title: Factors that influence the Cost of Deliberate Self-poisoning in Children and Adolescents.
abstract: BACKGROUND: Ideally, the type and quantity of services received by young people with mental health problems would be determined by need alone. In reality, however, a number of factors will influence resource-use, and thus the total cost of care. AIMS OF THE STUDY: The aim of this study was to evaluate the impact of baseline patient and family characteristics on the total cost of caring for children and adolescents who have deliberately poisoned themselves. It was hypothesised that the cost of this patient group would be associated with severity of suicidality and other psychiatric characteristics, the existence of current problems and demographic and socio-economic characteristics. METHODS: Univariate and multivariate regression analyses were used to examine the associations between baseline characteristics and both total statutory service costs and total NHS costs in 149 young people aged 16 years and under, referred to child mental health teams with a diagnosis of deliberate self-poisoning. RESULTS: Baseline variables found to be significantly associated with relatively more expensive care packages included a definite intention to die, the existence of current problems, being in foster care, poorer parental well being and not having a diagnosis of conduct disorder. No significant relationships were found between cost and measures of illness severity, including suicidal ideation, hopelessness and severity of depression. DISCUSSION: Although costs are not influenced by clinical measures of severity, service provision does appear to respond to more 'practical' notions of severity, such as intent to die and the existence of current problems. Some high-risk sub-groups, such as those with a conduct disorder and those who have experienced episodes of local authority care or accommodation, appear to be slipping through the health services net, although this may be due more to the demand-side problem of non-compliance than to issues of supply. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The evidence presented suggests that health care providers are directing more services towards those who are more in need, where need is defined in a practical rather than a clinical sense. More targeting of certain high-risk sub-groups may be needed, however, particularly those who are traditionally poor attenders and prone to drop-out. IMPLICATIONS FOR HEALTH POLICY FORMULATION: Interventions for young people who have attempted suicide should be better targeted towards high-risk groups, such as those with a diagnosis of conduct disorder. In addition, prevention schemes that target high-risk groups before a suicide attempt is made should be encouraged. IMPLICATIONS FOR FURTHER RESEARCH: This study is limited by small sample sizes. Research that focuses directly on the care of young people at high-risk for repeat suicide attempts is needed, since the results presented here can be viewed only as exploratory and not explanatory.
authors.affiliation: Centre for the Economics of Mental Health, David Goldberg Centre, Institute of Psychiatry, De Crespigny Park London, SE5 8AF, UK, Tel.: +44 20-7848 0043 Fax: +44 20-7701 7600, s.byford@iop.kcl.ac.uk
authors.forename: Sarah Sverre A.C.
authors.initials: SS
authors.lastname: Kittelsen
authors.forename: Julie A.
authors.initials: JA
authors.lastname: Barber
authors.forename: Richard
authors.initials: R
authors.lastname: Harrington