Does emergency department use and post-visit physician care cluster geographically and temporally for adolescents who self-harm? A population-based 9-year retrospective cohort study from Alberta, Canada.

Rhonda J Rosychuk,David W Johnson,Kathryn Dong,Liana Urichuk,Amanda S Newton

doi:10.1186/s12888-016-0941-3

Abstract

BackgroundClustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. We identified geographic areas with higher numbers of adolescents who (1) presented to an emergency department (ED) for self-harm, and (2) were without a physician follow-up visit for mental health within 14 days post-ED visit.MethodsWe extracted a population-based cohort of adolescents aged 15–17 years (n = 3,927) with ED visits during 2002–2011 in Alberta, Canada. We defined the case as an individual with one or more ED presentations for self-harm in the fiscal year of the analysis. Crude case rates were calculated and clusters were identified using a spatial scan.ResultsThe rates decreased over time for ED visits for self-harm (differences: girls −199.6/100,000; p < 0.01; boys −58.8/100,000; p < 0.01), and for adolescents without a follow-up visit within 14 days following an ED visit for self-harm (differences: girls −108.3/100,000; p < 0.01; boys −61.9/100,000; p < 0.01). Two space-time clusters were identified: (1) a North zone cluster during 2002–2006 (p < 0.01) and (2) a South zone cluster during 2003–2007 (p < 0.01). These clusters had higher numbers of adolescents who presented to the ED for self-harm (relative risks [RRs]: 1.58 for cluster 1, 3.54 for cluster 2) and were without a 14-day physician follow-up (RRs: 1.78 for cluster 1, 4.17 for cluster 2). In 2010/2011, clusters in the North, Edmonton, and Central zones were identified for adolescents with and without a follow-up visit within 14 days following an ED visit for self-harm (p < 0.01).ConclusionsThe rates for ED visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period. The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care. The 2010/2011 geographic cluster suggests that the northern part of the province still has elevated numbers of adolescents visiting the ED for self-harm. Prospective research is needed to determine outcomes associated with adolescents who receive physician follow-up following ED-based care for self-harm compared to those who do not.

Highlights

Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied
The rates for emergency department (ED) visits for adolescents who self-harm and rates of adolescents without a 14-day physician follow-up visit following emergency care for self-harm decreased during the study period
The space-time clusters identified the areas and years where visits to the ED by adolescents for self-harm were statistically higher than expected. These clusters can be used to identify locations where adolescents are potentially not receiving follow-up and the mental health support needed after emergency-based care

Summary

Introduction

Clustering of adolescent self-harming behaviours in the context of health care utilization has not been studied. In Canada, several recently publicized clusters of deaths by suicide among young people [1, 2] have focused attention on ‘point clusters’—unusually high numbers of suicides occurring in a close geographic location and brief time period. Such clusters have been documented globally for individuals of all ages, [3,4,5,6,7] clustering has been found to be up to four times more common among adolescents and young adults than among other age groups [3]. In a recent study, Swanson and Colman found that exposure to suicide is associated with increased suicidal ideation and attempt, [13] results that highlighted self-harm risks are spatially and temporally bound

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