1
|
Geith S, Lumpe M, Schurr J, Schmoll S, Rabe C, Ott A, Stich R, Rentrop M, Eyer F, Zellner T. Clinical course and demographic insights into suicide by self-poisoning: patterns of substance use and socio-economic factors. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02750-x. [PMID: 39317728 DOI: 10.1007/s00127-024-02750-x] [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: 04/04/2024] [Accepted: 08/15/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE To analyze whether sociodemographic characteristics influence the substance choice and preclinical and clinical course of suicidal poisoning. METHODS This was a retrospective single-center study in patients hospitalized due to suicidal poisoning and who received at least one psychiatric exploration during their inpatient stay. Patients' sociodemographic, anamnestic, preclinical, and clinical parameters were analyzed with respect to sex and age. RESULTS 1090 patients were included, 727 (67%) were females, median age was 39 years (min-max: 13-91) with 603 (55%) aged 18-44 years. 595 patients (54.8%) ingested a single substance for self-poisoning, 609 (59.5%) used their own long-term medication. Comparing to males, females preferred antidepressants (n = 223, 30.7%, vs n = 85, 23.4%; p = 0.013) and benzodiazepines (n = 202, 27.8%, vs n = 65, 17.9%; p < 0.001); males more often used cardiovascular drugs (n = 33, 9.1%, vs n = 34, 4.7%; p = 0.005) and carbon monoxide (n = 18, 5.0%, vs n = 2, 0.3%; p < 0.001). Use of Z-drugs (n = 1, 1.7%, to n = 37, 33.3%; p < 0.001) and benzodiazepines (n = 4, 6.9%, to n = 33, 29.7%; p = 0.003) increased with age (< 18 to > 64 years), while use of non-opioid analgesics (n = 23, 39.7%, to n = 20, 18.0%; p < 0.001) decreased. Average dose of substance in patients > 64 years was 12.9 ± 18.4 times higher than recommended maximum daily dose (compared to 8.7 ± 15.2 higher in those aged < 18 years; p < 0.001). Males more often required intensive care (n = 150, 41.3%, vs n = 205 females, 28.2%; p < 0.001). CONCLUSION These results underline the complexity of (para-)suicidal poisonings and identify potential measures for their prevention, such as restricting access and better oversight over the use of certain substances.
Collapse
Affiliation(s)
- Stefanie Geith
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Maja Lumpe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Johannes Schurr
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sabrina Schmoll
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Rabe
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | | | - Raphael Stich
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Rentrop
- Clinic and Policlinic for Psychiatry and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- kbo-Inn-Salzach Clinic, Wasserburg am Inn, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Tobias Zellner
- Department of Clinical Toxicology, Klinikum Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| |
Collapse
|
2
|
Al Babtain I, Almalki Y, Masud N, Asiri D. Unintentional Injuries Among Young Adolescents at a Level-One Trauma Center in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e36645. [PMID: 37101997 PMCID: PMC10123526 DOI: 10.7759/cureus.36645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/28/2023] Open
Abstract
Background Unintentional injuries are the leading preventable cause of mortality across different demographics. This study aims to assess the prevalence, severity, contributing factors, and clinical outcomes of unintentional injuries among adolescent patients. Methods A retrospective study was conducted using the charts of patients admitted with unintentional injuries (motor vehicle accidents (MVA), falls, pedestrian injuries, burns, etc.) to the emergency department (ED) from January 2016 to December 2018 at a level-one trauma center in Riyadh, Saudi Arabia. A total of 721 patients' charts were reviewed, but only 52 patients were consecutively included as per the definition of an adolescent. All variables, including severity and outcome, were assessed. Results The overall prevalence of unintentional injuries was 7.2 per 100 adolescent patients. The most common cause of unintentional injury were MVAs, which were reported in 35 (71%), with head and neck region injuries among 38 (73%) patients. The overall mortality was noted at 10 per 52 (19%) patients. The mean Injury Severity Score (ISS) score was 17.81±12.76. The patients who stayed longer in the ED were not associated with pelvic and lower extremity injuries, with a p-value=0.008. The ISS was the significant predictor of mortality, with an odds ratio (OR) of 1.6, a confidence interval (CI) of 1.02-2.65, and a p-value=0.04. Conclusion MVAs were the main cause of unintentional injuries among adolescents. Future recommendation plans for adolescents should include stricter implementation of road traffic laws to control this early, preventable death among adolescents.
Collapse
Affiliation(s)
| | - Yara Almalki
- General Surgery, King Abdulaziz Medical City Riyadh, Riyadh , SAU
| | - Nazish Masud
- Biostatistics, Epidemiology and Environmental Health Sciences, Georgia Southern University, Statesboro, USA
| | - Deemah Asiri
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| |
Collapse
|
3
|
Riehm KE, Brignone E, Gallo JJ, Stuart EA, Mojtabai R. Emergency health services use and medically-treated suicidal behaviors following depression screening among adolescents: A longitudinal cohort study. Prev Med 2022; 161:107148. [PMID: 35803349 DOI: 10.1016/j.ypmed.2022.107148] [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: 01/17/2022] [Revised: 05/24/2022] [Accepted: 07/03/2022] [Indexed: 11/28/2022]
Abstract
The primary goal of depression screening is to reduce adverse psychiatric outcomes, which may have downstream implications for reducing avoidable health services use. The objective of this study was to examine the association of depression screening with emergency health services use and medically-treated suicidal behaviors among adolescents in the U.S. This longitudinal cohort study used insurance claims data from 57,732 adolescents who had at least one well-visit between 2014 and 2017. Propensity score matching was used to compare adolescents who were screened for depression to similar adolescents who were not screened for depression during the well-visit. Outcomes were examined over two-year follow-up and included emergency department use and inpatient hospitalizations for depression-related reasons, mental health-related reasons, and any reason as well as medically-treated suicidal behaviors. Log-binomial regression models were used to examine associations between depression screening and each outcome in the matched sample. Heterogeneity of associations by sex was examined with interaction terms. Being screened for depression was not consistently associated with emergency department use (depression-related reasons: RR = 1.00, 95% CI = 0.76-1.30; mental health-related reasons: RR = 1.02, 95% CI = 0.80-1.29; any reason: RR = 0.96, 95% CI = 0.83-1.11), inpatient hospitalizations (depression-related reasons: RR = 1.05, 95% CI = 0.84-1.31; mental health-related reasons: RR = 1.16, 95% CI = 1.00-1.33; any reason: RR = 1.05, 95% CI = 0.99-1.12), or medically-treated suicidal behaviors (RR = 0.83, 95% CI = 0.51-1.36). Associations were similar in magnitude among male and female adolescents. The results of this study suggest that depression screening, as it is currently practiced in the U.S., may not deter avoidable health services use among adolescents.
Collapse
Affiliation(s)
- Kira E Riehm
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Emily Brignone
- Data Science Research and Development, Highmark Health, Pittsburgh, PA, USA
| | - Joseph J Gallo
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
4
|
Kasemy ZA, Sharif AF, Amin SA, Fayed MM, Desouky DE, Salama AA, Abo Shereda HM, Abdel-Aaty NB. Trend and epidemiology of suicide attempts by self-poisoning among Egyptians. PLoS One 2022; 17:e0270026. [PMID: 35709176 PMCID: PMC9202942 DOI: 10.1371/journal.pone.0270026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/02/2022] [Indexed: 11/19/2022] Open
Abstract
Suicide attempts by self-poisoning have become a critical health problem. This study aimed to investigate the trend, incidence, and the associated risk factors of suicide attempts by self-poisoning. A total of 7398 Egyptian patients were analyzed. The trend of suicide attempts by self-poisoning was analyzed using 6745 patients over four registry years from January 1, 2016, to January 1, 2020. Then, the associated risk factors behind attempted suicide by self-poisoning from January 1, 2019, to January 1, 2020, were assessed using 2523 suicide attempters by self-poisoning, 201 fatalities by self-poisoning, and another 653 survivors of accidental poisoning. Results showed a rising trend of suicide attempts by self-poisoning over the studied years. The incidence of suicide attempts through deliberate self-poisoning represented 26.63/1,000 (CI95%: 25.63-27.86) to the admitted patients and 26.10/100,000 (CI95%: 25.10-27.14) to the regional population. The death rate due to suicide attempts by self-poisoning was 2.08/100,000 (1.90-2.49). The case fatality rate and the proportionate mortality rate for suicide by self-poisoning were 7.38% (CI95%: 6.45-8.42) and 14.11% (CI95%: 12.4-16.0) respectively. Multivariate analysis revealed that attempted suicide by self-poisoning was predicted among patients aged <25 or 25-40 years old (OR = 27.49, CI95%: 15.28-49.64 and OR = 59.42, CI95%: 32.76-107.77 respectively), those of low or moderate socioeconomic status (OR = 35.03, CI95%: 21.32-57.56 and OR = 14.11, CI95%: 10.86-18.43 respectively), students (OR = 2.91, CI95%: 1.57-5.43) and those living in rural residency (OR = 4.12, CI95%: 3.27-5.19). Suicide attempts by self-poisoning exhibited an incremental rise across time which raises a serious concern. Efforts should be directed to overcome the mentioned risk factors triggering suicide attempts by self-poisoning.
Collapse
Affiliation(s)
- Zeinab A. Kasemy
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Asmaa Fady Sharif
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Department of Clinical Sciences, College of Medicine, Dar Al Uloom University, Riyadh, Saudi Arabia
| | - Safaa Abdelzaher Amin
- Department of Forensic medicine and clinical toxicology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Manar Maher Fayed
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dalia E. Desouky
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amal A. Salama
- Department of Family medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Hanaa Mohammad Abo Shereda
- Department of Psychiatric and Mental Health Nursing, Faculty of Nursing, Menoufia University, Menoufia, Egypt
| | - Nehad B. Abdel-Aaty
- Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| |
Collapse
|
5
|
Characteristics of children and adolescents presenting to the emergency department with self-inflicted injury: Retrospective analysis of two teaching hospitals. Pediatr Neonatol 2022; 63:131-138. [PMID: 34711528 DOI: 10.1016/j.pedneo.2021.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Data on Taiwanese adolescents with self-inflicted injuries are limited. We describe the epidemiology of children and adolescents visiting the emergency department for self-inflicted injuries in two geographically distinct teaching hospitals. METHODS Medical records of children 0-18 years old who visited the emergency department of Taipei Tzu Chi Hospital and Chi Mei Medical Center, Tainan between 2016 and 2019 coded with relevant diagnoses were reviewed. Visits with documented self-inflicted injury were included. RESULTS During the 4-year period, 62 children made 74 emergency visits for self-inflicted injury. A total of 88% of visits were made by children with a psychiatric diagnosis, with depressive disorders being the most common (57%). Interpersonal relationship issue was cited as a trigger for self-harm in 49% of visits. Adjusted for annual visit volumes, self-harm visits per 10,000 pediatric emergency visits increased nearly 5 fold between 2016 and 2019, with the most prominent increase in the final year. Poisoning was the most common mechanism of injury and was frequently used by females, as compared to males who tended to jump from heights. Up to 96% of adolescents with previous self-harm seen at the emergency department had sought psychiatric help in the past year. Urban-rural inequity in mental health resource utilization was observed. CONCLUSIONS Visits to the emergency department for self-inflicted injuries among children and adolescents increased, most remarkably in 2019, for both hospitals. Intentional poisoning with prescription and over-the-counter medications was the most common method. There was a high prevalence of psychiatric disorders in our study population. As the emergency department is likely the first point of medical contact for such visits, emergency personnel should be trained appropriately on managing such patients.
Collapse
|
6
|
Karnick AT, Boska RL, Caulfield NM, Winchell R, Capron DW. Suicide and self-injury outcomes for patients with comorbid psychiatric and physical health conditions. Psychiatry Res 2022; 308:114345. [PMID: 34954501 DOI: 10.1016/j.psychres.2021.114345] [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: 07/16/2021] [Revised: 12/08/2021] [Accepted: 12/12/2021] [Indexed: 11/29/2022]
Abstract
Suicide is a transdiagnostic public health issue that affects nearly all psychiatric disorders, individuals without a mental health diagnosis, and individuals with physical health issues. We assessed the relationship between these variables and suicide outcomes using a novel epidemiological research paradigm. Data were collected from the National Trauma Data Bank. Participants included patients admitted to trauma units for suicide and self-injury (n = 13,422). Patients were classified to one of four comorbid condition groups: no comorbidity, comorbid physical condition, comorbid major psychiatric condition, or multimorbidity (comorbid physical and psychiatric conditions). Multivariable logistic regression measured associations between comorbid condition and mortality and multivariable linear regression measured associations between comorbidity and injury severity. Mortality in patients with physical health comorbidity was not significant, but patients with psychiatric comorbidity or multimorbidity had significantly lower mortality than patients without either. No association between injury severity and comorbidity was detected. There were no differences in suicide mortality for individuals with a physical health comorbidity, but mortality was lower for individuals with a comorbid major psychiatric illness or multimorbidity. Since physical health conditions and psychiatric illness are associated with eventual suicide mortality, prevention strategies could target these populations at trauma units for suicide and self-injury admissions.
Collapse
Affiliation(s)
- Aleksandr T Karnick
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA.
| | - Rachel L Boska
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort hill Avenue, Canandaigua, NY, 14424; Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Blvd., Rochester, NY, 14642
| | - Nicole M Caulfield
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
| | - Robert Winchell
- Department of Surgery, Weill Cornell Medicine, 525 E. 68th Street, New York, NY, USA
| | - Daniel W Capron
- Department of Psychology, The University of Southern Mississippi, 118 College Drive, #5025, Hattiesburg, MS, USA
| |
Collapse
|
7
|
Substance use and suicide outcomes among self-injured trauma patients. Drug Alcohol Depend 2021; 226:108906. [PMID: 34315104 DOI: 10.1016/j.drugalcdep.2021.108906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/26/2021] [Accepted: 05/30/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Research indicates alcohol (AUD) or substance (SUD) use disorders and acute alcohol or drug use serve as risk factors for suicidal behaviors and death both distally and proximally to a suicidal event. However, limited research has investigated these relationships among medically serious suicide attempters at the time of injury without relying on cohorts of substance users only or by examining suicide decedent characteristics. METHODS Data were collected from the National Trauma Data Bank (NTDB) for 2017. The sample comprised patients who engaged in suicidal and self-injurious acts that were medically serious enough to require trauma admission and were tested for alcohol (N = 9,196) or drug (N = 8,121) exposure upon admission. Logistic regression determined relationships between acute alcohol/substance use, presence of AUDs and SUDs and suicide mortality risk, while linear regression evaluated substance conditions and injury severity and length of stay (LOS). RESULTS AUDs (OR = 0.59[0.42-0.83]) and SUDs (OR = 0.66[0.48-0.90]) had reduced odds of death but increased LOS (β = 1.7, p < .001; β = 0.82, p = .024). Blood alcohol concentration (BAC) was positively associated with reduced odds of death (OR = 0.20[0.06-0.61]), injury severity (β = -5.3, p < .001), and LOS (β = -7.5, p < .001). Presence of cocaine (β = -0.80, p = .044) and opioids (β = -1.4, p < .001) were associated lower injury severity, while MDMA (β = 3.6, p = .016) and methamphetamine (β = 1.5, p = .025) were associated with increased injury severity. CONCLUSIONS While higher BAC may be associated with lower odds of mortality during a single high-risk suicide event, substance users may be at increased risk for worse outcomes over time. Targeted interventions should be considered to interrupt and develop healthy alternatives for survivors with substance use conditions.
Collapse
|
8
|
Weiss R, He C, Gise R, Parsikia A, Mbekeani JN. Patterns of Pediatric Firearm-Related Ocular Trauma in the United States. JAMA Ophthalmol 2021; 137:1363-1370. [PMID: 31600369 DOI: 10.1001/jamaophthalmol.2019.3562] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Gun violence represents a substantial public health issue, and firearm-related injuries rank second among the causes of injury-related deaths in children aged 0 to 17 years in the United States. Ocular trauma from firearm-related injuries can lead to devastating vision loss, but little is known to date about the specific demographics and characteristics of such injuries in children. Objective To evaluate the epidemiologic pattern of pediatric firearm-related ocular injuries. Design, Setting, and Participants This retrospective analysis used deidentified data from the National Trauma Data Bank, the largest national registry of hospitalized trauma cases in the United States. The firearm-related ocular injuries (n = 1972) of pediatric patients (defined as those younger than 21 years) hospitalized between January 1, 2008, and December 31, 2014, were analyzed. Statistical analyses were conducted from July 15, 2017, to June 15, 2019. Exposure Firearm-related ocular trauma. Main Outcomes and Measures Pediatric patients with firearm-related ocular injuries were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes and external causes of injury codes. Patient demographics (age, sex, and race/ethnicity), type of ocular injury, injury intent, geographic location, length of hospital admission, health insurance status, disposition at discharge, Injury Severity Score (ISS), and Glasgow Coma Scale (GCS) score were collected. Results A total of 8715 firearm-related ocular injuries were identified. Of these injuries, 1972 (22.6%) occurred in pediatric patients, most of whom were male (1678 [85.1%]) and adolescents (1037 [52.6%]), with a mean (SD) age of 15.2 (5) years. Common locations of injury were home (761 [38.6%]) and street (490 [24.8%]). Mean (SD) hospital length of stay was 7.6 (12) days, ISS was 16 (13.1), and GCS score was 11 (5.1). The most common types of firearm-related ocular injuries were open wound of the eyeball (820 [41.6%]) and ocular adnexa (502 [25.5%]), orbital injuries or fractures (591 [30.0%]), and contusion of the eye or adnexa (417 [21.1%]). Patients aged 0 to 3 years had greater odds of unintentional injuries (odds ratio [OR], 4.41; 95% CI, 2.51-7.75; P < .001) and injuries occurring at home (OR, 5.39; 95% CI, 2.81-10.38; P < .001), and those aged 19 to 21 years had greater odds of assault injuries (OR, 2.17; 95% CI, 1.77-2.66; P < .001) and injuries occurring on the street (OR, 1.61; 95% CI, 1.3-1.98; P < .001). Black patients had the greatest odds of having injuries with assault intention (OR, 4.53; 95% CI, 3.68-5.59; P < .001), and white patients had the greatest likelihood for self-inflicted injury (OR, 7.1; 95% CI, 5.92-9.51; P < .001). Traumatic brain injury resulted mostly from self-inflicted trauma (OR, 5.99; 95% CI, 4.16-8.63; P < .001), as did visual pathway injuries (OR, 2.86; 95% CI, 1.95-4.20; P < .001). The inpatient mortality rate was 12.2%. Conclusions and Relevance This study found that pediatric firearm-related ocular injuries from 2008 through 2014 were predominantly sight-threatening and associated with traumatic brain injury. If the possible risk factors, including sex, age, race/ethnicity, and injury intention, can be confirmed for 2015 through 2019, these findings may be useful in developing strategies to prevent pediatric firearm-related ocular injuries.
Collapse
Affiliation(s)
- Rebecca Weiss
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York.,Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York
| | - Catherine He
- Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York
| | - Ryan Gise
- Neuro-Ophthalmology Service, Massachusetts Eye and Ear Infirmary, Boston
| | - Afshin Parsikia
- Department of Surgery (Trauma), Jacobi Medical Center, Bronx, New York
| | - Joyce N Mbekeani
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Bronx, New York.,Department of Ophthalmology and Visual Sciences, Albert Einstein College of Medicine, Bronx, New York.,Department of Surgery (Ophthalmology), Jacobi Medical Center, Bronx, New York
| |
Collapse
|
9
|
Katayama Y, Kiyohara K, Kitamura T, Hirose T, Ishida K, Umemura Y, Kiguchi T, Nakao S, Tachino J, Noda T, Shimazu T. Impact of medical reimbursement revision on ambulance transport of self-inflicted injury patients: a nationwide study in Japan. Acute Med Surg 2021; 8:e693. [PMID: 34589230 PMCID: PMC8459587 DOI: 10.1002/ams2.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/03/2021] [Accepted: 08/28/2021] [Indexed: 11/25/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kosuke Kiyohara
- Department of Food ScienceFaculty of Home EconomicsOtsuma Women’s University TokyoTokyoJapan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population SciencesDepartment of Social and Environmental MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical CenterOsaka National HospitalNational Hospital OrganizationOsakaJapan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical CareOsaka General Medical CenterOsakaJapan
- Kyoto University Health ServicesKyotoJapan
| | - Shunichiro Nakao
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| | - Tomohiro Noda
- Department of Traumatology and Critical Care MedicineOsaka City University Graduate School of MedicineOsakaJapan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical MedicineOsaka University Graduate School of MedicineSuitaJapan
| |
Collapse
|
10
|
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.
Collapse
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.
| |
Collapse
|
11
|
Cheon J, Oh D, Lee J, Ahn J, Song DH, Cheon KA. Increasing Trend and Characteristics of Korean Adolescents Presenting to Emergency Department for Self-Harm: A 5-Year Experience, 2015 to 2019. Yonsei Med J 2020; 61:614-622. [PMID: 32608205 PMCID: PMC7329735 DOI: 10.3349/ymj.2020.61.7.614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/24/2020] [Accepted: 05/18/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Emergency department (ED) is a common treatment setting for adolescents with clinically serious self-harm. Here, we investigated the clinical characteristics and trends of adolescents with self-harm who visited the ED in one Korean university hospital. We also compared patients with a single ED visit to those with multiple ED visits to identify the risk factor of repeated visits. MATERIALS AND METHODS We retrospectively identified patients aged 12 to 18 years who presented to ED for self-harm from January 2015 to December 2019, based on electronic medical records. Self-harm included all thoughts and behaviors indicating intents to harm or hurt oneself, regardless of the degree of such attempt. RESULTS A total of 168 individuals (male:female=31:137; average 15.99±1.64 years) presented to ED following 304 episodes (45 and 259 episodes in males and females, respectively). The number of episodes steeply increased between 2016 and 2019, and the overall number during the study showed an increasing trend (p=0.043). Repeated ED visitors with self-harm showed more history of psychiatric treatment/admission (58.3% vs. 85.4%, p=0.002; 14.2% vs. 43.9%, p<0.001), history of child abuse (32.3% vs. 53.7%, p=0.013), and familial psychiatric history (13.4% vs. 31.7%, p=0.008) compared to those with a single visit. CONCLUSION Among Korean adolescents, the number of ED visits and repetition of ED visits for self-harm is on the rise. For adolescents presenting to ED with self-harm, the history of psychiatric treatment/admission, child abuse, and familial psychiatric history should be properly obtained to identify the risk for multiple ED visits.
Collapse
Affiliation(s)
- Jooah Cheon
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Donghun Oh
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Junghan Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jaeun Ahn
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ho Song
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Keun Ah Cheon
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
12
|
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.
Collapse
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
| | | |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Gardner W, Pajer K, Cloutier P, Zemek R, Currie L, Hatcher S, Colman I, Bell D, Gray C, Cappelli M, Duque DR, Lima I. Changing Rates of Self-Harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-Sectional Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2019; 64:789-797. [PMID: 31184929 PMCID: PMC6882075 DOI: 10.1177/0706743719854070] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To document the rates of intentional self-harm and mental disorders among youths aged 13 to 17 years visiting Ontario emergency departments (EDs) from 2003-2017. METHODS This was a repeated cross-sectional observational design. Outcomes were rates of adolescents with (1) at least 1 self-harm ED visit and (2) a visit with a mental disorder code. RESULTS Rates of youths with self-harm visits fell 32% from 2.6/1000 in 2003 to 1.8 in 2009 but rose 135% to 4.2 by 2017. The slope of the trend in self-harm visits changed from -0.18 youths/1000/year (confidence interval [CI], -0.24 to -0.13) during 2003 to 2009 to 0.31 youths/1000/year (CI, 0.27 to 0.35) during 2009 to 2017 (P < 0.001). Rates of youths with mental health visits rose from 11.7/1000 in 2003 to 13.5 in 2009 (15%) and to 24.1 (78%) by 2017. The slope of mental health visits changed from 0.22 youths/1000/year (CI, 0.02 to 0.42) during 2003 to 2009 to 1.84 youths/1000/year (CI, 1.38 to 2.30) in 2009 to 2017 (P < 0.001). Females were more likely to have self-harm (P < 0.001) and mental health visits (P < 0.001). Rates of increase after 2009 were greater for females for both self-harm (P < 0.001) and mental health (P < 0.001). CONCLUSIONS Rates of adolescents with self-harm and mental health ED visits have increased since 2009, with greater increases among females. Research is required on the determinants of adolescents' self-harm and mental health ED visits and how they can be addressed in that setting. Sufficient treatment resources must be supplied to address increased demands for services.
Collapse
Affiliation(s)
- William Gardner
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathleen Pajer
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Paula Cloutier
- Research Institute, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Roger Zemek
- Department of Pediatrics & Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Currie
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian Colman
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Dayna Bell
- Department of Pediatrics & Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clare Gray
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Daniel Rodriguez Duque
- Department of Epidemiology, Biostatistics, and Public Health, McGill University, Montreal, Quebec, Canada
| | - Isac Lima
- ICES Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
15
|
Bai W, Specker B. Racial Differences in Hospitalizations Due to Injuries in South Dakota Children and Adolescents. J Racial Ethn Health Disparities 2019; 6:1087-1094. [PMID: 31301060 DOI: 10.1007/s40615-019-00611-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine racial differences and trends in pediatric injury hospitalization rates in a rural state. METHODS Hospital inpatient discharge data (2009-2014) for South Dakota residents aged 0-19 years were used to calculate annual hospitalization rates due to injuries. Race-, age-, and sex-specific rates were calculated, and trends over time were determined. RESULTS Between 2009 and 2014, there were 3701 pediatric hospitalizations (1008 American Indian [AI]; 2303 white) due to injuries at an average rate of 269/100,000 (95% CI 260-280/100,000). Injury hospitalization rates were higher for AI than white children (532 vs. 213 per 100,000, respectively; p < 0.001). Rates for both AI and white children increased between 2009 and 2014 (both, p < 0.001). Suicide attempts were the predominant manner of injury in both the 10-14- and 15-19-year age groups, with AI adolescents having 3.5 and 3.2 times higher rates than white adolescents. Among AI adolescents aged 15 to 19 years, hospitalizations due to homicide-related injuries were 12.6 times higher than that of white children. Injury hospitalization rates among females recently exceeded that of males, due primarily to an increase in attempted suicides. Mechanism and nature of hospitalized injuries were consistent with the high rate of suicide-related admissions. CONCLUSION South Dakota AI children have disproportionately higher hospitalization rates due to unintentional and attempted suicide- and homicide-related injuries, and the rate differences between AI and white children are increasing over time. Injury hospitalization rates among females have increased more rapidly and recently surpassed that of males.
Collapse
Affiliation(s)
- Wei Bai
- EA Martin Program, South Dakota State University, Brookings, SD, 57007, USA
| | - Bonny Specker
- EA Martin Program, South Dakota State University, Brookings, SD, 57007, USA.
| |
Collapse
|
16
|
Shafiq M. FREQUENCY, DISTRIBUTION AND TREATMENT OF ACUTE FLEXOR TENDON INJURIES IN ZONE V OF HAND. GOMAL JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.46903/gjms/17.01.1857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Flexor tendons injuries are common emergency procedures The objectives of this study were to determine the frequency, distribution and results of treatment of acute flexor tendon injuries in zone V of hand in our population. Material and Methods: This descriptive cross-sectional was conducted in the Department of Orthopedic, Gomal Medical College, D.I.Khan, Pakistan from January 2015 to December 2017. Sample size was 30, selected through consecutive technique. Patients having flexor tendon injuries in zone v, admitted through emergency department were included in this study. Demographic variable were sex and age-groups. The research variable were tendon involved, nerves involved, artery involved, mechanism of injury, wound size, duration of injury, season, type of injury, hand involved and results of treatment. All variables, being categorical were analyzed by frequency and percentages using SPSS version 16.0. Results: Out of 30 patients, 22(73.33%) were male. Twenty four (80%) patients were between 21 to 40 years age. Mechanism of injury was glass in 16(53.33%) cases, knife in 10(33.33%) cases. Twenty (66.66%) cases presented in summer. Flexor digitorum sublimus was injured in 21(70.0%), FCR in 11(36.66%), FPL in 8(26.66), FDP in 6(20.0%) and FCU in 4(13.33%) cases. Median nerve was involved in nine (30%) cases. Radial artery was involved in eight (26.66%) cases. Wound size was 2 cm in 24(80%) cases. Sixteen (53.33 %) cases came with self-inflicted injuries. Twenty (66.66 %) cases came after 12 hours. Twenty five (83.33%) patients achieved good to excellent results. Conclusion: Flexor digitorus sublimus was the most common tendon injured in non-dominant hand, especially in young males. Median nerve and radial artery were commonly injured structures mostly with glass. Majority patients presented more than 12 hours after injury, having wound size of 2cm. Mostly the injuries were self-inflicted and occurred in summer season.
Collapse
|
17
|
Cairns R, Karanges EA, Wong A, Brown JA, Robinson J, Pearson SA, Dawson AH, Buckley NA. Trends in self-poisoning and psychotropic drug use in people aged 5-19 years: a population-based retrospective cohort study in Australia. BMJ Open 2019; 9:e026001. [PMID: 30787095 PMCID: PMC6398641 DOI: 10.1136/bmjopen-2018-026001] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES To characterise trends in self-poisoning and psychotropic medicine use in young Australians. DESIGN Population-based retrospective cohort study. SETTING Calls taken by the New South Wales and Victorian Poisons Information Centres (2006-2016, accounting for 70% of Australian poisoning calls); medicine dispensings in the 10% sample of Australian Pharmaceutical Benefits Scheme data (July 2012 to June 2016). PARTICIPANTS People aged 5-19 years. MAIN OUTCOME MEASURES Yearly trends in intentional poisoning exposure calls, substances taken in intentional poisonings, a prevalence of psychotropic use (dispensing of antidepressants, antipsychotics, benzodiazepines and medicines for attention deficit hyperactivity disorder (ADHD)). RESULTS There were 33 501 intentional poisonings in people aged 5-19 years, with an increase of 8.39% per year (95% CI 6.08% to 10.74%, p<0.0001), with a 98% increase overall, 2006-2016. This effect was driven by increased poisonings in those born after 1997, suggesting a birth cohort effect. Females outnumbered males 3:1. Substances most commonly taken in self-poisonings were paracetamol, ibuprofen, fluoxetine, ethanol, quetiapine, paracetamol/opioid combinations, sertraline and escitalopram. Psychotropic dispensing also increased, with selective serotonin reuptake inhibitors (SSRIs) increasing 40% and 35% July 2012 to June 2016 in those aged 5-14 and 15-19, respectively. Fluoxetine was the most dispensed SSRI. Antipsychotics increased by 13% and 10%, while ADHD medication dispensing increased by 16% and 10%, in those aged 5-14 and 15-19, respectively. Conversely, dispensing of benzodiazepines to these age groups decreased by 4% and 5%, respectively. CONCLUSIONS Our results signal a generation that is increasingly engaging in self-harm and is increasingly prescribed psychotropic medications. These findings indicate growing mental distress in this cohort. Since people who self-harm are at increased risk of suicide later in life, these results may foretell future increases in suicide rates in Australia.
Collapse
Affiliation(s)
- Rose Cairns
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily A Karanges
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anselm Wong
- Victorian Poisons Information Centre and Austin Toxicology Service, Austin Health, Heidelberg, Victoria, Australia
| | - Jared A Brown
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jeff Robinson
- Victorian Poisons Information Centre, Austin Health, Heidelberg, Victoria, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew H Dawson
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas A Buckley
- NSW Poisons Information Centre, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Pharmacology, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
18
|
Goldman-Mellor S, Kwan K, Boyajian J, Gruenewald P, Brown P, Wiebe D, Cerdá M. Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study. Gen Hosp Psychiatry 2019; 56:28-35. [PMID: 30553125 PMCID: PMC6353680 DOI: 10.1016/j.genhosppsych.2018.12.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 11/29/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated patient- and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm. METHOD Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n = 480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm. RESULTS Self-harm patients (n = 5539) were significantly more likely than control patients (n = 16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk. CONCLUSIONS A range of patient- and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.
Collapse
Affiliation(s)
- Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Kevin Kwan
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | - Jonathan Boyajian
- Department of Public Health, 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.
| | - Paul Brown
- 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.
| | - Magdalena Cerdá
- Violence Prevention Research Program, University of California, Davis, Sacramento, CA 95817, USA.
| |
Collapse
|
19
|
Cutler GJ, Rodean J, Zima BT, Doupnik SK, Zagel AL, Bergmann KR, Hoffmann JA, Neuman MI. Trends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit. Acad Pediatr 2019; 19:948-955. [PMID: 31175994 PMCID: PMC7122010 DOI: 10.1016/j.acap.2019.05.132] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/11/2019] [Accepted: 05/31/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine trends in mental health (MH) visits to pediatric emergency departments (EDs) and identify whether ED disposition varies by presence of a hospital inpatient psychiatric unit (IPU). STUDY DESIGN Cross-sectional study of 8,479,311 ED visits to 35 children's hospitals from 2012 to 2016 for patients aged 3 to 21 years with a primary MH or non-MH diagnosis. Multivariable generalized estimating equations and bivariate Rao-Scott chi-square tests were used to examine trends in ED visits and ED disposition by IPU status, adjusted for clustering by hospital. RESULTS From 2012 to 2016, hospitals experienced a greater increase in ED visits with a primary MH versus non-MH diagnosis (50.7% vs 12.7% cumulative increase, P < .001). MH visits were associated with patients who were older, female, white non-Hispanic, and privately insured compared with patients of non-MH visits (all P < .001). Forty-four percent of MH visits in 2016 had a primary diagnosis of depressive disorders or suicide or self-injury, and the increase in visits was highest for these diagnosis groups (depression: 109.8%; suicide or self-injury: 110.2%). Among MH visits, presence of a hospital IPU was associated with increased hospitalizations (34.6% vs 22.5%, P < .001) and less transfers (9.2% vs 16.2%, P < .001). CONCLUSION The increase in ED MH visits from 2012 to 2016 was 4 times greater than non-MH visits at US children's hospitals and was primarily driven by patients diagnosed with depressive disorders and suicide or self-injury. Our findings have implications for strategic planning in tertiary children's hospitals dealing with a rising demand for acute MH care.
Collapse
Affiliation(s)
- Gretchen J Cutler
- Children's Minnesota Research Institute (CJ Cutler, AL Zagel), Children's Minnesota, Minneapolis, Minn.
| | | | - Bonnie T Zima
- UCLA Semel Institute for Neuroscience and Human Behavior (B Zima), University of California at Los Angeles, Los Angeles, Calif
| | - Stephanie K Doupnik
- Division of General Pediatrics (SK Doupnik), PolicyLab, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pa
| | - Alicia L Zagel
- Children's Minnesota Research Institute (CJ Cutler, AL Zagel), Children's Minnesota, Minneapolis, Minn
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine (KR Bergman), Children's Minnesota, South, Minneapolis, Minn
| | - Jennifer A Hoffmann
- Division of Emergency Medicine (JA Hoffmann, MI Neuman), Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mark I Neuman
- Division of Emergency Medicine (JA Hoffmann, MI Neuman), Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| |
Collapse
|
20
|
Jackman K, Edgar B, Ling A, Honig J, Bockting W. Experiences of transmasculine spectrum people who report nonsuicidal self-injury: A qualitative investigation. J Couns Psychol 2018; 65:586-597. [PMID: 30070562 DOI: 10.1037/cou0000304] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock's model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgender man, genderqueer, or nonbinary and who were assigned female at birth) who engage in NSSI. Qualitative interviews were conducted with transmasculine spectrum people (N = 18) who reported a history of NSSI. Their mean age was 24.9 years old (SD = 5.43, range = 17-38). Participants reported that NSSI was influenced by a variety of factors including stress from gender nonconformity in childhood and adolescence. Stigma related to minority status and identity as well as proximal minority stress processes of concealment and expectations of rejection were identified as contributing to NSSI. Transgender identity development tasks such as coming out and identity exploration also appeared to affect NSSI. Finding a community of peers who engage in NSSI was helpful in mitigating social isolation, but at times reinforced NSSI. We discuss clinical implications at the individual and family levels. Interventions to reduce NSSI among transmasculine-spectrum people should include facilitating connections with gender minority peers and providing individual support and family interventions to facilitate transgender identity development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
|
21
|
Shenoi RP, Camp EA, Rubalcava DM, Cruz AT. Characteristics and outcomes of acute pediatric blunt torso trauma based on injury intent. Am J Emerg Med 2017; 35:1791-1797. [PMID: 28592374 DOI: 10.1016/j.ajem.2017.05.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/28/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Blunt trauma is a leading cause of pediatric morbidity. We compared injuries, interventions and outcomes of acute pediatric blunt torso trauma based on intent. METHODS We analyzed de-identified data from a prospective, multi-center emergency department (ED)-based observational cohort of children under age eighteen. Injuries were classified based on intent (unintentional/inflicted). We compared demographic, physical and laboratory findings, ED disposition, hospitalization, need for surgery, 30-day mortality, and cause of death between groups using Chi-squared or Fisher's test for categorical variables, and Mann-Whitney test for non-normal continuous factors comparing median values and interquartile ranges (IQR). RESULTS There were 12,044 children who sustained blunt torso trauma: Inflicted=720 (6%); Unintentional=9563 (79.4%); Indeterminate=148 (1.2%); Missing=1613 (13.4%). Patients with unintentional torso injuries significantly differed from those with inflicted injuries in median age in years (IQR) [10 (5, 15) vs. 14 (8, 16); p-value<0.001], race, presence of pelvic fractures, hospitalization and need for non-abdominal surgery. Mortality rates did not differ based on intent. Further adjustment using binary, logistic regression revealed that the risk of pelvic fractures in the inflicted group was 96% less than the unintentional group (OR: 0.04; 95%CI: 0.01-0.26; p-value=0.001). CONCLUSIONS Children who sustain acute blunt torso trauma due to unintentional causes have a significantly higher risk of pelvic fractures and are more likely to be hospitalized compared to those with inflicted injuries.
Collapse
Affiliation(s)
- Rohit P Shenoi
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, TX, United States.
| | - Elizabeth A Camp
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, TX, United States.
| | - Daniel M Rubalcava
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, TX, United States.
| | - Andrea T Cruz
- Department of Pediatrics, Baylor College of Medicine, 6621 Fannin, Suite A 2210, Houston, TX, United States.
| |
Collapse
|
22
|
Zanus C, Battistutta S, Aliverti R, Montico M, Cremaschi S, Ronfani L, Monasta L, Carrozzi M. Adolescent Admissions to Emergency Departments for Self-Injurious Thoughts and Behaviors. PLoS One 2017; 12:e0170979. [PMID: 28125701 PMCID: PMC5268645 DOI: 10.1371/journal.pone.0170979] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 01/13/2017] [Indexed: 12/23/2022] Open
Abstract
The objective of the present study was to describe the incidence and the characteristics of Self-Injurious Thoughts and Behaviors (SITBs), among adolescents aged 11–18 admitted, over a two year period, to all the Emergency Departments of a Region of North-eastern Italy through a comprehensive analysis of medical records. A two-step search was performed in the regional ED electronic database. First, we identified the cases that had been clearly diagnosed as SITBs by an Emergency Department physician. Secondly, suspect cases were detected through a keyword search of the database, and the medical records of these cases were hand screened to identify SITBs. The mean annual incidence rate of SITBs was 90 per 100,000 adolescents aged 11–18 years. Events were more frequent in females. Drug poisoning was the most frequently adopted method (54%). In 42% of cases a diagnosis of SITB was not explicitly reported by the physician. In 65% of cases adolescents were discharged within hours of admission. Only 9% of patients started a psychiatric assessment and treatment program during hospital stay. This research confirms the high incidence of SITBs among adolescents and highlights the difficulty in their proper diagnosis and management. Such difficulty is confirmed by the fact that only a few patients, even among those with a clear diagnosis, were sent for psychiatric assessment. Correct identification and management of SITB patients needs to be improved, since SITBs are an important public health problem in adolescence and one of the main risk factors for suicide.
Collapse
Affiliation(s)
- Caterina Zanus
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Sara Battistutta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Renata Aliverti
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Marcella Montico
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Silvana Cremaschi
- Child and Adolescent Neuropsychiatry Service, ASS4 Medio Friuli, Udine, Italy
| | - Luca Ronfani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Lorenzo Monasta
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
- * E-mail:
| | - Marco Carrozzi
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo”, Trieste, Italy
| |
Collapse
|
23
|
Rosychuk RJ, Johnson DW, Urichuk L, Dong K, Newton AS. Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada. BMC Psychiatry 2016; 16:229. [PMID: 27400782 PMCID: PMC4940757 DOI: 10.1186/s12888-016-0941-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 06/20/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit. METHODS We extracted a population-based cohort of adolescents aged 15-17 years (n = 3,927) with ED visits during 2002-2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan. RESULTS The rates decreased over time for ED visits for self-harm (differences: girls -199.6/100,000; p < 0.01; boys -58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls -108.3/100,000; p < 0.01; boys -61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002-2006 (p < 0.01) and (2) a South zone cluster during 2003-2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01). CONCLUSIONS The rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.
Collapse
Affiliation(s)
- Rhonda J. Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada ,Women & Children’s Health Research Institute, Edmonton, AB Canada ,Department of Pediatrics, University of Alberta, Rm 3–524, Edmonton Clinic Health Academy (ECHA), 11405 87 Avenue NW, Edmonton, AB T6G 1C9 Canada
| | - David W. Johnson
- Department of Pedatrics, Cumming School of Medicine, University of Calgary, Calgary, AB Canada ,Department of Pharmacology and Physiology, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Liana Urichuk
- Addiction & Mental Health, Alberta Health Services, Edmonton, AB Canada ,Department of Psychiatry, University of Alberta, Edmonton, AB Canada
| | - Kathryn Dong
- Department of Emergency Medicine, University of Alberta, Edmonton, AB Canada
| | - Amanda S. Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB Canada ,Women & Children’s Health Research Institute, Edmonton, AB Canada
| |
Collapse
|
24
|
Bell TM, Qiao N, Jenkins PC, Siedlecki CB, Fecher AM. Trends in Emergency Department Visits for Nonfatal Violence-Related Injuries Among Adolescents in the United States, 2009-2013. J Adolesc Health 2016; 58:573-5. [PMID: 26907850 DOI: 10.1016/j.jadohealth.2015.12.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 12/07/2015] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Violence-related injuries are a major cause of death and disability among adolescents in the United States. The objective of this study was to examine trends in adolescent violence-related injuries between 2009 and 2013. METHODS This study examined data from the National Electronic Injury Surveillance System-All Injury Program for years 2009-2013. Linear regression was used to assess trends in rates of violence-related injuries among adolescents aged between 10 and 19 years. RESULTS We found overall rates of nonfatal violence-related injuries among all adolescents did not change significantly across the study years (p = .502). However, self-harm injury rates have significantly increased among female and younger adolescents during the period (p = .001 and .011, respectively). CONCLUSIONS Our results indicate that the overall intentional injury rates in adolescents have been stable; however, rates of self-injury have significantly increased in younger adolescents and females. Future research should focus on exploring causes of increases in self-harm injuries in these subpopulations.
Collapse
Affiliation(s)
- Teresa M Bell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana.
| | - Nan Qiao
- Department of Economics, Indiana University, Indianapolis, Indiana
| | - Peter C Jenkins
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Charles B Siedlecki
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alison M Fecher
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| |
Collapse
|