Emergency Department Use and Inpatient Admissions and Costs Among Adolescents With Deliberate Self-Harm: A Five-Year Follow-Up Study
| Autor: | Sidra Goldman-Mellor, Paul Brown, Dwena Phillips, Magdalena Cerdá, Paul Gruenewald, Deborah J. Wiebe |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Emergency Care California Article Adolescents/adolescence Hospital 03 medical and health sciences Young Adult 0302 clinical medicine Clinical Research Behavioral and Social Science medicine Humans 030212 general & internal medicine Child Retrospective Studies Pediatric Psychiatry Emergency Service business.industry Five year follow up Emergency department Health Care Costs Health Services Brain Disorders 030227 psychiatry Hospitalization Psychiatry and Mental health Mental Health Good Health and Well Being Adolescent Behavior Family medicine Suicide and self-destructive behavior Deliberate self-harm Public Health and Health Services Regression Analysis Female business Emergency Service Hospital Self-Injurious Behavior Follow-Up Studies |
| Zdroj: | Psychiatr Serv Psychiatric services (Washington, D.C.), vol 71, iss 2 |
| ISSN: | 1557-9700 |
| Popis: | OBJECTIVE: Adolescent self-harm rates have risen substantially in the U.S., yet health and social outcomes among contemporary self-harming youths are infrequently tracked and remain 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 adolescent deliberate self-harm patients. METHODS: This retrospective cohort study used statewide, all-payer, longitudinally-linked patient discharge data from California, USA. All CA residents aged 10–19 years presenting to EDs in 2010 with deliberate self-harm (n=5,396) were compared with two control groups: A random sample of adolescent patients with other complaints, matched on sex, age, residential ZIP code, and month of index visit (general control patients; n=14,921), and matched patients with psychiatric complaints but no self-harm (psychiatric controls; n=15,835). Study outcomes included five-year rates of subsequent ED visits, inpatient admissions, and inpatient costs, both overall and for psychiatric and non-psychiatric complaints separately. RESULTS: Self-harm patients’ rates of ED utilization, inpatient admissions, and inpatient costs were significantly higher than those of general control patients (by 39%, 81%, and 21%, respectively), controlling for confounding demographic and utilization characteristics. Associations mostly persisted, though smaller in magnitude, in comparisons with psychiatric control patients. Both psychiatric and non-psychiatric complaints contributed to self-harming adolescents’ excess health service utilization and costs. CONCLUSION: Adolescent deliberate self-harm is 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. |
| Databáze: | OpenAIRE |
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