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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

Cluster identified over space during 2010/2011. For both adolescents aged 15–17 years with ED visits for self-harm and without a 14-day physician follow-up after an ED visit. Cluster in dark grey
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Fig3: Cluster identified over space during 2010/2011. For both adolescents aged 15–17 years with ED visits for self-harm and without a 14-day physician follow-up after an ED visit. Cluster in dark grey

Mentions: To identify purely geographical clusters, we applied the KN test to data from each year separately and focused our results on the last two fiscal years. In 2009/2010, one potential cluster of adolescents with ED visits for self-harm was identified that contained seven of the sRHAs from the North zone (p < 0.001). The relative risk for this potential cluster was 2.71. The same sRHAs also formed a cluster of adolescents without follow-up (p < 0.001) and had a relative risk of 3.75. In 2010/2011, one potential cluster of adolescents with ED visits for self-harm was identified that contained all the sRHAs in the North and Edmonton zones (Fig. 3), as well as three north-western sRHAs in the Central zone (p < 0.001). The relative risk for this potential cluster was 1.66. The same cluster was also the only potential cluster identified for the adolescents without physician follow-up (p = 0.001) within 14 days. The relative risk for this potential cluster was 1.85.Fig. 3


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)

Cluster identified over space during 2010/2011. For both adolescents aged 15–17 years with ED visits for self-harm and without a 14-day physician follow-up after an ED visit. Cluster in dark grey
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Cluster identified over space during 2010/2011. For both adolescents aged 15–17 years with ED visits for self-harm and without a 14-day physician follow-up after an ED visit. Cluster in dark grey
Mentions: To identify purely geographical clusters, we applied the KN test to data from each year separately and focused our results on the last two fiscal years. In 2009/2010, one potential cluster of adolescents with ED visits for self-harm was identified that contained seven of the sRHAs from the North zone (p < 0.001). The relative risk for this potential cluster was 2.71. The same sRHAs also formed a cluster of adolescents without follow-up (p < 0.001) and had a relative risk of 3.75. In 2010/2011, one potential cluster of adolescents with ED visits for self-harm was identified that contained all the sRHAs in the North and Edmonton zones (Fig. 3), as well as three north-western sRHAs in the Central zone (p < 0.001). The relative risk for this potential cluster was 1.66. The same cluster was also the only potential cluster identified for the adolescents without physician follow-up (p = 0.001) within 14 days. The relative risk for this potential cluster was 1.85.Fig. 3

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