Long-term health of adolescent suicide attempters: Healthcare utilization morbidity and costs.

项目摘要。严重的自杀企图（需要急诊室就诊的）， 美国青少年在过去五年中飙升了65%（CDC，2015），令公众震惊 卫生官员。一个主要的问题是这些企图自杀的青少年的长期健康预后： 国际研究表明，他们可能面临终身过度医疗需求的极高风险， 损伤和健康相关经济压力（Goldman-Mellor et al. 2013，赫伯特et al. 2015）。等效 来自美国的数据，然而，缺乏-让临床医生和公共卫生官员在黑暗中如何 最好的办法来防止我们国家自杀青年的不良健康后果。当前的研究将解决这个问题 通过提供关于医疗保健利用、发病率和 在美国人口最多的州，青少年自杀者的医疗费用。该项目 三个具体目标：（1）调查急诊科（艾德）就诊的长期模式， 与对照组相比，青少年自杀者的住院时间、发病风险和医疗费用; (2)探讨自杀未遂者预后不良的预测因素;（3）让研究生 和本科生使用行政保健数据进行流行病学研究， 青少年自杀行为为了实现这些目标，该项目将使用来自国家级医院的数据， 加州，以确定所有青少年患者谁寻求艾德照顾指数自杀企图在2010年。我们将 利用国家的纵向记录联系能力，跟踪这一队列的自杀未遂者6 年-跨机构和跨州-并比较他们的后期艾德和医院就诊率， 特定的伤害和疾病（包括自杀企图、袭击伤害和慢性疾病并发症）， 和艾德/住院费用。该项目还将测试 青少年自杀倾向与更大的基线临床，社会或心理脆弱性表现出更差的 不良健康后果的风险。这项研究将包括最大的基于人群的随访分析， 美国年轻的自杀者，并对这些年轻人的长期健康状况进行初步评估， 医疗利用率和经济风险。该项目的结果将有助于指导未来的干预工作 在自杀青年中，以减少他们的终身发病率和费用，直接有助于NICHD的目标 儿科创伤和危重损伤分支（PTCIB）。通过揭示青少年自杀的未来风险， 不只是自我伤害，而是广泛的伤害和疾病相关的结果，这项工作将改善 临床护理的有效性，促进风险分层，并帮助分配稀缺的医疗保健 为脆弱和不断增长的青年人口提供资源。此外，该项目将提高 通过培养来自代表性不足群体的学生健康研究人员的新渠道， 为青少年健康领域创造了一个重要的新数据资源。

Project Summary. Serious suicide attempts (those requiring an emergency department visit) among adolescents in the United States have soared 65% over the past five years (CDC, 2015), alarming public health officials. One major concern is the long-term health prognosis of these suicide-attempting adolescents: International research suggests they may be at exceptionally high risk for lifelong excess healthcare needs, impairment, and health-related economic strain (Goldman-Mellor et al. 2013, Herbert et al. 2015). Equivalent data from the U.S., however, are lacking – leaving clinicians and public health officials in the dark about how best to prevent adverse health outcomes among our nation’s suicidal youth. The current study will address this gap by providing clinically relevant information about long-term patterns of healthcare utilization, morbidity, and healthcare costs among adolescent suicide attempters in the nation’s most populous state. The project has three specific aims: (1) To investigate long-term patterns of emergency department (ED) visits, hospital inpatient stays, morbidity risk, and healthcare costs among adolescent suicide attempters relative to controls; (2) To investigate factors predicting worse outcomes among suicide attempters; and (3) To engage graduate and undergraduate students in using administrative healthcare data to conduct epidemiologic research on adolescent suicidal behavior. To accomplish these aims, the project will use state-level hospital data from California to identify all adolescent patients who sought ED care for an index suicide attempt in 2010. We will capitalize on the state’s longitudinal record linkage capabilities to follow this cohort of suicide attempters for 6 years – across institutions and across the state – and compare their rate of later ED and hospital visits, risk for specific injuries and illnesses (including suicide attempt, assault injury, and complications of chronic disease), and ED/ hospitalization costs with those of matched non-suicidal controls. The project will also test whether adolescent suicide attempters with greater baseline clinical, social, or psychological vulnerability exhibit worse risk of adverse health outcomes. This study will comprise the largest population-based follow-up analysis of young suicide attempters in the U.S., and provide the first estimates of these youths’ long-term health, healthcare utilization, and economic risks. Results from this project will help guide future intervention efforts among suicidal youths to reduce their lifelong morbidity and costs, contributing directly to the goals of NICHD’s Pediatric Trauma and Critical Injury Branch (PTCIB). By shedding light on suicidal adolescents’ future risk of not just self-harm but a broad range of injury- and disease-related outcomes, this work will improve the effectiveness of clinical care, facilitate risk stratification, and aid in the allocation of scarce healthcare resources for a vulnerable and growing population of young people. Moreover, the project will enhance research capacity by fostering a new pipeline of student health researchers from underrepresented groups and by creating a significant new data resource for the field of adolescent health.