National trends in hospitalization of youth with intentional self-inflicted injuries
National trends in hospitalization of youth with intentional self-inflicted injuries
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DOI：
10.1176/appi.ajp.162.7.1328
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发表时间：
2005-07-01
影响因子：
17.7
通讯作者：
Shaffer, D
中科院分区：
文献类型：
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作者：
Olfson, M;Gameroff, MJ;Shaffer, D
目的：作者调查了1990年至2000年全国5-20岁故意自残的年轻人利用社区医院住院服务的趋势。方法：分析全国代表性社区医院样本的出院摘要，重点分析诊断为故意自残（ICD-9-CM: E950-E959）的青少年出院（N = 10,831）。人口普查数据用于得出以全国人口为基础的需要住院治疗的自我伤害率。计算了以人口为基础的自我伤害住院的总体趋势，并按性别和年龄分层。在因自己造成的伤害而住院的青少年中，还计算了住院时间、住院费用、受伤方法和相关精神障碍诊断的趋势。结果：青少年自伤住院率由1990年的49.1 / 10万下降到2000年的44.9 / 10万，平均住院时间由3.6 d下降到2.7 d。在住院患者中，割伤率（4.3%至13.2%）和服用对乙酰氨基酚（22.1%至26.9%）、抗抑郁药（10.0%至14.0%）和阿片类药物（2.3%至3.3%）作为损伤原因的比例有所上升，而服用水杨酸盐（14.9%至10.2%）和巴比妥酸盐（1.5%至0.7%）的比例有所下降。原发精神障碍出院诊断为抑郁症（29.2%至46.0%）、双相情感障碍（1.3%至8.2%）和物质使用障碍（5.4%至10.7%）的比例显著上升，适应障碍（22.2%至11.4%）和非精神障碍（31.9%至13.6%）的比例显著下降。在排除割伤后（割伤与自残的关系可能比自杀式自伤更密切），自伤青少年的年住院率从1990年的每10万人47.2人下降到2000年的每10万人39.4人。结论：在十年的研究中，因自残而入住社区医院的年轻人往往有更严重的精神诊断，住院时间也更短。这些趋势表明，青少年住院治疗的作用已经缩小，重点放在那些患有严重精神疾病的人身上。
Objective: The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries.Method: Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N = 10,831) with a diagnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring inpatient treatment. Overall population-based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, inpatient costs, method of injury, and associated mental disorder diagnoses.Results: The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were increases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%). There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and non-mental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000.Conclusions: Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders.