Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care
Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care
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DOI：
10.1136/bmj.j4351
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发表时间：
2017-10-18
影响因子：
105.7
通讯作者：
Ashcroft, Darren M.
中科院分区：
文献类型：
--
作者：
Morgan, Catharine;Webb, Roger T.;Ashcroft, Darren M.
研究时间趋势的性别和年龄的具体发病率的自我伤害的儿童和青少年，临床管理模式，和风险的原因特定的死亡率以下的指数自我伤害事件在一个年轻的age. DesignPopulationbased队列study.SettingUK临床实践研究Datalink电子健康记录从647个一般的做法，与实践水平剥夺生态测量使用指数的多重剥夺。符合条件的英国做法的患者与医院事件统计（HES）和国家统计局（ONS）的死亡率records. PropantsFor描述性分析阶段，我们检查了16912例患者的数据，年龄在10-19谁伤害了自己在2001-14。为了分析自我伤害后的特定原因死亡率，8638例符合HES和ONS关联的患者按年龄、性别和一般实践与20例未受影响的儿童和青少年（n=170 274）相匹配。主要结局指标在第一阶段，检查了性别和年龄特定年发病率的时间趋势。在第二阶段，根据转介到心理健康服务和精神药物处方的可能性评估临床管理。在第三阶段，所有原因死亡的相对风险，非自然死亡（包括自杀和意外死亡），根据分层考克斯比例风险模型，对自伤队列与匹配的未受影响的对照队列进行风险比估计。（37.4/10，000），而男孩（12.3/10，000），13-16岁女孩的发病率急剧上升68%，从2011年的45.9/10，000上升到2014年的77.0/10，000。在指数自我伤害事件发生后12个月内，在社会最贫困的实践中登记的年轻患者的转诊可能性降低了23%，尽管这些地方的发病率相当高。在随访期间，伤害自己的儿童和青少年非自然死亡的可能性约为9倍，自杀风险尤其明显增加（剥夺调整的风险比17.5，95%置信区间7.6至40.5）和致命的急性酒精或药物中毒（34.3，10.2至115.7）.结论更好地了解造成最近在早中期少女中自我伤害发生率明显增加的机制，在向贫困儿童和青少年提供服务方面，采取协调一致的举措，解决健康不平等问题，是多个公共机构的紧迫优先事项。
OBJECTIVES To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age.DesignPopulation based cohort study.SettingUK Clinical Practice Research Datalink-electronic health records from 647 general practices, with practice level deprivation measured ecologically using the index of multiple deprivation. Patients from eligible English practices were linked to hospital episode statistics (HES) and Office for National Statistics (ONS) mortality records.ParticipantsFor the descriptive analytical phases we examined data pertaining to 16 912 patients aged 10-19 who harmed themselves during 2001-14. For analysis of cause specific mortality following self harm, 8638 patients eligible for HES and ONS linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274).Main outcome measuresIn the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death), and fatal acute alcohol or drug poisoning were estimated as hazard ratios derived from stratified Cox proportional hazards models for the self harm cohort versus the matched unaffected comparison cohort.ResultsThe annual incidence of self harm was observed to increase in girls (37.4 per 10 000) compared with boys (12.3 per 10 000), and a sharp 68% increase occurred among girls aged 13-16, from 45.9 per 10 000 in 2011 to 77.0 per 10 000 in 2014. Referrals within 12 months of the index self harm episode were 23% less likely for young patients registered at the most socially deprived practices, even though incidences were considerably higher in these localities. Children and adolescents who harmed themselves were approximately nine times more likely to die unnaturally during follow-up, with especially noticeable increases in risks of suicide (deprivation adjusted hazard ratio 17.5, 95% confidence interval 7.6 to 40.5) and fatal acute alcohol or drug poisoning (34.3, 10.2 to 115.7).ConclusionsGaining a better understanding of the mechanisms responsible for the recent apparent increase in the incidence of self harm among early-mid teenage girls, and coordinated initiatives to tackle health inequalities in the provision of services to distressed children and adolescents, represent urgent priorities for multiple public agencies.