Abstract
SummaryBackgroundDevelopment of a better understanding of subsequent pathways for individuals who experienced trauma during childhood might usefully inform clinicians and public health professionals regarding the causes of self-harm and interpersonal violence. We aimed to examine these risks during late adolescence and early adulthood among people admitted to hospital following injuries or poisonings during their childhood.MethodsThis national cohort study included Danish people born between Jan 1, 1977, and Dec 31, 1997, and was linked to the National Patient Register and Psychiatric Central Research Register to identify all people exposed to hospital admissions for injuries or poisonings due to self-harm, interpersonal violence, or accidents before their 15th birthday. Linkage to these two registers and to the National Crime Register enabled ascertainment of self-harm and violent offending, respectively, as adverse outcomes at ages 15–35 years. Sex-specific incidence rate ratios (IRRs; relative risks) and cumulative incidence percentage values (absolute risks) were estimated. The confounding influence of parental socioeconomic status was also explored.Findings1 087 672 Danish people were included in this study. The prevalence of any trauma-related hospital admission was 10% (105 753 per 1 087 672; males: 64 454 [11%]; females: 44 299 [8%]) and for both sexes, accident was by far the most prevalent of the categories assessed (males: 59 011 [11%]; females: 40 756 [8%]). Similar patterns of increased risk for self-harm and violent criminality were observed in both sexes, although the IRRs were consistently and significantly larger in women (self-harm: IRR 1·94 [95% CI 1·85–2·02]; violent criminality: 2·16 [1·97–2·36]) than in men (self-harm: 1·61 [1·53–1·69]; violent criminality: 1·58 [1·53–1·63]). Confounding by parental socioeconomic status explained little of the increased risks observed. For young adult men, the highest absolute risk observed was for violent offending among individuals admitted to hospital for interpersonal violence injury during childhood (cumulative incidence 25·0% [95% CI 21·2–28·9]). For young adult women, absolute risk was highest for repeat self-harm among those admitted to hospital following self-harm during childhood (cumulative incidence 21·4% [95% CI 19·8–23·1]). More frequent trauma-related hospital admissions in childhood, and being admitted multiple times for more than one reason, conferred substantial risk increases among young people, with especially steep gradients of this nature observed among women.InterpretationTrauma-related hospital admission early in life could be a useful marker for childhood distress that subsequently predicts internalised and externalised destructive behaviours among youths and young adults and might provide a timely opportunity for initiating family-oriented interventions.FundingEuropean Research Council.
Highlights
Trauma-related hospital admission following serious injuries and poisonings, whether self-inflicted, perpetrated by other people, or occurring accidentally, can be highly distressing experiences for children and their families
Around one in seven men admitted to hospital during childhood following self-harm and one in four due to interpersonal violence will be convicted for committing a violent crime by age 35 years
The study cohort consisted of all people born in Denmark from Jan 1, 1977, to Dec 31, 1997, who still resided in Denmark at their 15th birthday, and whose parents were both Danish-born, thereby accounting for increased risks of self-harm and violent criminality linked with first and second generation immigrant status.[13]
Summary
Trauma-related hospital admission following serious injuries and poisonings, whether self-inflicted, perpetrated by other people, or occurring accidentally, can be highly distressing experiences for children and their families. These episodes predict shortterm and long-term increases in risk of suicide and other causes of premature death,[1,2,3,4] and they absorb scarce health-care resources disproportionately.[4] To inform the coordinated development of multiagency initiatives to reduce adverse outcome risks among psychosocially vulnerable young people, it is necessary to better understand the long-term trajectories of children who require hospital admission following major injuries or poisonings, to help to ensure their safe progression through to healthy adult maturity. The study indicated strong links between this exposure and risks of death and emergency readmission www.thelancet.com/public-health Vol 2 July 2017
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
