Objective: Describe emergency department (ED) presentations for self-harm by youth (12-17 yearolds), including the mental health follow-up they receive after their first-ever presentation, and analyze the association between this mental health follow-up and repeat presentation(s). Methods: Population-based health services data from Ontario, Canada, covering April 2002 to March 2009, were used to ascertain ED presentations for self-harm by youth (n=16,835). These data were used to create a retrospective cohort (n=3,497) of those making their first-ever presentation,
and individually-linked to inpatient admission and ambulatory physician contact data. Mental health follow-up within 30-days of discharge, either from a psychiatrist or from any physician specialty, was assessed. The associations between follow-up and repeat self-harm presentation(s) within the
following year were then analyzed.
Results: Conservatively, the overall incidence rate for ED presentations for self-harm by Ontario youth was 239.0 per 100,000 person-years. Rates were higher in girls, increased with age and inversely related to neighbourhood income and community size (population). Self-harm made up a small but severe proportion of ED use by youth. Over half (57.2%) making their first-ever self-harm presentation had no mental health contact with a physician within 30 days of discharge (and several demographic, clinical and health service variables were associated with follow-up). However, mental health follow-up was not associated with reduced odds of repetition or fewer repeat presentations.
Conclusions: ED presentations for self-harm by youth in Ontario are remarkably consistent with those reported from other Western countries. Self-harm is an important public health issue in Canada and requires a comprehensive prevention strategy. These data suggested follow-up youth received
after their first-ever ED presentation for self-harm may be inadequate and strategies to improve follow-up may be needed. Still, more research is needed to establish the effect of follow-up on relevant outcomes.
| Identifer | oai:union.ndltd.org:TORONTO/oai:tspace.library.utoronto.ca:1807/65460 |
| Date | 19 June 2014 |
| Creators | Bethell, Jennifer |
| Contributors | Rhodes, Anne, Bondy, Susan |
| Source Sets | University of Toronto |
| Language | en_ca |
| Detected Language | English |
| Type | Thesis |
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