Associations between self‐harm and chronic disease among adolescents: Cohort study using statewide emergency department data

Journal of Adolescence - Tập 72 - Trang 132-140 - 2019
Cristina Lidón-Moyano1, Deborah Wiebe2, Paul Gruenewald3, Magdalena Cerdá4, Paul Brown1, Sidra Goldman-Mellor1
1Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA
2Department of Psychology, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced CA 95343, USA
3Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA
4Violence Prevention Research Program, University of California, Davis, Sacramento, CA 95817, USA

Tóm tắt

AbstractIntroductionWe 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.MethodsWe 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.ResultsRisk 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]).ConclusionsFindings 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.

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Journal of Adolescence

Tập 72

132-140

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