Repeat Self-Inflicted Injury Among U.S. Youth in a Large Medical Claims Database

Economic Cost of U.S. Suicide and Nonfatal Self-harm

INTRODUCTION

The U.S. age-adjusted suicide rate is 35% higher than two decades ago and the COVID-19 pandemic era highlighted the urgent need to address nonfatal self-harm, particularly among youth. This study aimed to report the estimated annual economic cost of U.S. suicide and nonfatal self-harm.

METHODS

In 2023 CDC's WISQARS Cost of Injury provided the retrospective number of suicides and nonfatal self-harm injury emergency department (ED) visits from national surveillance sources by sex and age group, as well as the estimated annual economic cost of associated medical spending, lost work productivity, reduced quality of life from injury morbidity, and avoidable mortality based on the value of statistical life during 2015-2020.

RESULTS

The economic cost of suicide and nonfatal self-harm averaged $510 billion (2020 USD) annually, the majority from life years lost to suicide. Working-aged adults (aged 25-64 years) comprised nearly 75% of the average annual economic cost of suicide ($356B of $484B) and children and younger adults (aged 10-44 years) comprised nearly 75% of the average annual economic cost of nonfatal self-harm injuries ($19B of $26B).

CONCLUSIONS

Suicide and self-harm have substantial societal costs. Measuring the consequences in terms of comprehensive economic cost can inform investments in suicide prevention strategies.

High-risk group and functional subtypes of non-suicidal self-injury in young adults with mental disorders

BACKGROUND

Identifying high-risk groups of non-suicidal self-injury (NSSI) with multiple risk factors and different functional subtypes contribute to implementing person-centered interventions.

METHODS

We investigated NSSI profiles among a sample of 258 psychiatric inpatients aged 18-25 years. All participants completed well-validated measures of internal personal and external environmental characteristics. One-hundred and ninety patients reported a lifetime history of NSSI and completed an additional NSSI assessment. A k-means cluster analysis was conducted to extract characteristics of risk factors and functional subtypes. Independent sample t-test, analysis of variance and χ ² test were used to test the difference of demographic statistical factors, risk factors and functional scores among groups with different frequency of NSSI.

RESULTS

The clustering of risk factors analyses supported 4-clusters. The proportion of repeat NSSI patients was the highest (67.1%) in the group with unfavorable personal and unfavorable environmental characteristics. Functional subtype clustering analyses supported 5-clusters. Among patients with repeated NSSI, those with depression were mainly accompanied by the "Sensation Seeking" subtype (39.7%), bipolar disorder mainly supported the "Anti-suicide" subtype (37.9%), and eating disorders were mostly "Social Influence" subtype (33.3%). There was an interaction between functional subtypes and mental disorders.

LIMITATIONS

All participants were in treatment in a psychiatric service and the results may not be generalizable to a community sample. The data included retrospective self-report which may be inaccurate due to recall bias.

CONCLUSION

It is necessary to identify high-risk groups of NSSI who with unfavorable personal and environmental characteristics and clinical interventions need to consider the heterogeneity of patients' functional subtypes of NSSI.

Five-Year Trends in Pediatric Mental Health Emergency Department Visits in Massachusetts: A Population-Based Cohort Study

OBJECTIVES

To evaluate temporal changes in pediatric emergency department (ED) visits for mental health problems in Massachusetts based on diagnoses and patient characteristics and to assess trends in all-cause pediatric ED visits.

STUDY DESIGN

This statewide population-based retrospective cohort study used the Massachusetts All-Payer Claims Database, which includes almost all Massachusetts residents. The study sample consisted of residents aged <21 years who were enrolled in a health plan between 2013 and 2017. Using multivariate regression, we examined temporal trends in mental health-related and all-cause ED visits in 2013-2017, with person-quarter as the unit of analysis; we also estimated differential trends by sociodemographic and diagnostic subgroups. The outcomes were number of mental health-related (any diagnosis, plus 14 individual diagnoses) and all-cause ED visits/1000 patients/quarter.

RESULTS

Of the 967 590 Massachusetts residents in our study (representing 14.8 million person-quarters), the mean age was 8.1 years, 48% were female, and 57% had Medicaid coverage. For this population, mental health-related (any) and all-cause ED visits decreased from 2013 to 2017 (P < .001). Persons aged 18-21 years experienced the largest declines in mental health-related (63.0% decrease) and all-cause (60.9% decrease) ED visits. Although mental health-related ED visits declined across most diagnostic subgroups, ED visits related to autism spectrum disorder-related and suicide-related diagnoses increased by 108% and 44%, respectively.

CONCLUSIONS

Overall rates of pediatric ED visits with mental health diagnoses in Massachusetts declined from 2013 to 2017, although ED visits with autism- and suicide-related diagnoses increased. Massachusetts' policies and care delivery models aimed at pediatric mental health may hold promise, although there are important opportunities for improvement.

Impact of medical reimbursement revision on ambulance transport of self-inflicted injury patients: a nationwide study in Japan

AIM

Self-inflicted injury, as one reason to visit the emergency department, is an important issue in emergency medicine around the world. However, the impact of changes in social systems, such as medical reimbursement revision, on ambulance transport for self-inflicted injury remains unclear. The aim of this study was to assess the impact of medical reimbursement revision on the emergency transport of self-inflicted injury patients using nationwide ambulance records.

METHODS

This was a retrospective observational study from April 2012 to March 2016. We analyzed nationwide ambulance records in Japan, and included self-inflicted injury, drug poisoning, and drug overdose patients transported to hospitals by ambulance. The primary outcome of this study was age-adjusted number of self-inflicted injury patients transported by ambulance in each month per 1 million standard populations. To assess the impact of the medical reimbursement revision in 2014, we calculated the R 2, regression coefficients and 95% confidence interval (CI) using interrupted time series analysis.

RESULTS

This study included 148,873 patients. The R 2 for the interrupted time series model was 0.821. The regression coefficient for the time trend before the medical reimbursement revision was 0.167 (95% CI, 0.090 to 0.244; p < 0.001), that for the time trend after the medical reimbursement revision was -0.226 (95% CI, -0.327 to -0.125, p < 0.001), and that of the medical reimbursement revision was -2.165 (95% CI, -3.730 to -0.601, p = 0.008).

CONCLUSION

In Japan, the medical reimbursement revision in April 2014 helped to decrease the number of self-inflicted injury patients transported to hospitals by ambulance.

Repeated presentation of children and adolescents to the emergency department following self-harm: A retrospective audit of hospital data

OBJECTIVE

To examine re-presentation rates for self-harm in patients aged 0-18 years to the ED of a tertiary paediatric hospital in Melbourne, Australia, and associated patient, family and hospital presentation factors.

METHODS

Data for presentations from 1 July 2016 to 31 December 2018 were extracted from the hospital's electronic medical record system. Self-harm presentations were identified through automated, rule-based coding and manual review of medical notes. Re-presentation rates for intervals up to 12 months were estimated using survival methods with risk factor associations examined using Cox regression.

RESULTS

Of the 952 presentations for self-harm after 1 January 2017, 529 were considered first presentations. An estimated 15% (95% confidence interval [CI] 12-19), 20% (95% CI 17-24) and 23% (95% CI 19-27) re-presented for self-harm within 3, 6 and 12 months, respectively. A total of 82% of all presentations were for girls. Patients were more likely to re-present if they had previously presented more than once, were flagged as vulnerable (hazard ratio [HR] 1.35, 95% CI 1.08-1.68), had a history of substance abuse (HR 1.30, 95% CI 1.03-1.64), were female (HR 1.43, 95% CI 0.92-2.21), had self-cut (HR 1.38, 95% CI 0.96-1.97), had an aggressive behaviour response team called during the visit (HR 1.44, 95% CI 0.85-2.45) or had a history of depression (HR 1.27, 95% CI 0.99-1.63).

CONCLUSIONS

In this paediatric ED, almost one in four patients re-presented with self-harm within 12 months. Previous presentations and other factors were associated with risk of re-presenting, although no factor was strongly predictive. Future research might examine the generalisability of these findings across settings and explore strategies for prevention.