Citation

Goldman-Mellor S, Phillips D, Brown P, Gruenewald P, Cerdá M, Wiebe D. Psychiatr. Serv. 2019; ePub(ePub): appips201900153.

Affiliation

Department of Public Health (Goldman-Mellor, Phillips, Brown), Department of Psychology (Wiebe), School of Social Sciences, Humanities, and Arts, University of California, Merced; Prevention Research Center, Pacific Institute for Research and Evaluation; Oakland, California (Gruenewald); Department of Population Health, New York University; New York (Cerdá).

Copyright

(Copyright © 2019, American Psychiatric Association)

DOI

10.1176/appi.ps.201900153

PMID

31575352

Abstract

OBJECTIVE: Self-harm rates among U.S. adolescents have risen substantially. Health and social outcomes among contemporary self-harming youths are infrequently tracked and poorly understood. This study investigated long-term health service utilization (emergency department [ED] visits and inpatient admissions) and inpatient costs among a recent cohort of adolescents with deliberate self-harm.

METHODS: This retrospective cohort study used statewide, all-payer, longitudinally linked discharge data from California. All residents ages 10-19 presenting to EDs in 2010 with deliberate self-harm (N=5,396) were compared with two control groups: a random sample of adolescent ED patients with other complaints, matched on sex, age, residential zip code, and month of index visit (general control patients, N=14,921), and matched ED patients with psychiatric complaints but no self-harm (psychiatric control patients, N=15,835). Outcomes included 5-year rates of ED visits, inpatient admissions, and inpatient costs, overall and for psychiatric and nonpsychiatric complaints separately.

RESULTS: Self-harm patients' ED use, inpatient admissions, and inpatient costs were significantly higher than those of general control patients (by 39%, 81%, and 21%, respectively), when the analysis controlled for confounding demographic and utilization characteristics. Associations mostly persisted, although smaller in magnitude, in comparisons between self-harm and psychiatric control patients. Psychiatric and nonpsychiatric complaints contributed to self-harming adolescents' excess health service utilization and costs.

CONCLUSIONS: Deliberate self-harm among adolescents was found to be associated with long-lasting and costly patterns of health service utilization, often but not exclusively for psychiatric complaints. Future research should investigate the pathways underlying these associations and incorporate service utilization as a key patient outcome.

Language: en

Keywords

Adolescents/adolescence; Suicide and self-destructive behavior