Cristina Lidón-Moyano1, Deborah Wiebe2, Paul Gruenewald3, Magdalena Cerdá4, Paul Brown5, Sidra Goldman-Mellor6. 1. Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA. Electronic address: clidon-moyano@ucmerced.edu. 2. Department of Psychology, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA. Electronic address: dwiebe@ucmerced.edu. 3. Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA. Electronic address: paul@prev.org. 4. Violence Prevention Research Program, University of California, Davis, Sacramento, CA 95817, USA. Electronic address: cerda@ucdavis.edu. 5. Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA. Electronic address: pbrown3@ucmerced.edu. 6. Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA. Electronic address: sgoldman-mellor@ucmerced.edu.
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.
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 psychiatricpatients 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 psychiatricpatients 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 psychiatricpatients should be attended to, potentially involving new models of clinical follow-up care.
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