National Trends in Hospitalization of Youth With Intentional Self-Inflicted Injuries

New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, 1051 Riverside Drive, New York, NY 10032, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 08/2005; 162(7):1328-35. DOI: 10.1176/appi.ajp.162.7.1328
Source: PubMed


The authors examined national trends from 1990 to 2000 in the utilization of community hospital inpatient services by young people (5-20 years of age) with intentional self-inflicted injuries.
Discharge abstracts from a nationally representative sample of community hospitals were analyzed, with a focus on youth discharges (N=10,831) with a diagnosis of intentional self-inflicted injury (ICD-9-CM: E950-E959). Census data were used to derive national population-based rates of self-inflicted injuries requiring inpatient treatment. Overall population-based trends in hospitalizations for self-inflicted injury were calculated and stratified by gender and age. Among youths hospitalized with a self-inflicted injury, trends were also calculated for length of stay, inpatient costs, method of injury, and associated mental disorder diagnoses.
The annual hospitalization rate of youths with self-inflicted injuries declined from 49.1 per 100,000 in 1990 to 44.9 per 100,000 in 2000, and the mean length of inpatient stay significantly declined from 3.6 days to 2.7 days. Among the hospitalized patients, there were increases in the rate of cutting (4.3% to 13.2%) and ingestion of acetaminophen (22.1% to 26.9%), antidepressants (10.0% to 14.0%), and opiates (2.3% to 3.3%) as a cause of injury, whereas there were decreases in the ingestion of salicylates (14.9% to 10.2%) and barbiturates (1.5% to 0.7%). There were significant increases in the proportion of subjects with primary mental disorder discharge diagnoses of depressive disorder (29.2% to 46.0%), bipolar disorder (1.3% to 8.2%), and substance use disorder (5.4% to 10.7%) and significant decreases in the rate of adjustment disorders (22.2% to 11.4%) and nonmental disorders (31.9% to 13.6%). After excluding cutting, which may be more closely related to self-mutilation than suicidal self-injury, the annual hospitalization rate of youths with self-inflicted injuries declined from 47.2 per 100,000 in 1990 to 39.4 per 100,000 in 2000.
Over the decade of study, young people admitted to community hospitals with self-inflicted injuries tended to have more severe psychiatric diagnoses and to be treated during shorter inpatient stays. These trends suggest that the role of youth inpatient care has narrowed, becoming focused on those with severe psychiatric disorders.

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    • "Samtidig steg andelen som sa at de hadde gjort et alvorlig forsøk. Dette er i motstrid til tall som viser at andelen ungdommer i USA som ble innlagt på sykehus for selvpåførte skader sank i samme periode (Olfson et al., 2005). Vi har ingen gode sammenliknbare undersøkelser fra Norge. "
    05/2015; 13(1). DOI:10.5617/suicidologi.1935
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    • "Nonopioid analgesics , such as paracetamol, are the most common substances ingested, but benzodiazepines, antidepressants and antipsychotics are also used [3] [5] [6]. Significant sex differences have been found regarding suicidal intent [1], psychiatric disorders and place of discharge [7]. "
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    ABSTRACT: Objectives To examine characteristics of hospital admissions and risk-factors associated with re-hospitalization for self-poisoning with medications in adolescents aged 10–19 years. Method This study used data from the Norwegian Patient Register (NPR) from 2008 to 2011. The main outcome was hospital readmission within the observation period. A complementary log-log regression model was used to assess the effect of characteristics at index hospital admission on readmission. Results Of 1,497 patients, 76.4% were females and 89.8% were aged 15–19 years. At their first hospital admission, about one-third received a secondary psychiatric diagnosis. Females (47.5%) were registered with an E-code for intentional self-harm more often than males (33.7%) and females were more often than males discharged to further treatment (27.8% vs. 21.5%). As many as 18.4% was re-hospitalized for self-poisoning by medications. Significant predictors for hospital readmission were female sex (HR = 2.4, 95% CI 1.7, 3.6), discharge to further treatment (HR = 2.3, 95% CI 1.8, 2.9) and psychiatric secondary diagnoses (HR = 1.5, 95% CI 1.2, 1.9). Conclusion This national study demonstrated significant sex differences in adolescents treated in hospital for self-poisoning with medications. Psychiatric secondary diagnoses had a strong predictive effect on readmission, which indicates the importance of psychiatric/psychosocial assessment of adolescents who are admitted to hospital for self-poisoning with medications.
    General Hospital Psychiatry 09/2014; DOI:10.1016/j.genhosppsych.2014.09.004 · 2.61 Impact Factor
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    • "Suicide or deaths resulting from self inflicted injuries is estimated to be 0.8 per 100,000 population among children aged between 10 and 14 years [1]. Even though hospitalizations resulting from self inflicted injuries among children have been reported to be decreasing during the past few decades, this is still a major public health concern in the United States [2]. Nationwide estimates from previous decades using nationally representative samples such as the National Hospital Ambulatory Medical Care Survey indicate that the annual rate of emergency visits attributed to self-harm was 225.3 per 100,000 populations among youth [3]. "
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    ABSTRACT: The objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED) attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides. The Nationwide Emergency Department Sample (year 2007) was used. All ED visits occurring among children (aged ≤18 years) with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels. 77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females). The average age of the ED visits was 15.7 years. 134 patients died in ED's (106 males and 28 females) and 93 died in hospitals following in-patient admission (75 males and 18 females). A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%). A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%). 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits. Females comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED's or in hospitals. The current study results highlight the burden associated with such injuries among children.
    PLoS ONE 07/2013; 8(7):e69874. DOI:10.1371/journal.pone.0069874 · 3.23 Impact Factor
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