Key result
Adolescents with emergency department visits for self-harm had a significantly higher risk of repeat admission for self-harm (HR 4.84), suicide (HR 7.96), and overall mortality (HR 3.23) over 5 years compared to matched controls.
Why the study?
Self-harm is increasing among adolescents, and evolving behaviors necessitate current data on the outcomes and consequences of adolescent emergency department presentations for self-harm.
Does emergency department presentation for self-harm predict higher rates of mortality, suicide, recurrent self-harm, and healthcare costs in adolescents compared to presentations for other reasons?
Cohort (n=16,392)
Yes
Does emergency department presentation for self-harm predict higher rates of mortality, suicide, recurrent self-harm, and healthcare costs in adolescents compared to presentations for other reasons?
Adolescents presenting to the emergency department for self-harm are at significantly higher risk for recurrent self-harm, suicide, and overall mortality over the subsequent 5 years.
May support enhanced post-ED surveillance in adolescents with self-harm; leaves open whether interventions reduce mortality.
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.
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Gardner et al. (2019) conducted a cohort in Adolescent self-harm (n=16,392). Emergency department visit for self-harm vs. Emergency department visit for reasons other than self-harm was evaluated on Repeat emergency department or hospital admission for self-harm (HR 4.84, 95% CI 4.44-5.27). Adolescents with emergency department visits for self-harm had a significantly higher risk of repeat admission for self-harm (HR 4.84), suicide (HR 7.96), and overall mortality (HR 3.23) over 5 years compared to matched controls.
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