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Published Online: 2 October 2019

Emergency Department Use and Inpatient Admissions and Costs Among Adolescents With Deliberate Self-Harm: A Five-Year Follow-Up Study

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.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 136 - 143
PubMed: 31575352

History

Received: 22 March 2019
Revision received: 26 July 2019
Accepted: 8 August 2019
Published online: 2 October 2019
Published in print: February 01, 2020

Keywords

  1. Adolescents/adolescence
  2. Suicide and self-destructive behavior

Authors

Details

Sidra Goldman-Mellor, Ph.D. [email protected]
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).
Dwena Phillips, B.A.
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).
Paul Brown, Ph.D.
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).
Paul Gruenewald, Ph.D.
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).
Magdalena Cerdá, Dr.P.H.
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).
Deborah Wiebe, Ph.D.
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).

Notes

Send correspondence to Dr. Goldman-Mellor ([email protected]).
Data from this study were presented at the annual meeting of the American Association of Suicidology, Washington, D.C., April 18–21, 2018.

Funding Information

National Institute of Mental Healthhttp://dx.doi.org/10.13039/100000025: R15 MH113108-01

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