GP3b - Correlation Between Substance Use Disorder and Assault-Related Facial Trauma in Patients With Psychiatric Disorders

Abstract: Maxillofacial trauma has been consistently shown to correlate with geographic, temporal, and societal factors. In the United States, interpersonal violence emerges as the predominant cause of maxillofacial trauma raising crucial questions about its specific targets. Previous studies have noted an association between maxillofacial trauma and psychiatric conditions. However, these studies have not evaluated the predisposing predictive variable of substance use.1,2 The purpose of this study is to evaluate whether: 1. Patients with psychiatric disorders face an elevated risk of facial trauma from assault, 2. If patients with psychiatric conditions are at increased risk for surgical complications, and 3. If substance use disorder (SUD) is a complicating factor. Our hypothesis is that concurrent SUD in patients with psychiatric diagnoses elevates risk of sustaining facial trauma via assault.

A retrospective chart review of patients who underwent surgical intervention at two hospitals in New York City, New York – Mount Sinai West and Mount Sinai Beth Israel – after sustaining facial trauma from March 2018 to March 2022 was performed (n = 115). Our inclusion criteria were patients over 18 years old and those with at least one facial fracture requiring surgery. The covariates were demographics, medical history, psychiatric history, mechanism, fracture pattern, treatment, and surgical outcomes. Psychiatric diagnoses and substance use disorder were assigned based on chart review. The data was analyzed using Fisher’s exact text.

Our study population was 78.3% male with an average age of 39.3 (Stdev 14.4). Of the 115 patients, 33 patients had pre-existing psychiatric conditions including SUD (n = 18), major depressive disorder (n = 8), generalized anxiety disorder (n = 5), bipolar disorder (n = 6), post-traumatic stress disorder (n = 2), and primary psychotic disorders (n = 1). Of patients with a psychiatric diagnosis, 7 patients had more than one diagnosis. The mechanism of trauma in the overall study population was assault (n = 61, 53.0%), mechanical fall (n = 33, 28.7%), sports (n = 6, 5.2%), motor vehicle accident (n = 5, 4.3%), bike accident (n = 7, 6.1%), and e-scooter accident (n = 3, 2.6%). The incidence of specific fracture patterns in the study population was as follows: mandible (n = 71, 61.7%), nasal (n = 17, 14.8%), ZMC/zygomatic arch (n = 28, 24.3%), orbital (n = 18, 15.7%), and Le Fort 1/2/3 (n = 2, 1.7%, n = 2, 1.7%, n = 1, 0.8%).

During subgroup analysis, patients with any psychiatric condition were more likely to sustain facial trauma from assault compared to patients without a psychiatric condition (69.7% vs 45.1%, P = .017). Additionally, patients with SUD were more likely to sustain facial trauma from assault than patients without SUD (77.8% vs 50.0%, P = .018). When examining patients with non-SUD diagnoses, such as mood disorders and primary psychotic disorders, we did not find an association with sustaining trauma from assault (60.0% vs 50.5%, P = .515). There was no significant correlation between psychiatric diagnosis and type of fracture. Additionally, we found that patients with psychiatric conditions were more likely to experience surgical complications (39.4% vs 18.3%, P = .029). We found no significant difference in secondary surgical procedures in patients with a psychiatric condition (12.1% vs 9.76%, P = .741).

Our findings demonstrate that patients with psychiatric diagnoses, and more specifically patients with SUD, represent a vulnerable population that are more likely to sustain facial trauma via assault, require surgical intervention, and experience a higher incidence of postsurgical complications. Incorporating psychiatric and substance use assessments into the evaluation of facial trauma patients is crucial, as it facilitates concurrent care by specialists in psychiatry and addiction medicine. This approach represents an opportunity for implementing targeted interventions aimed at diminishing the likelihood of future occurrences of such injuries.<

References
1. Hoffman, Gary, etal. "Facial trauma patients with a preexisting psychiatric illness: a 5-year study." OOOO 116,no.5(2013):e368-e374.
2. Febbo, Anthony, etal. "To what extent does illicit drug use predispose to facial injury? An institutional investigation for an emergent problem." CMTR 14,no.1(2021):11-15.