Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data. (April 2019)

• Record Type: Journal Article
• Authors: Lidón-Moyano, Cristina; Wiebe, Deborah; Gruenewald, Paul; Cerdá, Magdalena; Brown, Paul; Goldman-Mellor, Sidra
• Is Part Of: Journal of adolescence. Volume 72(2019)
• Page Start: 132
• Page End: 140
• Publication Date: 2019-04
• Subjects: Self-injurious behavior -- Mental disorders -- Chronic disease -- Adolescent -- Emergency service; California Office of Statewide Health Planning and Development (OSHPD) -- External Cause of Injury code (E-code) -- Clinical Classification Software (CCS) -- International Classification of Diseases Ninth Revision -- Clinical Modification (ICD-9-CM); Adolescent psychiatry -- Periodicals; Adolescent psychology -- Periodicals; Adolescence -- Periodicals; Electronic journals; 305.23505
• DOI: 10.1016/j.adolescence.2019.03.005
• Languages: English
• ISSNs: 0140-1971

Abstract

Abstract: Introduction: We sought to understand the association between youthful self-harm and subsequent chronic disease-related healthcare utilization and whether self-harm reflects unique vulnerability in comparison with severe psychiatric disorders. Methods: We used a retrospective matched cohort design with statewide, all-payer, individually linked emergency department (ED) data from California, USA. Risk of future ED visits for common chronic conditions in adolescence (headaches, asthma, epilepsy, diabetes, and gastrointestinal disorders, assessed using ICD-9 diagnoses) were compared between three adolescent study groups presenting to an ED in 2010: self-harm patients (n = 5, 484), patients with psychiatric complaints but no self-harm (n = 14, 235), and patients with other complaints (n = 16, 452). Cohort follow-up ended on Sept. 30, 2015. Analyses were adjusted for patients' prior histories of ED utilization for chronic conditions as well as patient- and area-level sociodemographic characteristics. Results: Risk of subsequent ED visits was higher among self-harm patients compared to non-psychiatric control patients for subsequent epilepsy- (aRR = 1.77, 95% CI [1.42, 2.21]). Risk of subsequent ED visits was higher among psychiatric patients compared to non-psychiatric control patients for subsequent headache- (aRR = 1.31, 95% CI [1.21, 1.42]), and epilepsy-related problems (aRR = 1.85, 95% CI [1.55, 2.21]). Self-harm patients were at higher risk than psychiatric patients for subsequent gastrointestinal disorder (aRR = 1.76, 95% CI [1.03, 3.01]). Conclusions: Findings suggest that self-harm behavior and psychiatric disorders are associated with increased ED utilization for subsequent chronic disease-related ED utilization. Chronic disease among adolescent psychiatric patients should be attended to, potentially involving new models of clinical follow-up care.