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Wilson R, Jennings A, Redaniel MT, Samarakoon K, Dawson S, Lyttle MD, Savović J, Schofield B. Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review. Am J Emerg Med 2024; 81:23-34. [PMID: 38631148 DOI: 10.1016/j.ajem.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. METHODS Electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10-24 year olds. High impact use was defined as at least one return ED visit for mental health care. Primary studies of any quantitative design were included, with no exclusions based on language or country and all possible risk factors were considered. Data were extracted and synthesised using quantitative methods; frequencies of positive, negative and null associations were summarised for categories of potential risk factors. RESULTS Sixty-five studies were included in the review. Most studies were from North America and reported a wide range of measures of high impact ED use, the most common being a binary indicator of multiple ED visits. Sex/gender and age were the most frequently reported risk factors. Measure of previous or concurrent access to mental health care was consistently positively associated with high impact use. Having private health insurance, compared with public or no insurance, was generally negatively associated with high impact use. Proxy measures of socioeconomic position (SEP) showed associations between lower SEP and more high impact use in a small number of studies. No other factors were consistently or uniformly associated with high impact use. CONCLUSIONS The review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.
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Affiliation(s)
- Rebecca Wilson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | | | - Maria Theresa Redaniel
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Kithsiri Samarakoon
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Mark D Lyttle
- University of the West of England, Bristol, UK; Bristol Royal Hospital for Children, Bristol, UK.
| | - Jelena Savović
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
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Lu J, Ye Y, Lou J, Zhu H, Zhou X. Associations between unintentional injuries and deliberate self-harm behaviors of children and adolescents: A school-based cross-sectional survey. Gen Hosp Psychiatry 2024; 86:67-74. [PMID: 38118378 DOI: 10.1016/j.genhosppsych.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/27/2023] [Accepted: 12/03/2023] [Indexed: 12/22/2023]
Abstract
While statistics from hospitals showed that the proportion of self-harm or attempted suicide kept growing among children and adolescents aged 6-17 attending the emergency department, cases of self-harm or attempted suicide dissimulated as accidents received scant attention or were neglected. This study aimed to examine associations between unintentional injuries subtypes and deliberate self-harm behaviors from a school-based large-scale survey. A school-based cross-sectional study was conducted in Anhui, China, between November 2022 to January 2023. A total of 28,013 students (aged 11-17, 5th-12th grade) from 35 primary schools, 27 middle schools, and 6 high schools were included for the present study. Unintentional injuries in the past year of children and adolescents reported by parents. Self-harm behaviors in the past year of children and adolescents was measured with one question reported by students. Children and adolescents whose parents reported their contacts with sharp instruments demonstrated the highest risk for self-harm behaviors, followed by poisoning, exposure to electric current, falls, vehicle and traffic injuries, accidental drowning and submersion, and eating foreign bodies. And these associations distributed differently among children and adolescents reporting different frequencies of self-harm behaviors. Thus, we urge attention from parents, child caregivers, and teachers on children and adolescents experiencing certain types of unintentional injuries.
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Affiliation(s)
- Jingjing Lu
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Rd., Hangzhou, Zhejiang 310058, PR China.
| | - Ying Ye
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Rd., Hangzhou, Zhejiang 310058, PR China.
| | - Jiaxue Lou
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Rd., Hangzhou, Zhejiang 310058, PR China.
| | - Hui Zhu
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Rd., Hangzhou, Zhejiang 310058, PR China.
| | - Xudong Zhou
- The Institute of Social and Family Medicine, School of Medicine, Zhejiang University, 866 Yuhangtang Rd., Hangzhou, Zhejiang 310058, PR China; The Second Affiliated Hospital, School of Medicine, Zhejiang University, 68 Jiefang Rd., Hangzhou, Zhejiang 310009, PR China.
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Abramovich A, Gould WA, Pang N, de Oliveira C, Iwajomo T, Vigny-Pau M, MacKinnon K, Lam JSH, Kurdyak P. Exploring Mediators of Mental Health Service Use Among Transgender Individuals in Ontario, Canada. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:933-948. [PMID: 37165522 PMCID: PMC10657585 DOI: 10.1177/07067437231171541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To determine if and to what degree neighbourhood-level marginalization mediates mental health service use among transgender individuals. METHODS This retrospective cohort study identified 2,085 transgender individuals through data obtained from 4 outpatient community and hospital clinics in 3 large cities in Ontario, which were linked with administrative health data between January 2015 and December 2019. An age-matched 1:5 comparison cohort was created from the general population of Ontario. Outcome measures were analysed from March 2020 to May 2022. The primary outcome was mental health service utilization, which included mental health-related visits to primary care providers, psychiatrists, mental health- and self-harm-related emergency department visits, and mental health hospitalizations. Mediation variables included ethnic concentration, residential instability, dependency, and material deprivation at the neighbourhood level and were derived from the Ontario Marginalization Index. RESULTS This study identified 2,085 transgender individuals from participating outpatient community and hospital clinics, who were matched to the general population (n = 10,425). Overall, neighbourhood-level marginalization did not clinically mediate mental health service use. However, transgender individuals were more likely to be exposed to all forms of neighbourhood-level marginalization, as well as having higher rates of health service use across all outcome measures. CONCLUSIONS In this study, mental health service use among transgender individuals was not clinically mediated by marginalization at the neighbourhood level. This study highlights the need to explore marginalization and mental health service use at the individual level to better understand the mental health disparities experienced by transgender individuals and to ensure that health-care services are inclusive and affirming.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - W. Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
- Centre for Health Economics and Hull York Medical School, University of York, York, UK
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
| | - Myriam Vigny-Pau
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - June Sing Hong Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
- General and Health Systems Psychiatry Division, Centre for Addiction and Mental Health, Toronto, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Canada
- ICES University of Toronto, Mental Health and Addictions Research Program, Toronto, Canada
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Gong AK, Yun JH, Kim IS, Yuh MA, Woo SH, Kim J, Hong S. Factors Affecting Emergency Medical Utilization After Self-harm and Effectiveness of Community-Based Suicide Prevention Provisions in Preventing Self-harm: A Nationwide Registry-Based Study in Korea. Community Ment Health J 2023; 59:942-953. [PMID: 36547814 PMCID: PMC9772591 DOI: 10.1007/s10597-022-01077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
In order to formulate and implement a community-based suicide prevention program, as well as evaluate the effectiveness of these programs, it is necessary to understand the epidemiological characteristics of self-harm. Clinical data were collected from the National Emergency Department Information System (NEDIS) data panel in Korea for patients seen after self-harm episodes. Socioeconomic factors were collected from Statistics Korea. Variables representing SP provisions (SPPs) were collected from the Korea Foundation for Suicide Prevention. Increasing the number of mental health providers resulted in lower annual emergency department visit rate after self-harm (VRSH) in the entire population, as well as in both the young and elderly populations. An increase in the mental health budget led to a significant reduction in VRSHs. However, the number of suicide prevention centers did not have any significant association with the VRSH. This study also provides substantial evidence that community-based SPPs are effective in preventing self-harm.
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Affiliation(s)
- Ae Kyung Gong
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Ji Hyun Yun
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - In Soo Kim
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Min Ah Yuh
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Seon Hee Woo
- Department of Emergency Medicine, Incheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Jinwoo Kim
- Department of Emergency Medical Service, Daejeon Health Institute of Science, 21, Chungjeong-Ro, Dong-Gu, Daejeon, 34504, Republic of Korea
| | - Sungyoup Hong
- Department of Emergency Medicine, Daejeon St Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-Daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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Braciszewski JM, Lanier A, Yeh HH, Sala-Hamrick K, Simon GE, Rossom RC, Lynch FL, Waring SC, Lu CY, Owen-Smith AA, Beck A, Daida YG, Maye M, Frank C, Hendriks M, Fabian N, Ahmedani BK. Health Diagnoses and Service Utilization in the Year Before Youth and Young Adult Suicide. Psychiatr Serv 2023; 74:566-573. [PMID: 36349497 PMCID: PMC10166760 DOI: 10.1176/appi.ps.20220145] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Suicide rates among young people are rising. Health care visits provide opportunities for identification and intervention, yet studies have been limited by small or circumscribed samples. This study sought to expand the knowledge base by examining health care encounters and diagnoses among young people who later died by suicide. METHODS This case-control study examined diagnoses of mental and general medical disorders and health care utilization in the 30 and 365 days before suicide death in nine large U.S. health care systems. Data (years 2000-2015) from 445 suicide decedents ages 10-24 years were matched with data from 4,450 control group patients. RESULTS Suicide decedents were more likely to have at least one mental disorder diagnosis (51% vs. 16%; adjusted OR [AOR]=5.74, 95% CI=4.60-7.18) and had higher rates of nearly all mental health conditions. Substance use disorders were common (12%) and more likely (AOR=8.50, 95% CI=5.53-13.06) among suicide decedents. More than one in three (42%) suicide decedents had a health care visit in the month before death, and nearly all (88%) had a visit in the previous year. CONCLUSIONS Despite the greater likelihood of suicide associated with mental disorder diagnoses, such disorders were present among only 51% of suicide decedents. High rates of health care utilization among suicide decedents indicate a need for improving identification of mental health conditions and suicide risk across the health care system. Increased substance use screening may help identify youths at high risk because substance use disorders were significantly more prevalent and likely among suicide decedents.
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Affiliation(s)
- Jordan M. Braciszewski
- Center for Health Policy & Health Services Research, Henry Ford Health System, One Ford Place, Suite 3A, Detroit, MI, 48202 USA
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, One Ford Place, Suite 1F, Detroit, MI, 48202 USA
| | - Ana Lanier
- School of Medicine, Wayne State University, 540 E Canfield St, Detroit, MI 48201 USA
| | - Hsueh-Han Yeh
- Center for Health Policy & Health Services Research, Henry Ford Health System, One Ford Place, Suite 3A, Detroit, MI, 48202 USA
| | | | - Gregory E. Simon
- Health Research Institute, Kaiser Permanente Washington, 1730 Minor Ave, Suite 1600, Seattle, WA 98101 USA
| | - Rebecca C. Rossom
- HealthPartners Institute, 8170 33rd Ave S, Bloomington, MN 55425 USA
| | - Frances L. Lynch
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR 97227 USA
| | - Stephen C. Waring
- Essentia Institute of Rural Health, Essentia Health, 502 East 2nd Street, 6AV-2, Duluth, MN 55805 USA
| | - Christine Y. Lu
- Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr #401, Boston, MA 02215 USA
| | - Ashli A. Owen-Smith
- Center for Research and Evaluation, Kaiser Permanente Georgia, 1375 Peachtree Street, N.E., Suite 380, Atlanta, Georgia 30309 USA
- School of Public Health, Georgia State University, 140 Decatur Street, Office #434, Atlanta, GA 30303 USA
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, 2550 S. Parker Rd., Suite #200, Aurora, CO 80014 USA
| | - Yihe G. Daida
- Center for Integrated Health Care Research, Kaiser Permanente Hawaii, 501 Alakawa St, Suite 201, Honolulu, HI 96817 USA
| | - Melissa Maye
- Center for Health Policy & Health Services Research, Henry Ford Health System, One Ford Place, Suite 3A, Detroit, MI, 48202 USA
| | - Cathrine Frank
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, One Ford Place, Suite 1F, Detroit, MI, 48202 USA
| | - Melissa Hendriks
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, One Ford Place, Suite 1F, Detroit, MI, 48202 USA
| | - Nina Fabian
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, One Ford Place, Suite 1F, Detroit, MI, 48202 USA
| | - Brian K. Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, One Ford Place, Suite 3A, Detroit, MI, 48202 USA
- Department of Psychiatry, Henry Ford Health System, Detroit, MI, One Ford Place, Suite 1F, Detroit, MI, 48202 USA
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Yan Y, Leong F, Song A, Goldman-Mellor S. Incidence and Correlates of Emergency Department Visits for Deliberate Self-Harm Among Asian American Youth. J Adolesc Health 2023; 72:510-518. [PMID: 36535866 PMCID: PMC10494551 DOI: 10.1016/j.jadohealth.2022.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 10/13/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE This study examined the epidemiology of self-harm emergency department (ED) visits among Asian American and Pacific Islander (AAPI) youth, and associated factors. METHODS We used California ED visit records in 2010 and 2011 to calculate incidence rates of self-harm ED visits for AAPI versus non-Hispanic White (NHW) patients aged 10-29 years. Demographic and clinical characteristics were compared for AAPI versus NHW patients presenting with self-harm. We used modified Poisson regression models to estimate the relative risk of recurrent ED self-harm visits for AAPI versus NHW patients and examined the association of insurance type and gender with recurrent self-harm among AAPIs. RESULTS Rates of self-harm ED visits for young AAPI patients were 38 and 26 per 100,000 among females and males, respectively. Although AAPI patients presenting with self-harm were equally or less likely than NHW patients to have comorbid psychological and substance use diagnoses at their index visit, they were 25% more likely to be admitted to hospital. However, they were 40% less likely to have a recurrent ED self-harm visit. Among AAPI patients, those who used Medicaid were significantly more likely than those with other insurance to be admitted as inpatients. DISCUSSION Young AAPI patients presenting to EDs with deliberate self-harm have different sociodemographic and clinical profiles compared to NHW patients. Our study also demonstrates significant heterogeneity in risk of recurrent self-harm by gender and insurance type among AAPI patients. This information may be useful for future intervention programs among self-harming AAPI youth.
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Affiliation(s)
- Yueqi Yan
- Health Sciences Research Institute, University of California, Merced, California
| | - Frederick Leong
- Department of Psychology, Michigan State University, East Lansing, Michigan
| | - Anna Song
- Department of Psychological Science, University of California, Merced, California
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Patra BN, Sen MS, Sagar R, Bhargava R. Deliberate self-harm in adolescents: A review of literature. Ind Psychiatry J 2023; 32:9-14. [PMID: 37274564 PMCID: PMC10236686 DOI: 10.4103/ipj.ipj_215_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/11/2022] Open
Abstract
Deliberate self-harm is a rising epidemic in the youth. This review examined the different self-harm behavior, approach to treatment, and the implication of such behaviors in the adolescent population in the academic literature. Using the PubMed database, we searched for specific terms related to different self-harm behaviors in Adolescents. The bibliography of the articles found relevant for the review was also screened. Each study's findings were taken with reference to our topic and findings were summarized. After reviewing the literature, we found that the prevalence of suicidal attempts was as high as 18% in the past year While the nonsuicidal attempts were as high as 31%. Risk factors associated with higher levels of suicide were bullying, loneliness and anxiety, tobacco and alcohol use, and weak family and social relationships. While the factors playing a protective role are being connected to school, having good social support, and attending school. There are very few studies focused on interventions related to suicide prevention in Adolescent and postvention programs. Out of the evidence available, the interventions are not focused on the target individuals and lack replicability. Self-harm is a major public health concern which needs to be understood holistically. The interventions aimed at preventing and managing self-harm behavior still need to be more targeted and precise. Other targets may include interventions suited to different phases of development, stopping the progression of the behavior to adulthood, including the varied population in such intervention, etc.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Mahadev Singh Sen
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Rachna Bhargava
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
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Sakai-Bizmark R, Kumamaru H, Estevez D, Bedel LEM, Marr EH, Mena LA, Kaplan MS. Association between suicide attempt and previous healthcare utilization among homeless youth. Suicide Life Threat Behav 2022; 52:994-1001. [PMID: 35765815 DOI: 10.1111/sltb.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/14/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The purpose of this study was to examine the association between prior emergency department (ED) visit or hospitalization and subsequent suicide attempt among homeless youth aged 10-17 years old. METHODS With New York statewide databases, a case-control design was conducted. Cases and controls were homeless patients with an ED visit or hospitalization due to suicide attempt (cases) or appendicitis (controls) between April and December. We examined ED and inpatient records for 90 days prior to the visit for suicide attempt or appendicitis. The primary exposure variable was prior healthcare utilization for any reason other than the following four reasons: mental health disorder, substance use, self-harm, and other injuries. Multivariable logistic regression models, with year fixed effect and hospital random effect, were used. RESULTS A total of 335 cases and 742 controls were identified. Cases had lower odds of prior healthcare utilization for any reason other than the four reasons listed above. (adjusted Odds Ratio [aOR]: 0.53, p-value = 0.03). CONCLUSIONS The association between prior healthcare utilization and decreased risk of suicide attempt among homeless youth may be due to comprehensive care provided during healthcare utilization. It may also reflect the presence of a social network that provided a protective effect.
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Affiliation(s)
- Rie Sakai-Bizmark
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California, USA.,David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Hiraku Kumamaru
- Department of Healthcare Quality Assessment, The University of Tokyo School of Medicine, Tokyo, Japan
| | - Dennys Estevez
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lauren E M Bedel
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA.,Network for Excellence in Health Innovation (NEHI), Boston, Massachusetts, USA
| | - Emily H Marr
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Laurie A Mena
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Mark S Kaplan
- The Luskin School of Public Affairs, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Theodorou CM, Yamashiro KJ, Stokes SC, Salcedo ES, Hirose S, Beres AL. Pediatric suicide by violent means: a cry for help and a call for action. Inj Epidemiol 2022; 9:13. [PMID: 35395936 PMCID: PMC8991570 DOI: 10.1186/s40621-022-00378-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/29/2022] [Indexed: 12/28/2022] Open
Abstract
Background Suicide is the second most common cause of death among adolescents and young adults. In the pediatric population, gunshot wounds (GSWs) and hangings are common mechanisms of pediatric suicide. Comorbid psychiatric illness is prevalent in this population, but psychiatric resource utilization after self-inflicted traumatic injury is not well characterized. Methods We analyzed patients < 18 years old presenting to a level 1 pediatric trauma center after suicide attempt by GSW, hanging, or jumping from a height from 2009 to 2019. The primary outcome was psychiatric resource utilization. Secondary outcomes included prior emergency department (ED) visits to identify prior opportunities for intervention. Results Of 6538 pediatric trauma patients, there were 219 GSWs, 7 hangings, and 7 jumps from height, for a total of 233 patients. Of these, 14 presented following a suicide attempt (four GSWs, six hangings, and four jumps, total 6.0%). Half of these patients died due to their injuries. Self-inflicted GSWs had the highest mortality (75%). Most surviving patients were placed on involuntary psychiatric holds (n = 5/7, 71.4%), and three patients were discharged to an inpatient psychiatric hospital (n = 3/7, 42.9%). Five of the 14 patients had prior ED visits (35.7%), and of these, 60% were for suicidal ideation or suicide attempts. Conclusions Among pediatric trauma patients, suicide attempts are rare, but are highly lethal, with the highest mortality rate seen in self-inflicted GSWs. Psychiatric resource utilization is high both during and after the hospitalization. Prior ED visits may represent opportunities for depression and suicidality screening in this at-risk population.
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Affiliation(s)
- Christina M Theodorou
- Division of Pediatric General, Thoracic, and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA.
| | - Kaeli J Yamashiro
- Division of Pediatric General, Thoracic, and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA
| | - Sarah C Stokes
- Division of Pediatric General, Thoracic, and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA
| | - Edgardo S Salcedo
- Division of Trauma, Acute Care Surgery, and Surgical Critical Care, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Sacramento, CA, USA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic, and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA
| | - Alana L Beres
- Division of Pediatric General, Thoracic, and Fetal Surgery, Department of Surgery, University of California Davis Medical Center, 2335 Stockton Blvd, Room 5107, Sacramento, CA, 95817, USA
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Sakai-Bizmark R, Kumamaru H, Estevez D, Neman S, Bedel LEM, Mena LA, Marr EH, Ross MG. Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data. BMJ Qual Saf 2022; 31:267-277. [DOI: 10.1136/bmjqs-2020-012898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/27/2021] [Indexed: 01/04/2023]
Abstract
ObjectiveTo assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women.DesignCross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect.SettingNew York statewide inpatient and emergency department databases (2009–2014).Participants82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.Main outcome measuresPostpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation.ResultsHomeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased.ConclusionsTwo factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.
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Goldman-Mellor SJ, Bhat HS, Allen MH, Schoenbaum M. Suicide Risk Among Hospitalized Versus Discharged Deliberate Self-Harm Patients: Generalized Random Forest Analysis Using a Large Claims Data Set. Am J Prev Med 2022; 62:558-566. [PMID: 34810041 PMCID: PMC8940689 DOI: 10.1016/j.amepre.2021.08.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Suicide rates are extremely high among emergency department patients seen for deliberate self-harm. Inpatient hospitalization is often recommended for these patients, but evidence on the suicide prevention impacts of hospitalization is scarce. Confounding by indication and challenges to implementing randomized designs are barriers to advances in this field. METHODS Investigators used 2009-2012 statewide data on 57,312 self-harm emergency department patients from California, linked to mortality records. Naive 12-month and 30-day suicide risks were estimated among patients who were hospitalized versus those who were discharged. Then, generalized random forest methods were applied to estimate the average treatment impacts of hospitalization on suicide, conditioning on observable covariates. Associations were calculated separately for sex- and age-specific subgroups. Analyses were conducted in February 2019-August 2021. RESULTS In naive analyses, suicide risk was significantly higher in hospitalized than in discharged patients in each subgroup. In 12-month models accounting for the observed covariates through generalized random forest methods, hospitalized male patients had 5.4 more suicides per 1,000 patients (95% CI=3.0, 7.8), hospitalized patients aged 10-29 years had 2.4 more suicides per 1,000 (95% CI=1.1, 3.6), and those aged ≥50 years had 5.8 more suicides per 1,000 (95% CI=0.5, 11.2) than corresponding discharged patients. Hospitalization was not significantly associated with suicide among female patients or patients aged 30-49 years in generalized random forest analyses. Patterns were similar in 30-day generalized random forest models. CONCLUSIONS Emergency department personnel intend to hospitalize self-harm patients with high suicide risk; this study suggests that this goal is largely realized. Analyses that control for confounding by observable covariates did not find clear evidence that hospitalization reduces suicide risk and could not rule out the possibility of iatrogenic effects.
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Affiliation(s)
- Sidra J Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California Merced, Merced, California.
| | - Harish S Bhat
- Department of Applied Mathematics, School of Natural Sciences, University of California Merced, Merced, California
| | - Michael H Allen
- Helen and Arthur E. Johnson Depression Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Michael Schoenbaum
- Division of Services and Intervention Research, National Institute of Mental Health, Bethesda, Maryland
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12
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Poyraz Fındık OT, Erdoğdu AB, Fadıloğlu E, Rodopman Arman A. Emergency Department Visits for Non-suicidal Self-harm, Suicidal Ideation, and Suicide Attempts in Children and Adolescents. Child Psychiatry Hum Dev 2022; 53:289-299. [PMID: 33523341 DOI: 10.1007/s10578-021-01125-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 11/26/2022]
Abstract
Self-harm presentations to emergency departments (ED) have become a growing concern, yet little is known about self-harm visits in pediatric EDs. This study aimed to investigate the clinical and demographic characteristics of patients who presented to the pediatric ED between 2012 and 2017 with non-suicidal self-harm (NSSH, n = 63, 60.3% female, M = 14.25 years), suicidal ideation (SI, n = 75, 57.3% female, M = 14.83 years), and suicide attempts (SA, n = 461, 82.9% female, M = 15.41 years). Also, predictors of SA were investigated. Of the patients, 79.4% had at least a psychiatric disorder. Depression was the most common diagnosis in the SI and SA groups, and autism spectrum disorder and intellectual disability were the leading diagnoses in the NSSH group. Self-poisoning was the most common method, and older age, female sex, having relational problems, and prior or current psychiatric admissions were the most important predictive factors of SA. NSSH, SI, and SA exhibit different features in early life. EDs provide an important opportunity for initiating developmentally appropriate interventions to reduce future risks.
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Affiliation(s)
- Onur Tuğçe Poyraz Fındık
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Pendik Research and Training Hospital, Istanbul, Turkey.
| | - Ayşe Burcu Erdoğdu
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
| | - Eray Fadıloğlu
- Child and Psychiatry Clinic, University of Health Sciences, Van Research and Training Hospital, Van, Turkey
| | - Ayşe Rodopman Arman
- Department of Child and Adolescent Psychiatry, Marmara University, School of Medicine, Istanbul, Turkey
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13
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Wang P, Li C, Del Sol-Calderón P, Mallol L, Hernández-Álvarez E, Donoso-Navarro E, Gil-Ligero M, Rosado-Garcia S, Sánchez-Lòpez AJ, Martín-Moratinos M, Bella-Fernández M, Blasco-Fontecilla H. Biosignature of self-injury behaviors in adolescence: Role of β-endorphin in an acute inpatient unit. Front Psychiatry 2022; 13:933275. [PMID: 36046158 PMCID: PMC9421366 DOI: 10.3389/fpsyt.2022.933275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Self-injurious behavior (SIB) (either non-suicidal self-injury, NSSI; or suicide attempts, SA) is a common reason for adolescent psychiatric emergency hospitalizations. Altered basal serum β-endorphin (BE) levels have been reported in adults with a history of SIB, but information is lacking in adolescents. We analyzed the psychoclinical profile and serum BE level of 39 adolescents admitted to the acute unit at a hospital in Spain due to SIB. The Mean (SD) serum BE level was high (190.53 ± 74.83). Regarding time sequence, the onset age of NSSI and SA were related (p < 0.001). The older the onset age of NSSI, the shorter the transition between NSSI and the onset of SA behavior (p = 0.05), but this difference does not lead the variation of BE (p = 0.81). Patients diagnosed with depression had lower serum BE levels than adolescents with other diagnoses (p = 0.03). Although adolescents who seem to be addicted to SIB had higher levels of BE, this finding was not statistically significant. The relationship between serum BE levels and SIB in adolescents requires further investigation.
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Affiliation(s)
- Ping Wang
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Chao Li
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Pablo Del Sol-Calderón
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Leticia Mallol
- Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Elena Hernández-Álvarez
- Department of Clinical Biochemistry, Puerta de Hierro University Hospital, IDIPHISA, Madrid, Spain
| | | | - María Gil-Ligero
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Silvia Rosado-Garcia
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Antonio José Sánchez-Lòpez
- Biobank, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain.,Neuroimmunology Unit, Puerta de Hierro-Segovia de Arana Health Research Institute, Madrid, Spain
| | - Marina Martín-Moratinos
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain
| | - Marcos Bella-Fernández
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain.,Department of Psychology, Pontifical University of Comillas, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Faculty of Medicine, Autonomous University of Madrid, Madrid, Spain.,Department of Psychiatry, Puerta de Hierro University Hospital, Health Research Institute Puerta de Hierro-Segovia de Arana (IDIPHISA), Madrid, Spain.,Center of Biomedical Network Research on Mental Health (CIBERSAM), Madrid, Spain.,Korian, Paris, France
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14
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Sakai-Bizmark R, Kumamaru H, Estevez D, Marr EH, Haghnazarian E, Bedel LEM, Mena LA, Kaplan MS. Health-Care Utilization Due to Suicide Attempts Among Homeless Youth in New York State. Am J Epidemiol 2021; 190:1582-1591. [PMID: 33576370 PMCID: PMC8484771 DOI: 10.1093/aje/kwab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
Suicide remains the leading cause of death among homeless youth. We assessed differences in health-care utilization between homeless and nonhomeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009-2014) were used to identify homeless and nonhomeless youth aged 10-17 who utilized health-care services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models adjusted for individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with health-care utilization rates of 347.2 (95% confidence interval (CI): 317.5, 377.0) and 67.3 (95% CI: 66.3, 68.3) per 100,000 person-years for homeless and nonhomeless youth, respectively. Length of stay for homeless youth was statistically longer than that for nonhomeless youth (incidence rate ratio = 1.53, 95% CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with nonhomeless youth. Interventions tailored to homeless youth should be developed.
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Affiliation(s)
- Rie Sakai-Bizmark
- Correspondence to Dr. Rie Sakai-Bizmark, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Torrance Street, Torrance, CA 90502 (e-mail: )
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15
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Imm P, Grogan B, Diallo O. Self-harm injury hospitalisations: an analysis of case selection criteria. Inj Prev 2021; 27:i49-i55. [PMID: 33674333 PMCID: PMC7948187 DOI: 10.1136/injuryprev-2019-043514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/13/2020] [Accepted: 05/21/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study explores the impact of using different criteria to identify nonfatal hospitalisations with self-harm injuries using 2017-2018 Wisconsin discharge data. METHODS Using International Classification of Diseases, 10th Revision, Clinical Modification codes, we classified records by three mutually exclusive selection criteria: subset A--principal diagnosis of injury, and any code for self-harm, initial encounter only; subset B--non-injury principal diagnosis, and any code for self-harm, initial encounter only; subset C--any principal diagnosis, and any code for self-harm, subsequent and sequelae encounters only. These categories were used to conduct two separate logistic regression models. Model 1 analysed the impact of surveillance limited to a principal diagnosis of injury, initial self-harm encounter (subset B compared with A). Model 2 analysed the impact if limited to initial encounters for self-harm, regardless of principal diagnosis (subset C compared with (A+B)). Both patient-level and visit-level analyses were conducted. RESULTS For both patient-level models, subsets that included additional records based on an expansion of selection criteria were significantly more likely to include children (model 1: OR 2.8, model 2: OR 2.9; compared with those 25-54 years), those with mental health disorders (model 1: OR 6.5, model 2: OR 4.3) and rural residents (model 1: OR 1.2, model 2: OR 1.4). Drug-related disorder and means of self-harm were significantly different among subsets for both models. Visit-level analyses revealed similar results. DISCUSSION Expanding case selection criteria would better capture the scale of hospitalisation for nonfatal self-harm. Using restrictive selection criteria may result in biased understanding of the affected populations, potentially impacting the development of policy and prevention programmes.
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Affiliation(s)
- Pamela Imm
- University of Wisconsin Population Health Institute, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Brittany Grogan
- Public Health Madison & Dane County, City of Madison Wisconsin, Madison, Wisconsin, USA
| | - Ousmane Diallo
- Wisconsin Department of Health Services, Wisconsin Division of Public Health, Madison, Wisconsin, USA
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16
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Kipoulas E, Berzengi A, Kyriakopoulos M. Prevalence and clinical correlates of self-harm and suicidality during admission of children in a mental health inpatient unit. Eur Psychiatry 2020; 64:e1. [PMID: 33323142 PMCID: PMC8057375 DOI: 10.1192/j.eurpsy.2020.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Self-harm and suicidality are common presentations in children and adolescents requiring a mental health inpatient admission. Although there are several studies on adolescents, there is relatively limited research into childhood self-harm and suicidality during such admissions. Methods A retrospective electronic file review was conducted on all children discharged from a national mental health inpatient children’s unit over a 6-year period. Several independent variables were compared between self-harm/suicidal and non-self-harm/non-suicidal children. Separate analyses investigated changes in self-harm/suicidality, functional outcomes, and risk assessment ratings between admission and discharge. Results A total of 105 children were included in this study. During admission, 65.7% of them reported self-harm thoughts, 61% engaged in self-harm, 50.5% expressed suicidal thoughts, and 14.3% engaged in suicidal behavior. Thoughts and acts of self-harm were associated with previous self-harm, longer admissions, and Attention Deficit Hyperactivity Disorder. Suicidality overlapped with self-harm and was strongly predicted by previous self-harm. The prevalence of self-harm and suicidal thoughts and acts significantly decreased during admission. Children in the non-self-harm group had marginally better functional outcomes upon discharge compared to those in the self-harm group. Children and parents/caregivers were similarly satisfied with treatment, irrespective of children’s self-harm/suicidality. Conclusions Self-harm and suicidality were widespread among children admitted to hospital. Better understanding of the mechanisms and factors related to self-harm and suicidality in this age group could help mitigate associated risks and improve existing safety strategies.
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Affiliation(s)
- Eleftherios Kipoulas
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Azi Berzengi
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Marinos Kyriakopoulos
- National and Specialist Acorn Lodge Inpatient Children's Unit, Child and Adolescent Mental Health Services, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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17
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Ahmed AE, Alaqeel M, Alasmari NA, Jradi H, Al Otaibi H, A Abbas O, Alyabsi M, Almutairi AF, Al-Qunaibet A, Al-Jahdali H. Risk Assessment of Repeated Suicide Attempts Among Youth in Saudi Arabia. Risk Manag Healthc Policy 2020; 13:1633-1638. [PMID: 32982521 PMCID: PMC7509329 DOI: 10.2147/rmhp.s245175] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/10/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Although the incidence of suicide attempts continues to increase among youth in Saudi Arabia, no risk assessment tool has been established for suicide attempt repetition in the country's youth population. The objective of the study was to develop risk assessment of suicide attempt repetition among youth in Saudi Arabia. Methods This is a retrospective study of youth (10-24 years) with intentional suicide attempt(s) who presented to the emergency departments (ED) at King Abdullah Specialist Children's Hospital (KASCH) and King Abdulaziz Medical City-Riyadh (KAMC-R), Saudi Arabia between 1 January 2015 and 31 December 2017. We excluded youth having unintentional suicide attempts. Data were retrieved for the 157 eligible as having attempted suicide. Results Forty-one of 157 (26.1%) had repeated suicide attempts (95% confidence limits: 19.433.7%). Four independent factors were identified that were associated with an increased risk of repeated suicide attempts: age (adjusted odds ratio [aOR] = 1.147, 95% confidence interval (CI) = 11.015-1.297, P=0.028), family problems (aOR = 4.218, 95% CI = 1.690-10.528, P=0.002), psychiatric disorders (aOR = 3.497, 95% CI = 1.519-8.051, P=0.003), and hospitalization (aOR = 5.143, 95% CI = 1.421-18.610, P=0.013). This risk model showed adequate utility with an area under the receiver operating characteristic (ROC) curve (AUC): 77.9%, 95% CI: 69.486.3% with optimism-corrected AUC = 71.8%. Youden index defined a probability of ≥0.38 to predict a high risk of repeated suicide attempts. Conclusion The risk of repeated suicide attempts among Saudi youth was high, compatible with what has been reported among youth in England and in France. Age, family problems, psychiatric disorders, and hospitalization are risk factors for repeated suicide attempts. A prevention program for suicide attempts in youth may take into account family problems, screening for psychiatric disorders, and suicidal behavior.
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Affiliation(s)
- Anwar E Ahmed
- Uniformed Services University of the Health Sciences, F. Edward Hébert School of Medicine, Department of Preventive Medicine & Biostatistics, Bethesda, Maryland, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA
| | - Mody Alaqeel
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Hoda Jradi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Hazza Al Otaibi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Mesnad Alyabsi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Adel F Almutairi
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ada Al-Qunaibet
- Saudi Center for Disease Prevention and Control, Riyadh, Saudi Arabia
| | - Hamdan Al-Jahdali
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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18
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Kim H, Ryu JM, Kim HW. Characteristics and Trends of Suicide Attempt or Non-suicidal Self-injury in Children and Adolescents Visiting Emergency Department. J Korean Med Sci 2020; 35:e276. [PMID: 32830466 PMCID: PMC7445307 DOI: 10.3346/jkms.2020.35.e276] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/03/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) and suicidality are common reasons for child and adolescent psychiatric emergencies. We aimed to investigate the incidence of pediatric emergency department (PED) utilization for psychiatric problems in children and adolescents and to identify demographic and clinical characteristics of youths who visited the PED for suicide attempt (SA) and/or NSSI. METHODS The medical records of children and adolescents who visited the PED for psychiatric problems from January 2015 to November 2019 were reviewed retrospectively. Demographic and clinical variables including psychiatric disorders were collected. We compared the characteristics of youths who presented to the PED for SA and/or NSSI with those of youths without SA or NSSI. Student's t-test, χ² test, and multivariate logistic regression were used for statistical analysis. RESULTS During 59 months of observation, 194 youths visited the PED and the number of total PED visits was 336. Among them, 46 youths (23.7%) visited the PED for SA and/or NSSI at least once, and the number of visits was 91 (27.1% of PED visits). Youths with SA and/or NSSI were older (P = 0.001) and more likely to be a girl (P = 0.005) and to report parental absence (P = 0.023). Bipolar and related disorders (P = 0.032) and depressive disorders (P = 0.004) were more common in youths with SA and/or NSSI, while schizophrenia spectrum and other psychotic disorders (P = 0.030) and somatic symptom and related disorders (P = 0.007) were more common in those without SA and NSSI. After adjusting for age, sex, and parental marital status, bipolar and related disorders (odds ratio [OR], 6.72), depressive disorders (OR, 9.59), and somatic symptom and related disorders (OR, 0.12) were significantly associated with SA and/or NSSI. Youths with SA and/or NSSI also stayed longer in the PED (P = 0.007). CONCLUSION SA and NSSI are one of the main reasons for child and adolescent admittance to psychiatric services in the PED and are associated with psychiatric comorbidities. An appropriate risk assessment for suicidality and self-injury and proper management and referral to mental health services at the PED are of the utmost importance.
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Affiliation(s)
- Harin Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong Min Ryu
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Won Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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O'Connor E, Thomas R, Senger CA, Perdue L, Robalino S, Patnode C. Interventions to Prevent Illicit and Nonmedical Drug Use in Children, Adolescents, and Young Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA 2020; 323:2067-2079. [PMID: 32453373 DOI: 10.1001/jama.2020.1432] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Illicit and nonmedical (use in ways other than instructed) drug use is common in adolescents and young adults and increases the risk of harmful outcomes such as injuries, violence, and poorer academic performance. OBJECTIVE To review the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force. DATA SOURCES MEDLINE, PubMED, PsycINFO, and the Cochrane Central Register of Controlled Trials (January 1, 2013, to January 31, 2019 [children and adolescents]; January 1, 1992, to January 31, 2019 [young adults <25 years]); surveillance through March 20, 2020. STUDY SELECTION Clinical trials of behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among young people. DATA EXTRACTION AND SYNTHESIS Critical appraisal was completed independently by 2 investigators. Data were extracted by 1 reviewer and checked by a second. Random-effects meta-analysis was used to estimate the effect sizes associated with the interventions. MAIN OUTCOMES AND MEASURES Number of times illicit drugs were used; any illicit drug or any cannabis use. RESULTS Twenty-nine trials (N = 18 353) met inclusion criteria. Health, social, or legal outcomes such as mental health symptoms, family functioning, consequences of drug use, and arrests were reported in 19 trials and most showed no group differences. The effects on illicit drug use in 26 trials among nonpregnant youth (n = 17 811) were highly variable; the pooled result did not show a clinically important or statistically significant association with illicit drug use (standardized mean difference, -0.08 [95% CI, -0.16 to 0.001]; 24 effects [from 23 studies]; n = 12 801; I2 = 57.0%). The percentage of participants using illicit drugs ranged from 2.3% to 38.6% in the control groups and 2.4% to 33.7% in the intervention groups at 3 to 32 months' follow-up. The median absolute risk difference between groups was -2.8%, favoring the intervention group (range, -11.5% to 14.8%). The remaining 3 trials provided a perinatal home-visiting intervention to pregnant Native American youth. One trial (n=322) found a reduction in illicit drug use at 38 months (eg, cannabis use in the previous month, 10.7% in the intervention group and 15.6% in the control group) but not at earlier follow-up assessments. Across all 29 trials, only 1 trial reported on harms and found no statistically significant group differences. CONCLUSIONS AND RELEVANCE The evidence for behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements.
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Affiliation(s)
- Elizabeth O'Connor
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Rachel Thomas
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Caitlyn A Senger
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Leslie Perdue
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
| | - Shannon Robalino
- Center for Evidence-based Policy, Oregon Health & Science University, Portland
| | - Carrie Patnode
- Kaiser Permanente Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon
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Goldman-Mellor S, Phillips D, Brown P, Gruenewald P, Cerdá M, Wiebe D. Emergency Department Use and Inpatient Admissions and Costs Among Adolescents With Deliberate Self-Harm: A Five-Year Follow-Up Study. Psychiatr Serv 2020; 71:136-143. [PMID: 31575352 PMCID: PMC7002213 DOI: 10.1176/appi.ps.201900153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Self-harm rates among U.S. adolescents have risen substantially. Health and social outcomes among contemporary self-harming youths are infrequently tracked and poorly understood. This study investigated long-term health service utilization (emergency department [ED] visits and inpatient admissions) and inpatient costs among a recent cohort of adolescents with deliberate self-harm. METHODS This retrospective cohort study used statewide, all-payer, longitudinally linked discharge data from California. All residents ages 10-19 presenting to EDs in 2010 with deliberate self-harm (N=5,396) were compared with two control groups: a random sample of adolescent ED patients with other complaints, matched on sex, age, residential zip code, and month of index visit (general control patients, N=14,921), and matched ED patients with psychiatric complaints but no self-harm (psychiatric control patients, N=15,835). Outcomes included 5-year rates of ED visits, inpatient admissions, and inpatient costs, overall and for psychiatric and nonpsychiatric complaints separately. RESULTS Self-harm patients' ED use, inpatient admissions, and inpatient costs were significantly higher than those of general control patients (by 39%, 81%, and 21%, respectively), when the analysis controlled for confounding demographic and utilization characteristics. Associations mostly persisted, although smaller in magnitude, in comparisons between self-harm and psychiatric control patients. Psychiatric and nonpsychiatric complaints contributed to self-harming adolescents' excess health service utilization and costs. CONCLUSIONS Deliberate self-harm among adolescents was found to be associated with long-lasting and costly patterns of health service utilization, often but not exclusively for psychiatric complaints. Future research should investigate the pathways underlying these associations and incorporate service utilization as a key patient outcome.
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Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health (Goldman-Mellor, Phillips, Brown), Department of Psychology (Wiebe), School of Social Sciences, Humanities, and Arts, University of California, Merced; Prevention Research Center, Pacific Institute for Research and Evaluation; Oakland, California (Gruenewald); Department of Population Health, New York University; New York (Cerdá)
| | - Dwena Phillips
- Department of Public Health (Goldman-Mellor, Phillips, Brown), Department of Psychology (Wiebe), School of Social Sciences, Humanities, and Arts, University of California, Merced; Prevention Research Center, Pacific Institute for Research and Evaluation; Oakland, California (Gruenewald); Department of Population Health, New York University; New York (Cerdá)
| | - Paul Brown
- Department of Public Health (Goldman-Mellor, Phillips, Brown), Department of Psychology (Wiebe), School of Social Sciences, Humanities, and Arts, University of California, Merced; Prevention Research Center, Pacific Institute for Research and Evaluation; Oakland, California (Gruenewald); Department of Population Health, New York University; New York (Cerdá)
| | - Paul Gruenewald
- Department of Public Health (Goldman-Mellor, Phillips, Brown), Department of Psychology (Wiebe), School of Social Sciences, Humanities, and Arts, University of California, Merced; Prevention Research Center, Pacific Institute for Research and Evaluation; Oakland, California (Gruenewald); Department of Population Health, New York University; New York (Cerdá)
| | - Magdalena Cerdá
- Department of Public Health (Goldman-Mellor, Phillips, Brown), Department of Psychology (Wiebe), School of Social Sciences, Humanities, and Arts, University of California, Merced; Prevention Research Center, Pacific Institute for Research and Evaluation; Oakland, California (Gruenewald); Department of Population Health, New York University; New York (Cerdá)
| | - Deborah Wiebe
- Department of Public Health (Goldman-Mellor, Phillips, Brown), Department of Psychology (Wiebe), School of Social Sciences, Humanities, and Arts, University of California, Merced; Prevention Research Center, Pacific Institute for Research and Evaluation; Oakland, California (Gruenewald); Department of Population Health, New York University; New York (Cerdá)
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Jones MJ, Lin AL, Marshall RD, Sheridan DC. Adolescent Intentional Ingestions in a Community Hospital. Hosp Pediatr 2020; 10:138-146. [PMID: 31980442 DOI: 10.1542/hpeds.2019-0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Suicide is the second leading cause of death in the adolescent population, presenting a public health crisis. The goal of this study was to evaluate adolescent intentional ingestions in a community hospital and to identify variables associated with the risk of admission to inpatient medical and psychiatric settings. METHODS This study was a retrospective chart review from a hospital system in the Pacific Northwest over 2 years for patients aged 9 to 18 years. Variables examined include age, sex, type of ingestion, emergency department length of stay (LOS), admission to the inpatient setting, LOS of inpatient admission, admission to psychiatry, presence of a therapist, and insurance type. RESULTS During the study period, 233 individual intentional ingestions occurred. The most commonly ingested substances were psychiatric medications (30.9%), prescription medications (28.3%), and ibuprofen (24.0%). One-third of patients (33.9%) required admission to a medical hospital, whereas one-quarter (24.9%) required admission to a psychiatric hospital. The following variables were associated with risk of admission to a medical hospital: female sex, shorter emergency department LOS, and ingestion of psychiatric medications, prescription medication, and/or salicylates. Risk of admission to a psychiatric hospital was associated with an inpatient medical admission, an increased duration of medical admission, and an ingestion of a psychiatric medication. CONCLUSIONS In this study, we describe important epidemiology on adolescent intentional ingestions in a community setting, providing variables associated with a risk of admission to medical and psychiatric hospitals.
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Affiliation(s)
- Michael J Jones
- Department of Pediatrics, PeaceHealth Sacred Heart Riverbend Hospital, Springfield, Oregon; .,Departments of Pediatrics
| | | | - Rebecca D Marshall
- Child and Adolescent Psychiatry, Oregon Health and Science University, Portland, Oregon
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Phillips D, Lidón-Moyano C, Cerdá M, Gruenewald P, Goldman-Mellor S. Association between unintentional injuries and self-harm among adolescent emergency department patients. Gen Hosp Psychiatry 2020; 64:87-92. [PMID: 32304935 PMCID: PMC7211429 DOI: 10.1016/j.genhosppsych.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Unintentional injury, a leading cause of morbidity among adolescents, may also be a risk factor for deliberate self-harm. To inform clinical and public health prevention efforts in adolescent populations, we examined whether distinct subtypes of unintentional injury were differentially associated with deliberate self-harm. METHODS Statewide, all-payer, individually linkable administrative data on adolescent patients presenting to any California emergency department (ED) in 2010 (n = 490,071) were used to investigate longitudinal associations between subtypes of unintentional injury and deliberate self-harm. Adolescents aged 10-19 years presenting with unintentional drug poisoning, other poisoning, fall, suffocation, or cutting/piercing injuries formed the exposure groups; adolescents presenting with unintentional strike injuries formed the primary referent group. Study patients were followed back in time (2006-2009) to compare the groups' odds of a prior ED visit for deliberate self-harm, as well as forwards in time (2010-2015) to compare their risks of subsequent self-harm. RESULTS Unintentional drug-poisoning injury was strongly associated with increased likelihood of ED visits for deliberate self-harm, assessed both retrospectively (adjusted OR = 4.52; 95% confidence interval [CI] = 3.08, 6.64) and prospectively (adjusted RR = 3.74; 95% CI = 3.03, 4.60). Positive associations with odds of prior self-harm and/or risk of subsequent self-harm were also observed for patients with unintentional non-drug poisoning, suffocation, and cutting/piercing injuries. CONCLUSIONS Certain subtypes of unintentional injury, particularly drug poisoning, are strongly associated with risk for deliberate self-harm among adolescents, a finding with implications for targeting clinical assessment and intervention in emergency department settings. More research is needed to understand the mechanisms underlying these associations.
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Affiliation(s)
- Dwena Phillips
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | | | - Magdalena Cerdá
- Department of Population Health, New York University, New York, NY 10016, USA.
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA.
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
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Lidón-Moyano C, Wiebe D, Gruenewald P, Cerdá M, Brown P, Goldman-Mellor S. Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data. J Adolesc 2019; 72:132-140. [PMID: 30903930 DOI: 10.1016/j.adolescence.2019.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to understand the association between youthful self-harm and subsequent chronic disease-related healthcare utilization and whether self-harm reflects unique vulnerability in comparison with severe psychiatric disorders. METHODS We used a retrospective matched cohort design with statewide, all-payer, individually linked emergency department (ED) data from California, USA. Risk of future ED visits for common chronic conditions in adolescence (headaches, asthma, epilepsy, diabetes, and gastrointestinal disorders, assessed using ICD-9 diagnoses) were compared between three adolescent study groups presenting to an ED in 2010: self-harm patients (n = 5,484), patients with psychiatric complaints but no self-harm (n = 14,235), and patients with other complaints (n = 16,452). Cohort follow-up ended on Sept. 30, 2015. Analyses were adjusted for patients' prior histories of ED utilization for chronic conditions as well as patient- and area-level sociodemographic characteristics. RESULTS Risk of subsequent ED visits was higher among self-harm patients compared to non-psychiatric control patients for subsequent epilepsy- (aRR = 1.77, 95% CI [1.42, 2.21]). Risk of subsequent ED visits was higher among psychiatric patients compared to non-psychiatric control patients for subsequent headache- (aRR = 1.31, 95% CI [1.21, 1.42]), and epilepsy-related problems (aRR = 1.85, 95% CI [1.55, 2.21]). Self-harm patients were at higher risk than psychiatric patients for subsequent gastrointestinal disorder (aRR = 1.76, 95% CI [1.03, 3.01]). CONCLUSIONS Findings suggest that self-harm behavior and psychiatric disorders are associated with increased ED utilization for subsequent chronic disease-related ED utilization. Chronic disease among adolescent psychiatric patients should be attended to, potentially involving new models of clinical follow-up care.
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Affiliation(s)
- Cristina Lidón-Moyano
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA.
| | - Deborah Wiebe
- Department of Psychology, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA.
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA.
| | - Magdalena Cerdá
- Violence Prevention Research Program, University of California, Davis, Sacramento, CA 95817, USA.
| | - Paul Brown
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA.
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA.
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