2018. We calculated all-cause and cause-specific crude mortality rates, age- and sex-adjusted standardised mortality ratios, and modelled the association between preexisting mental disorder and mortality by fitting flexible parametric survival models, stratified by age (16-64 and ≥65 years).

Results

23% of the cohort had mental illness only, 6% had substance use disorder (SUD) only, and 5% had a dual diagnosis of mental illness and SUD. The crude mortality rate was 84.1 (95% CI 81.8–86.5) deaths per 1 000 person-years. Compared to the general population, the younger age stratum for those with dual diagnosis (standardised mortality ratio, SMR = 17.6; 95% CI 14.1–21.9), SUD only (SMR = 9.2; 95% CI 7.3–11.7), and mental illness only (SMR = 4.4; 95% CI 3.3–5.8) had markedly elevated mortality. Compared to those without mental disorder, all mental disorder groups were at increased risk of mortality after TSI, except for the mental illness only group in the younger age stratum.

Conclusions

Preexisting mental disorders are associated with increased mortality after TSI, and markedly so for individuals aged 16–64 years. Increased integration with mental healthcare and addiction medicine is likely critical for reducing health disparities for those with mental disorders after TSI.

Data registration

This is an observational study that used routinely-collected administrative data from New South Wales, Australia. These data are subject to ethical and data privacy requirements that preclude making them publicly available. Therefore, we cannot share and register them in international data repositories.

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Key words : Spinal Injuries, Mortality, Diagnosis, Dual (Psychiatry), Mental Disorders, Substance-Related Disorders

Abbreviations : ARIA, CMR, ED, GRIM, ICD-10, ICD-10-AM, ICISS, ICU, NSW, RECORD, SCI, SEIFA, SMR, SNOMED-CT, SUD, TSI