Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study
Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study
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DOI：
10.1016/j.genhosppsych.2018.12.004
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发表时间：
2019-01-01
影响因子：
7
通讯作者：
Cerda, Magdalena
中科院分区：
文献类型：
--
作者：
Goldman-Mellor, Sidra;Kwan, Kevin;Cerda, Magdalena
目的：本研究调查了青少年急诊科（ED）患者随后去急诊室自残风险的患者和地区水平特征。方法：回顾性分析2010年在加州急诊科就诊的青少年患者（n=480,706），使用全州范围的、全付费的、可单独链接的行政数据。我们研究了2010年多个感兴趣的预测因素（患者社会人口学因素、既往急诊科使用情况、居住流动性和区域水平特征）与自残急诊科就诊几率之间的关联。研究人员对2010年有自残行为的患者进行了数年的随访，以评估复发性自残的预测因素。结果：自残患者（n=5539）比对照组患者（n=16,617）更有可能有ED使用史，特别是精神健康问题、药物滥用和伤害。居住地的流动性也会增加自残的风险，但种族/少数民族身份和居住在弱势邮编地区会降低风险。5年累计自残发生率为19.3%。住院就诊、医疗补助保险、既往因精神问题或受伤而使用急诊科都增加了复发性自残的风险。结论：在ED环境中观察到的一系列患者和区域水平的特征与青少年随后的自我伤害风险相关，这为这种临床背景下的干预提供了新的目标。
Objective: This study investigated patient-and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm.Method: Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n=480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm.Results: Self-harm patients (n=5539) were significantly more likely than control patients (n=16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk.Conclusions: A range of patient-and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.