title: National trends in hospital-treated self-harm events among middle-aged adults.
abstract: OBJECTIVE
  To assess national trends in hospital-treated self-harm events focusing on adults aged 45-64years.
  
  
  METHODS
  Healthcare Cost and Utilization Project data from 2001 (N=7,452,727) to 2011 (N=7,893,587) were used to assess national trends in hospital stays for suicide and self-inflicted injury among youth (0-24years), young adults (35-44years), middle-aged adults (45-64years) and older adults (≥65years).
  
  
  RESULTS
  Among middle-aged adults, hospital-treated self-harm events increased from 5.1 (2001) to 7.1 (2011) per 10,000 population (OR=1.4, 95% CI=1.2, 1.6). This increase was larger than corresponding changes among youth (5.2-4.9) (interaction P=.0003), young adults (10.0-10.6) (interaction P=.006) or older adults (2.2-2.4) (interaction P=.07). Among middle-aged adults, hospital-treated self-harm events per 100 hospital discharges significantly increased (OR=1.4, 95% CI=1.3, 1.6), but there was not a significant increase in self-harm discharges per 100 mental disorder discharges (OR=1.2, 95% CI=1.0, 1.4).
  
  
  CONCLUSIONS
  Between 2001 and 2011, there was a disproportionate national increase in hospital-treated self-harm events among middle-aged adults that mirrored national trends in suicide. Because the increase was largely accounted for by an overall increase in mental health hospitalizations of middle-aged adults, the rising rate of hospital-treated self-harm events may reflect broader population-based mental health challenges facing US middle-aged adults.
authors.affiliation: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Olfson
authors.affiliation: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.affiliation: New York State Psychiatric Institute/Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
authors.forename: Carlos
authors.initials: C
authors.lastname: Blanco
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D007223:Infant; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology; D008875:Middle Aged; D016728:Self-Injurious Behavior / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Inpatient mental healthcare; Mental health services; National trends; Suicide/self-injury