Deliberate self-harm in older adults: A national analysis of US emergency department visits and follow-up care.

Abstract

To examine mental health care received by older adults following emergency department (ED) visits for deliberate self-harm. This retrospective cohort analysis examined 2015 Medicare claims for adults ≥65years of age with ED visits for deliberate self-harm (N=16495). We estimated adjusted risk ratios (ARR) for discharge disposition, ED coding of mental disorder, and 30-day follow-up mental health outpatient care. Most patients (76.9%) were hospitalized with lower likelihoods observed for African American patients (ARR=0.86, 99% CI=0.79-0.94) and patients with either one medical comorbidity (ARR=0.91, 99% CI=0.83-0.99) or two to three comorbidities (ARR=0.93, 99% CI=0.88-0.99). Hospitalization was associated with recent depression (ARR=1.09, 99% CI=1.03-1.16) and recent psychiatric inpatient care (ARR=1.13, 99% CI=1.04-1.22). Among patients discharged to the community (n=3818), 56.4% received an ED mental disorder diagnosis. Predictors of an ED mental disorder diagnosis included younger age (65-69years; ARR=1.53, 99% CI=1.31-1.78), recent mental health care in ED (ARR=1.50, 99% CI=1.29-1.74) or outpatient (ARR=1.62, 99% CI=1.44-1.82) settings, recent diagnosis of mental disorder (ARR=1.61, 99% CI=1.43-1.80), and other/unknown lethality methods of self-harm (ARR=1.24, 99% CI=1.01-1.52). Among community discharged patients, 39.0% received 30-day follow-up outpatient mental health care, which was most strongly predicted by an ED diagnosis of mental disorder (ARR=2.65, 99% CI=2.25-3.12) and prior outpatient mental health care (ARR=2.62, 99% CI=2.28-3.00). Most older adult Medicare beneficiaries who present to EDs with self-harm are hospitalized. Of those who are discharged to the community, many are not diagnosed with mental disorder in the ED or receive timely follow-up mental health care.