likewise , psychiatric disorders , being a major public health concern , are associated with high disability rates ( 3 ) . notably , unipolar depressive disorder single - handedly causes the highest yld and is projected to impose the highest daly in 2030 ( 4 ) . in iran , injuries followed by mental disorders are associated with highest rates of disability and burden in both sexes and all age groups , contributing to 28% and 16% of daly , respectively ( 5 ) . psychiatric disorders and traumatic injuries are bi - directionally correlated ( 6 ) . psychiatric complications of injuries , regardless of the mechanism of injury and the injured organ , have been extensively studied ( 79 ) . these complications consist of anxiety disorders such as post - traumatic stress disorder ( ptsd ) ( 10 ) , mood disorders such as major depressive disorder ( mdd ) ( 8 , 9 ) and alcohol related disorders ( 11 ) . on the other hand , evidence shows that traumas do not randomly happen in people , but rather in those with a history of psychopathology and mal - adaptive coping mechanisms ( 12 , 13 ) . similar finding has been observed in children and adolescents as well ( 14 , 15 ) . this has led to the paradigm shift from the traditional concept of injuries as accidental incidents to a preventable public health concern . increased rates of injuries have been observed in those with a mental illness in several studies as well ( 12 , 1621 ) . in a retrospective cohort , higher rates of prior mental health morbidity and service use have been found in the injured population ( 19 ) . in addition , a higher incidence of traumatic brain injury ( tbi ) has been reported in psychiatric patients ( 22 , 23 ) . several underlying mechanisms such as cognitive impairment , lack of concentration and daytime drowsiness due to psychotropic medications have been proposed ( 16 ) . few studies have addressed the relationship of injuries with mental and behavioral disorders in general population . this is the first study assessing such association in a population - based national survey in iran and to authors knowledge , the first ever to implement a structured diagnostic tool to assess psychiatric disorders for this purpose . the current study is a part of the iranian national mental health survey ( iranmhs ) , a household survey conducted in 2011 . a comprehensive description of the iranmhs study method is explained elsewhere ( 24 , 25 ) . study sample consisted of iranian citizens , 1564 yr of age , selected through a three - stage cluster random sampling method . first , 1525 blocks were randomly selected from the national list of the blocks developed from the 2006 national census . the number of selected blocks in each province was proportional to population of the province . then , six families were randomly selected from within the block . finally , one family member , aged 1564 was randomly selected using the kish grid table . the research protocol was approved by the ethics committee of tehran university of medical sciences in iran . informed consent was obtained from all participants before the interview and the data was analyzed anonymously . demographic data , consisting of gender , age , marital status , education , employment and area of residence was gathered . socio - economic status was assessed using the latest version of a questionnaire used in the health service utilization study in 2005 ( 26 ) . in order to assess psychiatric disorders in the past 12 months , composite international diagnostic interview version 2.1 ( cidi 2.1 ) was utilized . the farsi version of cidi had been validated before ( 27 ) . traumas and injuries were assessed using short form injury questionnaire ( sfiq-7 ) , previously shown good reliability ( 28 ) . injuries were defined as any kind of trauma , laceration or harm to the tissues that required treatment , whether as simple as a plastering tape or as serious as those which required further medical attention in a treatment facility . sfiq-7 asks participants about injuries in the past twelve and three months and then inquires the activity , place , mechanism , nature , body part , treatment setting and the treatment required for each injury during the past three months . a total of 232 trained interviewers who were all psychologists , with a minimum bachelor degree and some clinical expertise conducted face to face interviews in the participant s home . quality control was ensured using a hierarchy of supervising officers in two levels : survey secretariat and the field of study . narrative data , acquired by the sfiq were coded using the short form of international classification of diseases , 10 revision ( icd-10 ) coding of injuries for type and mechanism of injuries . those who reported having more than a single injury in the past three months , were regarded as having recurrent injuries ( as opposed to single injury ) ( 12 ) and those who required medical attention in a clinical setting were regarded as having a major injury ( as opposed to minor injuries ) ( 29 ) . for each of the 7886 participants , the weighting process consisted of inverse probability of unit selection , non - response and post - stratification weights ( 25 ) . statistical analysis was performed by the stata 8.0 se software . adjusted odds ratio and logistic regression with corresponding 95% confidence interval was applied to examine correlates of major and recurrent injuries and road / traffic accidents , including demographic variables , presence of a psychiatric or substance use disorder and taking psychotropic medications . the current study is a part of the iranian national mental health survey ( iranmhs ) , a household survey conducted in 2011 . a comprehensive description of the iranmhs study method is explained elsewhere ( 24 , 25 ) . study sample consisted of iranian citizens , 1564 yr of age , selected through a three - stage cluster random sampling method . first , 1525 blocks were randomly selected from the national list of the blocks developed from the 2006 national census . the number of selected blocks in each province was proportional to population of the province . then , six families were randomly selected from within the block . finally , one family member , aged 1564 was randomly selected using the kish grid table . the research protocol was approved by the ethics committee of tehran university of medical sciences in iran . informed consent was obtained from all participants before the interview and the data was analyzed anonymously . demographic data , consisting of gender , age , marital status , education , employment and area of residence was gathered . socio - economic status was assessed using the latest version of a questionnaire used in the health service utilization study in 2005 ( 26 ) . in order to assess psychiatric disorders in the past 12 months traumas and injuries were assessed using short form injury questionnaire ( sfiq-7 ) , previously shown good reliability ( 28 ) . injuries were defined as any kind of trauma , laceration or harm to the tissues that required treatment , whether as simple as a plastering tape or as serious as those which required further medical attention in a treatment facility . sfiq-7 asks participants about injuries in the past twelve and three months and then inquires the activity , place , mechanism , nature , body part , treatment setting and the treatment required for each injury during the past three months . a total of 232 trained interviewers who were all psychologists , with a minimum bachelor degree and some clinical expertise conducted face to face interviews in the participant s home . quality control was ensured using a hierarchy of supervising officers in two levels : survey secretariat and the field of study . narrative data , acquired by the sfiq were coded using the short form of international classification of diseases , 10 revision ( icd-10 ) coding of injuries for type and mechanism of injuries . those who reported having more than a single injury in the past three months , were regarded as having recurrent injuries ( as opposed to single injury ) ( 12 ) and those who required medical attention in a clinical setting were regarded as having a major injury ( as opposed to minor injuries ) ( 29 ) . for each of the 7886 participants , a weight has been attributed . the weighting process consisted of inverse probability of unit selection , non - response and post - stratification weights ( 25 ) . statistical analysis was performed by the stata 8.0 se software . adjusted odds ratio and logistic regression with corresponding 95% confidence interval was applied to examine correlates of major and recurrent injuries and road / traffic accidents , including demographic variables , presence of a psychiatric or substance use disorder and taking psychotropic medications . from a total number of 9150 randomly selected eligible individuals , 7886 ( 3366 male and 4472 female participants ) completed the interview . the highest proportion of the study population was seen in the 2029 age groups . out of the 7886 respondents , a total of 2637 participants ( 35.9% ) mentioned history of having an injury in the past twelve months and 1657 ( 22.8% ) had such history in the past three months . among participants , 280 ( 4.1% ) , 247 ( 3.4% ) and 74 ( 1.2% ) reported having major , recurrent and road traffic injuries in the past three months , respectively . table 1 summarizes the socio - demographic characteristics of the injured population during the last three months . higher incidence of injury was seen in the younger age group , singles , more educated individuals and urban residents . demographic characteristics of the injured population during last 3 months ( n=7838 ) l3 m : last three months/ ci : confidence interval of those who had a history of psychiatric disorder in the past twelve months , 45.3% also mentioned history of injury during the same period . thus , presence of a psychiatric disorder , consisting of mood , anxiety and psychotic disorders , as well as alcohol and substance use disorders , imposed a 1.67 times ( ci : 1.471.91 ) greater risk of injury in the past twelve months . table 2 demonstrates the incidence of injuries in the past three months and prevalence of major and recurrent injuries across different psychiatric diagnoses . in bivariate analysis , presence of a mood disorder , anxiety disorder , psychotic disorders or alcohol use disorder was associated with 1.47 ( ci : 1.241.75 ) , 1.67 ( ci : 1.401.98 ) , 3.42 ( ci : 1.517.72 ) and 2.06 ( ci : 1.064.02 ) greater risk of injuries in the past three months , respectively . substance use disorder ( mainly consisting of opioids , amphetamine - type stimulants and cannabis use disorders ) did not increase the risk of injuries in the past three months ( or=0.90 , ci : 0.571.41 ) . substances mainly consisted of opioids , amphetamine - type stimulants and cannabis table 3 demonstrates the incidence of injury during the last three months according to the pattern of alcohol use in the past 12 months . as observed in the table , most of the patterns of alcohol use are associated with an increase in the injury rates . history of any alcohol consumption , consumption of more than 12 drinks , more than four consecutive drinks , and alcohol use disorders ( consisting of alcohol abuse and alcohol dependence ) in the past year are significantly correlated with injuries . pattern of alcohol consumption and incidence of injury l3 m : last three months ci : confidence interval l12 m : last twelve months in order to eliminate the role of potential confounding factors , multivariate regression analysis was also performed . variables consisting of sex , age , marital status , level of education , place of residence , employment , socio - economic status , psychiatric disorders , alcohol and substance use disorders and current medication use were analyzed . table 4 summarizes the bivariate and multivariate analyses of factors correlating with injuries in the past three months . mental illnesses ( consisting of mood , anxiety and psychotic disorders ) were associated with 1.59 times ( ci : 1.361.87 ) greater risk of injuries in the past three months . bivariate and multivariate analysis of factors correlated to injury in the last three months ( n=1657 ) l3 m : last three months table 5 and 6 show multivariate analyses for major and recurrent injuries , respectively . major injuries ( n=280 ) were significantly less prevalent in women , 4049 age group and those residing in rural areas . considering the marital status , the previously married group had an increased risk of major injuries . major injuries were more prevalent in those with a psychiatric disorder ( or=1.28 ) , alcohol use disorders ( or=2.35 ) and substance use disorders ( or=1.15 ) . recurrent injuries ( n=247 ) were significantly higher in the 1519 age group and those who dwell in the cities . having a history of a mental disorder was associated with 1.71 ( ci : 1.212.41 ) times increase in the probability of recurrent injuries . bivariate and multivariate analysis of correlated factors of major injury in the last three months ( n=280 ) l3 m : last three months bivariate and multivariate analysis of factors correlated with recurrent injury in the last three months ( n=247 ) l3 m : last three months table 7 demonstrates multivariate analyses of factors related to road traffic accidents . road traffic accidents ( n=74 ) were significantly more prevalent in men ( or=5.55 , ci : 2.0814.28 ) and those who had a psychiatric disorder ( or=2.37 , ci : 1.284.49 ) . bivariate and multivariate analysis of factors of traffic accidents in last three months ( n=74 ) l3 m : last three months alcohol and substance use disorders were also associated with higher rates of road traffic accidents ; then again this finding was not statistically significant . from a total number of 9150 randomly selected eligible individuals , 7886 ( 3366 male and 4472 female participants ) completed the interview . the highest proportion of the study population was seen in the 2029 age groups . out of the 7886 respondents , a total of 2637 participants ( 35.9% ) mentioned history of having an injury in the past twelve months and 1657 ( 22.8% ) had such history in the past three months . among participants , 280 ( 4.1% ) , 247 ( 3.4% ) and 74 ( 1.2% ) reported having major , recurrent and road traffic injuries in the past three months , respectively . table 1 summarizes the socio - demographic characteristics of the injured population during the last three months . higher incidence of injury was seen in the younger age group , singles , more educated individuals and urban residents . demographic characteristics of the injured population during last 3 months ( n=7838 ) l3 m : last three months/ ci : confidence interval of those who had a history of psychiatric disorder in the past twelve months , 45.3% also mentioned history of injury during the same period . thus , presence of a psychiatric disorder , consisting of mood , anxiety and psychotic disorders , as well as alcohol and substance use disorders , imposed a 1.67 times ( ci : 1.471.91 ) greater risk of injury in the past twelve months . table 2 demonstrates the incidence of injuries in the past three months and prevalence of major and recurrent injuries across different psychiatric diagnoses . in bivariate analysis , presence of a mood disorder , anxiety disorder , psychotic disorders or alcohol use disorder was associated with 1.47 ( ci : 1.241.75 ) , 1.67 ( ci : 1.401.98 ) , 3.42 ( ci : 1.517.72 ) and 2.06 ( ci : 1.064.02 ) greater risk of injuries in the past three months , respectively . substance use disorder ( mainly consisting of opioids , amphetamine - type stimulants and cannabis use disorders ) did not increase the risk of injuries in the past three months ( or=0.90 , ci : 0.571.41 ) . substances mainly consisted of opioids , amphetamine - type stimulants and cannabis table 3 demonstrates the incidence of injury during the last three months according to the pattern of alcohol use in the past 12 months . as observed in the table , most of the patterns of alcohol use are associated with an increase in the injury rates . history of any alcohol consumption , consumption of more than 12 drinks , more than four consecutive drinks , and alcohol use disorders ( consisting of alcohol abuse and alcohol dependence ) in the past year are significantly correlated with injuries . pattern of alcohol consumption and incidence of injury l3 m : last three months ci : confidence interval l12 m : last twelve months in order to eliminate the role of potential confounding factors , multivariate regression analysis was also performed . variables consisting of sex , age , marital status , level of education , place of residence , employment , socio - economic status , psychiatric disorders , alcohol and substance use disorders and current medication use were analyzed . table 4 summarizes the bivariate and multivariate analyses of factors correlating with injuries in the past three months . mental illnesses ( consisting of mood , anxiety and psychotic disorders ) were associated with 1.59 times ( ci : 1.361.87 ) greater risk of injuries in the past three months . bivariate and multivariate analysis of factors correlated to injury in the last three months ( n=1657 ) l3 m : last three months table 5 and 6 show multivariate analyses for major and recurrent injuries , respectively . major injuries ( n=280 ) were significantly less prevalent in women , 4049 age group and those residing in rural areas . considering the marital status , the previously married group had an increased risk of major injuries . major injuries were more prevalent in those with a psychiatric disorder ( or=1.28 ) , alcohol use disorders ( or=2.35 ) and substance use disorders ( or=1.15 ) recurrent injuries ( n=247 ) were significantly higher in the 1519 age group and those who dwell in the cities . having a history of a mental disorder was associated with 1.71 ( ci : 1.212.41 ) times increase in the probability of recurrent injuries . bivariate and multivariate analysis of correlated factors of major injury in the last three months ( n=280 ) l3 m : last three months bivariate and multivariate analysis of factors correlated with recurrent injury in the last three months ( n=247 ) l3 m : last three months table 7 demonstrates multivariate analyses of factors related to road traffic accidents . road traffic accidents ( n=74 ) were significantly more prevalent in men ( or=5.55 , ci : 2.0814.28 ) and those who had a psychiatric disorder ( or=2.37 , ci : 1.284.49 ) . bivariate and multivariate analysis of factors of traffic accidents in last three months ( n=74 ) l3 m : last three months alcohol and substance use disorders were also associated with higher rates of road traffic accidents ; then again this finding was not statistically significant . this study was carried out to assess the association of mental disorders with non - fatal injuries . this finding was statistically significant after the omission of potential confounding factors in the multivariate regression analysis . we also found that psychiatric disorders were associated with higher risk for recurrent injuries and road traffic accidents . higher odds ratios for traumatic injuries in the mentally ill have been reported in the previous studies , both in general population ( 18 , 19 ) and specific trauma patients such as traumatic brain injuries ( 22 , 23 ) . fann and colleagues reported a 1.6 times greater risk of traumatic brain injuries in those who had a combination of psychiatric diagnosis , psychotropic medication and mental health service use during the past year ( 23 ) . odds ratios ranging from 1.62.5 for traumatic brain injuries across different psychiatric disorders have been reported ( 22 ) . chen and colleagues reported higher rates of injuries in those with personality disorders ( 30 ) . high levels of depressive symptoms were associated with increased rates of injuries , especially in women ( 31 ) . similarly , major depressive episodes were associated with an adjusted hazard ratio of 1.6 for injuries ( 17 ) . considering the high prevalence of both psychiatric disorders ( 23.6% ) and injuries ( 35.9% and 22.8% for the past twelve and three months , respectively ) , detected in the survey , one can highlight the importance of these major public health issues . thus , treatment of psychiatric disorders can contribute to injury prevention and result in the reduction of its associated costs and disability rates . in the current study , mental disorders , regardless of psychotropic medications , were associated with injuries . similar finding has been observed in other studies as well , in which depressive symptoms , regardless of receiving medications , were associated with increased risk of injuries ( 16 , 17 ) . the role of psychoactive medications has been majorly attributed to falls in the elderly and accidents in the workplace ( 32 , 33 ) . as mentioned before , this study was part of a national household survey with participants aging from 15 to 64 . therefore , lack of association between medication use and injuries might be due to the fact that the geriatric population was not part of the study . lack of significant correlation between psychiatric disorders and major injuries might be due to the fact that this study mainly focused on non - fatal injuries in a household survey . people suffering from severe mental illnesses might be more prone to fatal injuries and thus , have been excluded from this study . in future studies , we also found that most of the patterns of alcohol consumption were associated with increased rates of injury . , one has to bear in mind the legal and cultural sanctions towards alcohol consumption in iran . moreover , this study was carried out through face - to - face interview and there is a high possibility of under - reporting . most studies emphasize on the acute effects of alcohol use and traumatic injuries ( 31 , 3436 ) . in the current study , more attention has been given on the patterns of alcohol use and psychiatric comorbidities of alcohol use disorders . in addition to that , it was found that alcohol use disorders were associated with highest odds ratios in bivariate analysis for the incidence of injuries , recurrent and major injuries . thus , a study with a larger study population is needed to address the correlation . the observed correlation of alcohol use disorders with injuries in bivariate analyses emphasizes the need for screening of alcohol use disorders in trauma and accident - prone populations . similar to alcohol use , previous studies mainly had focused on the acute and intoxication effects of substance use in injuries ( 37 , 38 ) . lack of a strong correlation between substance use disorder and injuries in the current study , might be due to the associated stigma and legal consequences of substance use in iran , which can lead to underreporting of substance use disorders . opium use and opium use disorder are associated with lower health and social consequences comparing to other illicit opioids ( 39 ) . opium users lead a more sedentary lifestyle and therefore might not be as prone to injuries as others . however , higher rates of traffic accidents have also been reported among opioid addicts in iranian studies ( 40 , 41 ) . these studies focused on opium use among applicants of driving license and interstate truck drivers . moreover , assessment of injuries was not restricted to a specific type or mechanism of injury . as mentioned before , to authors knowledge , this is the first study on injury implemented a structural diagnostic tool to evaluate psychiatric disorders . relying exclusively on self - report in the assessment of injuries and lack of medical records in this regard can be counted as a study limitation . the cross - sectional design of the study should also be considered as another study limitation , because it does not allow one to interpret the observed associations as a causal , but merely a temporal relationship . this study was a part of iranmhs and therefore had a large sample size . moreover , assessment of injuries was not restricted to a specific type or mechanism of injury . as mentioned before , to authors knowledge , this is the first study on injury implemented a structural diagnostic tool to evaluate psychiatric disorders . relying exclusively on self - report in the assessment of injuries and lack of medical records in this regard can be counted as a study limitation . the cross - sectional design of the study should also be considered as another study limitation , because it does not allow one to interpret the observed associations as a causal , but merely a temporal relationship . psychiatric disorders in the past twelve months were associated increased risk of injuries , as well as recurrent injuries and road traffic accidents in the past three months . thus , early detection and treatment of mental disorders , shown to be quite prevalent , might help in prevention of injuries . authors suggest that prospective studies could further enrich our understanding of the impact of mental disorders upon unintentional non - fatal injuries . ethical issues ( including plagiarism , informed consent , misconduct , data fabrication and/or falsification , double publication and/or submission , redundancy , etc . ) have been completely observed by the authors .
background : injuries and psychiatric disorders , notably both major public health concerns , are associated with a high burden and are believed to be bi - directionally correlated . 
 those inflicted with injuries face increased risks of mental illnesses . 
 psychiatric disorders may make the individual prone to injuries . 
 the objective of the study was to assess the correlation of mental disorders with non - fatal injuries.methods:a total of 7886 participants aged 15 to 64 yr were interviewed in a national household survey in 2011 in iran . 
 composite international diagnostic interview ( cidi v2.1 ) was implemented to assess the prevalence of psychiatric disorders in the past twelve months . 
 injuries were assessed using short form injury questionnaire ( sfiq-7).results : injury was reported in 35.9% and 22.8% of participants in the past twelve and past three months , respectively . 
 using multivariate logistic regression analysis , mental disorders were significantly associated with injuries in the past three months ( or=1.6 , 95% ci:1.361.87 ) , recurrent injuries ( or=1.7 , 95% ci : 1.212.41 ) and road / traffic accidents ( or=2.4 , 95% ci : 1.284.49).conclusion : psychiatric disorders were found to be associated with an increased risk of injuries . 
 early detection and treatment of mental illnesses can contribute to injury prevention .