Deliberate self-harm in older adults: A national analysis of US emergency department visits and follow-up care.
Deliberate self-harm in older adults: A national analysis of US emergency department visits and follow-up care.
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老年人故意自残：对美国急诊科就诊和后续护理的全国分析。
DOI：
10.1002/gps.5109
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发表时间：
2019
影响因子：
4
通讯作者：
Marcus,StevenC
中科院分区：
文献类型：
--
作者：
Schmutte,Timothy;Olfson,Mark;Xie,Ming;Marcus,StevenC
目的调查老年人在急诊室（ED）因故意自残而接受的心理健康护理。方法回顾性队列分析了2015年因故意自残而就诊的≥65岁成人的医疗保险索赔（N = 16495）。我们估计了出院处置、精神障碍ED编码和30天心理健康门诊随访的调整风险比（ARR）。结果大多数患者（76.9%）住院，非裔美国患者（ARR = 0.86, 99% CI = 0.79‐0.94）和有一种医学合并症（ARR = 0.91, 99% CI = 0.83‐0.99）或两到三种合并症（ARR = 0.93, 99% CI = 0.88‐0.99）的可能性较低。住院与近期抑郁症（ARR = 1.09, 99% CI = 1.03‐1.16）和近期精神科住院治疗（ARR = 1.13, 99% CI = 1.04‐1.22）相关。在社区出院的患者中（n = 3818）， 56.4%的患者被诊断为ED精神障碍。ED精神障碍诊断的预测因子包括年龄较低（65 ~ 69岁；ARR = 1.53, 99% CI = 1.31 ~ 1.78）， ED近期的精神卫生保健（ARR = 1.50, 99% CI = 1.29 ~ 1.74）或门诊（ARR = 1.62, 99% CI = 1.44 ~ 1.82），近期的精神障碍诊断（ARR = 1.61, 99% CI = 1.43 ~ 1.80），以及其他/未知的自残致死率方法（ARR = 1.24, 99% CI = 1.01 ~ 1.52）。在社区出院患者中，39.0%的患者接受了30天的门诊精神卫生保健随访，这与ED诊断的精神障碍（ARR = 2.65, 99% CI = 2.25‐3.12）和之前的门诊精神卫生保健（ARR = 2.62, 99% CI = 2.28‐3.00）最为密切相关。结论：大多数老年医疗保险受益人因自残而入院。在那些出院到社区的人中，许多人在急诊科没有被诊断出患有精神障碍，也没有得到及时的随访精神卫生保健。
ObjectiveTo examine mental health care received by older adults following emergency department (ED) visits for deliberate self‐harm.MethodsThis retrospective cohort analysis examined 2015 Medicare claims for adults ≥65 years of age with ED visits for deliberate self‐harm (N = 16 495). We estimated adjusted risk ratios (ARR) for discharge disposition, ED coding of mental disorder, and 30‐day follow‐up mental health outpatient care.ResultsMost patients (76.9%) were hospitalized with lower likelihoods observed for African American patients (ARR = 0.86, 99% CI = 0.79‐0.94) and patients with either one medical comorbidity (ARR = 0.91, 99% CI = 0.83‐0.99) or two to three comorbidities (ARR = 0.93, 99% CI = 0.88‐0.99). Hospitalization was associated with recent depression (ARR = 1.09, 99% CI = 1.03‐1.16) and recent psychiatric inpatient care (ARR = 1.13, 99% CI = 1.04‐1.22). Among patients discharged to the community (n = 3818), 56.4% received an ED mental disorder diagnosis. Predictors of an ED mental disorder diagnosis included younger age (65‐69 years; ARR = 1.53, 99% CI = 1.31‐1.78), recent mental health care in ED (ARR = 1.50, 99% CI = 1.29‐1.74) or outpatient (ARR = 1.62, 99% CI = 1.44‐1.82) settings, recent diagnosis of mental disorder (ARR = 1.61, 99% CI = 1.43‐1.80), and other/unknown lethality methods of self‐harm (ARR = 1.24, 99% CI = 1.01‐1.52). Among community discharged patients, 39.0% received 30‐day follow‐up outpatient mental health care, which was most strongly predicted by an ED diagnosis of mental disorder (ARR = 2.65, 99% CI = 2.25‐3.12) and prior outpatient mental health care (ARR = 2.62, 99% CI = 2.28‐3.00).ConclusionMost older adult Medicare beneficiaries who present to EDs with self‐harm are hospitalized. Of those who are discharged to the community, many are not diagnosed with mental disorder in the ED or receive timely follow‐up mental health care.