Association Between Social Determinants of Health and Deliberate Self-Harm Among Youths With Psychiatric Diagnoses.
Association Between Social Determinants of Health and Deliberate Self-Harm Among Youths With Psychiatric Diagnoses.
复制标题
患有精神病诊断的青少年中健康的社会决定因素与故意自残之间的关联。
DOI：
10.1176/appi.ps.20220180
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Fontanella,CynthiaA
中科院分区：
文献类型：
--
作者：
Llamocca,ElyseN;Steelesmith,DanielleL;Ruch,DonnaA;Bridge,JeffreyA;Fontanella,CynthiaA
目的作者试图研究不良健康社会决定因素 (SDoH) 与青少年自残风险之间的关联。方法作者对俄亥俄州医疗补助索赔数据（2016 年 4 月 1 日至 2018 年 12 月 31 日）进行了回顾性纵向分析，研究对象为 244,958 名患有初级精神病学诊断的青少年（年龄 10-17 岁）。 SDoH 根据 ICD-10 代码进行识别，分为 14 类，包括虐待和忽视、儿童福利安置、教育问题、财务问题、遭受暴力、住房不稳定、法律问题、家庭成员失踪或死亡、分居或离婚导致的家庭破裂、家庭酗酒或吸毒、亲子冲突、其他家庭问题、社会和环境问题以及非特定社会心理需求。 Cox 比例风险分析用于检查 SDoH 与自残（即非自杀性自残或自杀企图）之间的关联。对人口特征以及共存精神疾病和一般医疗状况进行控制分析。结果在指数索赔事件后的随访期间，51,796 名青少年 (21.1%) 至少有一项不良 SDoH 指标，3,262 名青少年 (1.3%) 至少有一次自残事件。虐待和忽视（风险比[HR]=1.90，99% CI=1.70–2.12）、儿童福利安置（HR=1.32，99% CI=1.04–1.67）、亲子冲突（HR=1.52，99% CI=1.23–1.87）、其他家庭问题（HR=1.25，99%） CI=1.01–1.54）和非特异性心理社会需求（HR=1.41，99% CI=1.06–1.89）与自残风险显着增加相关。 结论 即使在控制了人口和临床特征之后，不良 SDoH 仍与自残显着相关，这强调了在医疗记录中获取 SDoH 信息的必要性，以识别自杀风险较高的青少年并为有针对性的干预措施提供信息。
ObjectiveThe authors sought to examine the association between adverse social determinants of health (SDoHs) and risk for self-harm among youths.MethodsThe authors performed a retrospective longitudinal analysis of Ohio Medicaid claims data (April 1, 2016–December 31, 2018) of 244,958 youths (ages 10–17 years) with a primary psychiatric diagnosis. SDoHs were identified fromICD-10codes and classified into 14 categories, encompassing abuse and neglect, child welfare placement, educational problems, financial problems, exposure to violence, housing instability, legal issues, disappearance or death of a family member, family disruption by separation or divorce, family alcohol or drug use, parent-child conflict, other family problems, social and environmental problems, and nonspecific psychosocial needs. Cox proportional hazards analysis was used to examine the association between SDoHs and self-harm (i.e., nonsuicidal self-injury or suicide attempt). Analyses controlled for demographic characteristics and comorbid psychiatric and general medical conditions.ResultsDuring follow-up after an index claim event, 51,796 youths (21.1%) had at least one adverse SDoH indicator, and 3,262 (1.3%) had at least one self-harm event. Abuse and neglect (hazard ratio [HR]=1.90, 99% CI=1.70–2.12), child welfare placement (HR=1.32, 99% CI=1.04–1.67), parent-child conflict (HR=1.52, 99% CI=1.23–1.87), other family problems (HR=1.25, 99% CI=1.01–1.54), and nonspecific psychosocial needs (HR=1.41, 99% CI=1.06–1.89) were associated with significantly increased hazard of self-harm.ConclusionsAdverse SDoHs were significantly associated with self-harm, even after controlling for demographic and clinical characteristics, underscoring the need for capturing SDoH information in medical records to identify youths at elevated suicide risk and to inform targeted interventions.
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