William Gardner1, Kathleen Pajer2, Paula Cloutier2, Lisa Currie2, Ian Colman2, Roger Zemek2, Simon Hatcher2, Isac Lima2, Mario Cappelli2. 1. School of Epidemiology & Public Health (Gardner, Currie, Colman), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Gardner, Cloutier, Zemek, Cappelli); Departments of Psychiatry (Pajer) and Pediatrics (Zemek), University of Ottawa; The Ottawa Hospital Research Institute (Hatcher, Lima); ICES uOttawa (Lima), Ottawa, Ont. wgardner@cheo.on.ca. 2. School of Epidemiology & Public Health (Gardner, Currie, Colman), University of Ottawa; Children's Hospital of Eastern Ontario Research Institute (Gardner, Cloutier, Zemek, Cappelli); Departments of Psychiatry (Pajer) and Pediatrics (Zemek), University of Ottawa; The Ottawa Hospital Research Institute (Hatcher, Lima); ICES uOttawa (Lima), Ottawa, Ont.
Abstract
BACKGROUND: Self-harm is increasing among adolescents, and because of changing behaviours, current data are needed on the consequences of self-harm. We sought to investigate the trends related to hospital presentation, readmission, patient outcome and medical costs in adolescents who presented with self-harm to the emergency department. METHODS: We used administrative data on 403 805 adolescents aged 13-17 years presenting to Ontario emergency departments in 2011-2013. Adolescents with self-harm visits were 1:2 propensity matched to controls with visits without self-harm, using demographic, mental health and other clinical variables. Five years after the index presentation, hospital or emergency department admission rates for self-harm, overall mortality, suicides and conservative cost estimates were compared between the 2 groups. RESULTS: Of 5832 adolescents who visited Ontario emergency departments in 2011-2013 after self-harm (1.4% of visits), 5661 were matched to 10 731 adolescents who presented for reasons other than self-harm. Adolescents who presented with self-harm had a shorter time to a repeat emergency department or hospital admission for self-harm (hazard ratio [HR] 4.84, 95% confidence interval [CI] 4.44-5.27), more suicides (HR 7.96, 95% CI 4.00-15.86), and higher overall mortality (HR 3.23, 95% CI 2.12-4.93; p < 0.001). The positive predictive value of self-harm-related emergency department visits for suicide was 0.7%. Adolescents with self-harm visits had mean 5-year estimates of health care costs of $30 388 compared with $19 055 for controls (p < 0.001). INTERPRETATION: Adolescents with emergency department visits for self-harm have higher rates of mortality, suicide and recurrent self-harm, as well as higher health care costs, than matched controls. Development of algorithms and interventions that can identify and help adolescents at highest risk of recurrent self-harm is warranted.
BACKGROUND: Self-harm is increasing among adolescents, and because of changing behaviours, current data are needed on the consequences of self-harm. We sought to investigate the trends related to hospital presentation, readmission, patient outcome and medical costs in adolescents who presented with self-harm to the emergency department. METHODS: We used administrative data on 403 805 adolescents aged 13-17 years presenting to Ontario emergency departments in 2011-2013. Adolescents with self-harm visits were 1:2 propensity matched to controls with visits without self-harm, using demographic, mental health and other clinical variables. Five years after the index presentation, hospital or emergency department admission rates for self-harm, overall mortality, suicides and conservative cost estimates were compared between the 2 groups. RESULTS: Of 5832 adolescents who visited Ontario emergency departments in 2011-2013 after self-harm (1.4% of visits), 5661 were matched to 10 731 adolescents who presented for reasons other than self-harm. Adolescents who presented with self-harm had a shorter time to a repeat emergency department or hospital admission for self-harm (hazard ratio [HR] 4.84, 95% confidence interval [CI] 4.44-5.27), more suicides (HR 7.96, 95% CI 4.00-15.86), and higher overall mortality (HR 3.23, 95% CI 2.12-4.93; p < 0.001). The positive predictive value of self-harm-related emergency department visits for suicide was 0.7%. Adolescents with self-harm visits had mean 5-year estimates of health care costs of $30 388 compared with $19 055 for controls (p < 0.001). INTERPRETATION: Adolescents with emergency department visits for self-harm have higher rates of mortality, suicide and recurrent self-harm, as well as higher health care costs, than matched controls. Development of algorithms and interventions that can identify and help adolescents at highest risk of recurrent self-harm is warranted.
Authors: Keith Hawton; Helen Bergen; Jayne Cooper; Pauline Turnbull; Keith Waters; Jennifer Ness; Nav Kapur Journal: J Affect Disord Date: 2015-01-08 Impact factor: 4.839
Authors: William Gardner; Kathleen Pajer; Paula Cloutier; Roger Zemek; Lisa Currie; Simon Hatcher; Ian Colman; Dayna Bell; Clare Gray; Mario Cappelli; Daniel Rodriguez Duque; Isac Lima Journal: Can J Psychiatry Date: 2019-06-11 Impact factor: 4.356
Authors: Rohan Borschmann; Denise Becker; Carolyn Coffey; Elizabeth Spry; Margarita Moreno-Betancur; Paul Moran; George C Patton Journal: Lancet Child Adolesc Health Date: 2017-07-08