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CMAJ. 2019 Nov 4;191(44):E1207-E1216. doi: 10.1503/cmaj.190188.

Health outcomes associated with emergency department visits by adolescents for self-harm: a propensity-matched cohort study.

Author information

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.

PMID:
31685664
DOI:
10.1503/cmaj.190188

Conflict of interest statement

Competing interests: William Gardner reports receiving grants from the Canadian Institutes of Health Research and research contracts from the Public Health Agency of Canada and the US Centers for Disease Control. Dr. Gardner is also the CHEO and University of Ottawa Senior Research Chair in Child and Adolescent Psychiatry. Ian Colman is a Canada Research Chair in mental health epidemiology. Roger Zemek reports receiving competitively funded research grants from the Canadian Institutes of Health Research, Ontario Neurotrauma Foundation, Physician Services Incorporated Foundation, CHEO Foundation, Ontario Brain Institute, the Ontario SPOR Support Unit and the National Football League. Dr. Zemek is also the Clinical Research Chair in Pediatric Concussion at University of Ottawa. No other competing interests were declared.

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