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Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada.

Rosychuk RJ, Johnson DW, Urichuk L, Dong K, Newton AS - BMC Psychiatry (2016)

Bottom Line: Two space-time clusters were identified: (1) a North zone cluster during 2002-2006 (p < 0.01) and (2) a South zone cluster during 2003-2007 (p < 0.01).These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care.Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. rhonda.rosychuk@ualberta.ca.

ABSTRACT

Background: Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit.

Methods: We extracted a population-based cohort of adolescents aged 15-17 years (n = 3,927) with ED visits during 2002-2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan.

Results: The rates decreased over time for ED visits for self-harm (differences: girls -199.6/100,000; p < 0.01; boys -58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls -108.3/100,000; p < 0.01; boys -61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002-2006 (p < 0.01) and (2) a South zone cluster during 2003-2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01).

Conclusions: The rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

No MeSH data available.


Related in: MedlinePlus

Crude case rates per 100,000 adolescents aged 15–17 years by sex over time. a adolescents with ED visits for deliberate self-harm; (b) adolescents with an ED visit for self-harm but without a 14-day physician follow-up. females (○) and males (∆)
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Fig1: Crude case rates per 100,000 adolescents aged 15–17 years by sex over time. a adolescents with ED visits for deliberate self-harm; (b) adolescents with an ED visit for self-harm but without a 14-day physician follow-up. females (○) and males (∆)

Mentions: During the study period, 3,927 adolescents aged 15–17 years made 4,453 ED visits for self-harming behavior. The most common self-harm method was self-poisoning (65.5 %), followed by self-cutting (27.4 %). Asphyxiation was the least commonly reported (2.2 %). The majority of the ED visits occurred in the major urban areas of Edmonton and Calgary (Table 1). Females had disproportionately more ED visits (72.2 %) than would be suggested by the population distribution (48.5 %, Fig. 1a, p < 0.01). Approximately 55 % of adolescents with an ED visit for self-harm did not have a mental health follow-up with a physician within 14 days (Table 1). Females had fewer follow-up visits to physicians (Fig. 1b). Rates of ED visits for self-harm decreased from 2002 to 2011 for girls (from 603.5 to 403.8 per 100,000 adolescents, p < 0.01) and boys (from 213.9 to 155.0 per 100,000 adolescents, p < 0.01). Among the adolescents with ED visits for self-harm, the rates of those without a 14-day physician follow-up decreased over time for girls (from 333.6 to 225.3 per 100,000 adolescents, p < 0.01) and boys (from 142.1 to 80.2 per 100,000 adolescents, p < 0.01). There was a statistically significant sex by time interaction for ED visits for self-harm (p = 0.030) but not for the 14-day physician follow-up outcome (p = 0.107).Table 1


Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada.

Rosychuk RJ, Johnson DW, Urichuk L, Dong K, Newton AS - BMC Psychiatry (2016)

Crude case rates per 100,000 adolescents aged 15–17 years by sex over time. a adolescents with ED visits for deliberate self-harm; (b) adolescents with an ED visit for self-harm but without a 14-day physician follow-up. females (○) and males (∆)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4940757&req=5

Fig1: Crude case rates per 100,000 adolescents aged 15–17 years by sex over time. a adolescents with ED visits for deliberate self-harm; (b) adolescents with an ED visit for self-harm but without a 14-day physician follow-up. females (○) and males (∆)
Mentions: During the study period, 3,927 adolescents aged 15–17 years made 4,453 ED visits for self-harming behavior. The most common self-harm method was self-poisoning (65.5 %), followed by self-cutting (27.4 %). Asphyxiation was the least commonly reported (2.2 %). The majority of the ED visits occurred in the major urban areas of Edmonton and Calgary (Table 1). Females had disproportionately more ED visits (72.2 %) than would be suggested by the population distribution (48.5 %, Fig. 1a, p < 0.01). Approximately 55 % of adolescents with an ED visit for self-harm did not have a mental health follow-up with a physician within 14 days (Table 1). Females had fewer follow-up visits to physicians (Fig. 1b). Rates of ED visits for self-harm decreased from 2002 to 2011 for girls (from 603.5 to 403.8 per 100,000 adolescents, p < 0.01) and boys (from 213.9 to 155.0 per 100,000 adolescents, p < 0.01). Among the adolescents with ED visits for self-harm, the rates of those without a 14-day physician follow-up decreased over time for girls (from 333.6 to 225.3 per 100,000 adolescents, p < 0.01) and boys (from 142.1 to 80.2 per 100,000 adolescents, p < 0.01). There was a statistically significant sex by time interaction for ED visits for self-harm (p = 0.030) but not for the 14-day physician follow-up outcome (p = 0.107).Table 1

Bottom Line: Two space-time clusters were identified: (1) a North zone cluster during 2002-2006 (p < 0.01) and (2) a South zone cluster during 2003-2007 (p < 0.01).These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care.Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. rhonda.rosychuk@ualberta.ca.

ABSTRACT

Background: Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit.

Methods: We extracted a population-based cohort of adolescents aged 15-17 years (n = 3,927) with ED visits during 2002-2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan.

Results: The rates decreased over time for ED visits for self-harm (differences: girls -199.6/100,000; p < 0.01; boys -58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls -108.3/100,000; p < 0.01; boys -61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002-2006 (p < 0.01) and (2) a South zone cluster during 2003-2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01).

Conclusions: The rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

No MeSH data available.


Related in: MedlinePlus