Emergency treatment of young people following deliberate self-harm.
OBJECTIVE
To examine national patterns in the emergency department assessment and treatment during visits by young people, aged 7 to 24 years, who are seen following an episode of deliberate self-harm.


METHODS
An analysis was conducted of a nationally representative sample of hospital emergency department visits from the 1997-2002 National Hospital Ambulatory Medical Care Survey focusing on visits by persons aged 7 to 24 years related to deliberate self-harm. National census data were used to derive population-based rates of emergency department visits for deliberate self-harm overall and stratified by sex, age, race, and ethnicity. Demographic, clinical, and treatment characteristics of the visits are presented including comparisons of visits that resulted in an inpatient admission with those that resulted in discharge to the community.


RESULTS
Among young people aged 7 to 24 years, the annual rate of emergency visits with self-harm was 225.3 per 100,000. A mental disorder was diagnosed in 56.0% of these visits including depressive disorders in 15.1% and substance use disorders in 7.3%. Approximately one half of the visits (56.1%) resulted in an inpatient admission. As compared with visits resulting in discharge to the community, emergency department visits that resulted in inpatient admission were significantly more likely to result in the patients receiving a mental disorder diagnosis (63.8% vs 45.7%; P = .03), especially a depressive disorder (22.5% vs 5.8%; P = .005), and receiving psychotropic medications (18.0% vs 4.7%; P = .007), intravenous fluids (39.2% vs 22.3%; P = .02), gastric lavage (24.1% vs 9.8%; P = .02), and a specific antidote for poisoning (12.2% vs 1.3%; P = .02).


CONCLUSIONS
Mental disorders are diagnosed in roughly one half of emergency department visits by young people following an episode of deliberate self-harm. Systematic mental health assessments in the emergency department of young people following an episode of deliberate self-harm may improve detection of mental disorders.
Olfson
Mark
M
New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, USA. mo49@child.cpmc.columbia.edu
Gameroff
Marc J
MJ
Marcus
Steven C
SC
Greenberg
Ted
T
Shaffer
David
D
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry) / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D010351:Patient Discharge / Q000706:statistics & numerical data; D012652:Self Mutilation / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D017678:Sex Distribution; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology