Dataset Information

Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data.

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.

SUBMITTER: Lidon-Moyano C

PROVIDER: S-EPMC6443424 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Publications

Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data.

Lidón-Moyano Cristina C Wiebe Deborah D Gruenewald Paul P Cerdá Magdalena M Brown Paul P Goldman-Mellor Sidra S

Journal of adolescence 20190320

<h4>Introduction</h4>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.<h4>Methods</h4>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 ...[more]

PMID: 30903930

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Project description:BackgroundPresentation to the emergency department (ED) with an index episode of self-harm is recognised as a risk factor for subsequent repeated self-harm and suicide. We describe demographic and clinical characteristics of adults (>18 years) presenting with mental health problems and self-harm to EDs in Queensland, Australia, and identify risk factors associated with repeated self-harm and suicide.MethodsThis was a state-wide retrospective cohort study of adults presenting with an index self-harm presentation to any of the 27 public EDs in Queensland, Australia, over six years (1st January 2012 to 31st December 2017). We linked ED records with a state-wide death register. Primary outcomes were re-presentation with self-harm, or death by suicide. We constructed a multivariable Cox regression model to identify independent risk factors for re-presentation with self-harm, or death by suicide. We calculated the risk of repeated ED presentation for self-harm and suicide at 12- and 24-months.FindingsDuring the study period, 43,797 individuals presented to Queensland EDs with a self-harm related diagnosis. Half of the cohort were female (n = 20,980, 47.9%) and under age 35 (n = 23,871, 54.5%). A quarter (n = 10,991; 25.1%) had a repeated episode of self-harm and 515 (1.2%) died by suicide. Socioeconomic disadvantage, arrival by ambulance, self-presentation, small/medium hospital size, less-urgent triage category, not admitted status and previous mental health or physical health visits were associated with a re-presentation with self-harm. Suicide was associated with male sex, older age, and hospital admission. The repeated self-harm risk was 18.9% (95%CI, 18.5%-19.3%) at 12-months and 24.3% (95%CI, 23.9%-24.7%) at 24-months. The suicide risk was 0.7% (95%CI, 0.6%-0.7%) at 12-months and 1.0% (95%CI, 0.9%-1.1%) at 24-months.InterpretationOne in four people re-presented to ED with self-harm. Suicide was particularly associated with older males. Implementing evidence-based interventions to support people presenting to ED with self-harm should be a public health priority.FundingThis study was funded by an Emergency Medicine Foundation (EMF) grant (EMJS-382-R35-2021) and a National Health and Research Council Grant (1121898).

Project description:AimsSuicidal ideation constitutes a central element of most theories of suicide and is the defining facet separating suicide from other causes of death such as accidents. However, despite a high worldwide prevalence, most research has focused on suicidal behaviours, such as completed suicide and suicide attempts, while the greater proportion who experienced ideation, which frequently precedes suicidal behaviour, have received much less attention. This study aims to examine the characteristics of those presenting to EDs with suicidal ideation and quantify the associated risk of suicide and other causes of death.MethodsRetrospective cohort study was performed based on population-wide health administration data linked to data from the Northern Ireland Registry of Self-Harm and centrally held mortality records from April 2012 to December 2019. Mortality data, coded as suicide, all-external causes and all-cause mortality were analysed using Cox proportional hazards. Additional cause-specific analyses included accidental deaths, deaths from natural causes and drug and alcohol-related causes.ResultsThere were 1,662,118 individuals aged over 10 years, of whom 15,267 presented to the ED with ideation during the study period. Individuals with ideation had a 10-fold increased risk of death from suicide (hazard ratio [HRadj] = 10.84, 95% confidence interval [CI] 9.18, 12.80) and from all-external causes (HRadj = 10.65, 95% CI 9.66, 11.74) and a threefold risk of death from all-causes (HRadj = 3.01, 95% CI 2.84, 3.20). Further cause-specific analyses indicated that risk of accidental death (HRadj = 8.24, 95% CI 6.29, 10.81), drug-related (HRadj = 15.17, 95% CI 11.36, 20.26) and alcohol-related (HRadj = 10.57, 95% CI 9.07, 12.31) has also significantly increased. There were few socio-demographic and economic characteristics that would identify which of these patients are most at risk of suicide or other causes of death.ConclusionsIdentifying people with suicidal ideation is recognized to be both important but difficult in practice; this study shows that presentations to EDs with self-harm or suicide ideation represent an important potential intervention point for this hard-to-reach vulnerable population. However, and unlike individuals presenting with self-harm, clinical guidelines for the management and recommended best practice and care of these individuals are lacking. Whilst suicide prevention may be the primary focus of interventions aimed at those experiencing self-harm and suicide ideation, death from other preventable causes, especially substance misuse, should also be a cause of concern.

Dataset Information

Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data.

Introduction

Methods

Results

Conclusions

Publications

Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data.

Similar Datasets

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