Association Between Social Determinants of Health and Deliberate Self-Harm Among Youths With Psychiatric Diagnoses
Abstract
Objective:
Methods:
Results:
Conclusions:
HIGHLIGHTS
Methods
Study Design and Cohort
Data Sources
Measures
Dependent variable.
SDoHs.
Covariates.
Statistical Analysis
Results
Demographic or clinical characteristic | N | % |
---|---|---|
Age at index date (M±SD years) | 12.9±2.4 | |
Sex | ||
Male | 133,167 | 54.4 |
Female | 111,791 | 45.6 |
Race-ethnicity | ||
Non-Hispanic White | 158,244 | 64.6 |
Non-Hispanic Black | 63,490 | 25.9 |
Hispanic | 10,434 | 4.3 |
Othera | 12,790 | 5.2 |
Eligibility status at index date | ||
Poverty | 212,892 | 86.9 |
Disability | 18,766 | 7.7 |
Foster care | 12,415 | 5.1 |
Otherb | 885 | .4 |
County of residence | ||
Metropolitan | 192,937 | 78.8 |
Nonmetropolitan | 52,021 | 21.2 |
Psychiatric conditionc,d | ||
Attention-deficit hyperactivity disorder | 97,257 | 39.7 |
Anxiety | 58,624 | 23.9 |
Bipolar disorder | 10,949 | 4.5 |
Conduct disorder or oppositional defiant disorder | 47,464 | 19.4 |
Depression | 64,214 | 26.2 |
Intellectual disability | 21,838 | 8.9 |
Personality disorder | 2,067 | .8 |
Schizophrenia | 3,556 | 1.5 |
Substance use disorder | 20,705 | 8.5 |
Chronic general medical conditiond | ||
None | 86,245 | 35.2 |
Noncomplex | 126,236 | 51.5 |
Complex | 32,477 | 13.3 |
History of suicidal ideation | 8,833 | 3.6 |
History of self-harm | 3,004 | 1.2 |
Previous inpatient mental health care | 3,567 | 1.5 |
Previous emergency room mental health care | 5,615 | 2.3 |
Previous outpatient mental health care | 124,754 | 50.9 |
Incident self-harm | 3,262 | 1.3 |
Prevalence of Adverse SDoHs
SDoH categoryc | Overalla (N=244,958) | Nonfatal self-harmb (N=3,262) | Unadjusted hazard ratiod | 99% CI | ||
---|---|---|---|---|---|---|
N | % | N | % | |||
Abuse and neglect | 32,556 | 13.3 | 1,061 | 33 | 5.03 | 4.57–5.54 |
Child welfare placement | 5,300 | 2.2 | 146 | 5 | 3.93 | 3.16–4.89 |
Disappearance or death of family member | 2,387 | 1.0 | 62 | 2 | 4.35 | 3.13–6.05 |
Educational problems | 6,667 | 2.7 | 79 | 2 | 1.95 | 1.46–2.62 |
Employment or financial problems | 1,557 | .6 | 28 | 1 | 3.81 | 2.33–6.21 |
Exposure to violence | 4,490 | 1.8 | 76 | 2 | 3.02 | 2.24–4.07 |
Family alcohol or drug use | 343 | .1 | 8 | <1 | 3.99 | 1.60–9.94 |
Family disruption by separation or divorce | 908 | .4 | 12 | <1 | 2.27 | 1.08–4.79 |
Housing instability | 672 | .3 | 21 | 1 | 6.98 | 3.97–12.27 |
Parent-child conflict | 5,464 | 2.2 | 188 | 6 | 5.91 | 4.87–7.17 |
Other family problems | 7,703 | 3.1 | 206 | 6 | 4.97 | 4.13–5.98 |
Social environmental problem | 2,817 | 1.1 | 100 | 3 | 6.49 | 4.99–8.43 |
Nonspecific psychosocial needs | 2,736 | 1.1 | 91 | 3 | 6.29 | 4.78–8.27 |
Associations Between Adverse SDoHs and Nonfatal Self-Harm
Model 1a | Model 2b | |||
---|---|---|---|---|
Variable | HR | 99% CI | HR | 99% CI |
Age at index date | 1.07 | 1.04–1.09 | 1.08 | 1.05–1.10 |
Female (reference: male) | 2.23 | 2.00–2.49 | 2.09 | 1.87–2.34 |
Race-ethnicity (reference: non-Hispanic White) | ||||
Non-Hispanic Black | .97 | .87–1.09 | .96 | .86–1.07 |
Hispanic | .94 | .73–1.20 | .96 | .75–1.23 |
Otherc | .88 | .71–1.09 | .86 | .70–1.07 |
Eligibility status at index date (reference: poverty) | ||||
Disability | .77 | .61–.97 | .78 | .61–.98 |
Foster care | 1.15 | .97–1.35 | .97 | .82–1.16 |
Otherd | .79 | .25–2.51 | .57 | .18–1.82 |
Nonmetropolitan residence (reference: metropolitan residence) | .91 | .81–1.03 | .94 | .84–1.06 |
Psychiatric conditione | ||||
Attention-deficit hyperactivity disorder | 1.08 | .97–1.21 | 1.05 | .94–1.17 |
Anxiety | 1.44 | 1.30–1.60 | 1.32 | 1.19–1.47 |
Bipolar disorder | 1.92 | 1.66–2.21 | 1.72 | 1.49–1.98 |
Conduct disorder or oppositional defiant disorder | 1.63 | 1.46–1.82 | 1.50 | 1.34–1.68 |
Depression | 3.91 | 3.50–4.38 | 3.61 | 3.22–4.05 |
Intellectual disability | .94 | .77–1.15 | .94 | .77–1.14 |
Personality disorder | 1.60 | 1.28–2.01 | 1.45 | 1.15–1.82 |
Schizophrenia | 1.75 | 1.44–2.13 | 1.60 | 1.32–1.95 |
Substance use disorder | 1.37 | 1.20–1.56 | 1.26 | 1.11–1.44 |
Chronic general medical condition (reference: no chronic medical condition) | ||||
Noncomplex | 1.30 | 1.16–1.45 | 1.26 | 1.12–1.41 |
Complex | 1.30 | 1.12–1.51 | 1.25 | 1.07–1.45 |
History of suicidal ideation | 1.81 | 1.55–2.10 | 1.68 | 1.44–1.96 |
History of self-harm | 2.02 | 1.71–2.38 | 1.99 | 1.69–2.34 |
Previous inpatient mental health care | .76 | .62–.93 | .73 | .59–.89 |
Previous emergency room mental health care | 1.01 | .84–1.20 | .98 | .82–1.18 |
Previous outpatient mental health care | .77 | .69–.86 | .77 | .70–.86 |
Social determinants of healthf | ||||
Abuse and neglect | 1.90 | 1.70–2.12 | ||
Child welfare placement | 1.32 | 1.04–1.67 | ||
Disappearance or death of family member | 1.17 | .83–1.65 | ||
Educational problems | 1.17 | .86–1.59 | ||
Employment or financial problems | .83 | .50–1.38 | ||
Exposure to violence | 1.18 | .87–1.60 | ||
Family alcohol or drug use | 1.46 | .58–3.67 | ||
Family disruption by separation or divorce | .90 | .42–1.94 | ||
Housing instability | .87 | .49–1.55 | ||
Parent-child conflict | 1.52 | 1.23–1.87 | ||
Other family problems | 1.25 | 1.01–1.54 | ||
Social environmental problem | 1.24 | .93–1.66 | ||
Nonspecific psychosocial needs | 1.41 | 1.06–1.89 |
Discussion
Conclusions
Supplementary Material
- View/Download
- 87.46 KB
References
Information & Authors
Information
Published In
History
Keywords
Authors
Competing Interests
Funding Information
Metrics & Citations
Metrics
Citations
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
There are no citations for this item
View Options
View options
PDF/ePub
View PDF/ePubGet Access
Login options
Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.
Personal login Institutional Login Open Athens loginNot a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).