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

项目摘要。严重自杀未遂(需要急诊科就诊的) 美国青少年在过去五年里飙升了65%(CDC，2015)，这让公众感到震惊 卫生官员。一个主要的担忧是这些试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异常高风险， 损害和与健康相关的经济压力(Goldman-Mellor等人)。2013年，赫伯特等人。2015年)。等价物 然而，来自美国的数据缺乏，这让临床医生和公共卫生官员对如何 最好是防止我国有自杀倾向的年轻人出现不良健康后果。目前的研究将解决这一问题 通过提供有关医疗保健利用的长期模式、发病率和 在美国人口最多的州，青少年自杀未遂者的医疗费用。该项目已 三个具体目标：(1)调查急诊科(ED)就诊医院的长期模式 与对照组相比，青少年自杀未遂者的住院天数、发病风险和医疗费用； (2)调查自杀未遂者预后较差的因素；及(3)聘请毕业生 和本科生利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 加州将确定所有在2010年因自杀未遂而寻求ED护理的青少年患者。我们会 利用该州创纪录的纵向联系能力，跟踪这群自杀未遂者6年 年-跨机构和跨州-并比较他们较晚的急诊率和住院就诊率，风险 具体伤害和疾病(包括自杀未遂、殴打伤害和慢性病并发症)， 和ED/住院费用与匹配的非自杀对照的费用。该项目还将测试 临床、社会或心理脆弱程度越高的青少年自杀未遂者表现得越差 有害健康后果的风险。这项研究将包括基于人口的最大规模的后续分析 并对这些年轻人的长期健康状况进行了初步估计， 医疗保健利用率和经济风险。该项目的结果将有助于指导未来的干预工作 在有自杀倾向的年轻人中，减少他们的终生发病率和费用，直接为NICHD的目标做出贡献 儿童创伤和危重伤科(PTCIB)。通过揭示有自杀倾向的青少年未来 不仅是自我伤害，而且是与伤害和疾病相关的广泛后果，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 为弱势群体和不断增长的年轻人提供资源。此外，该项目将增强 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来提高研究能力 通过为青少年健康领域创建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.