Abstract
BackgroundIndividuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown.MethodsThe study is based on Finnish administrative register data on all individuals born 1986–1994. Adolescents and young adults with an episode of self-harm treated in specialised healthcare at ages 16–21 in 2002–2015 (n=4280, 64% female) were identified and followed 2 years before and after the episode. Probabilities of specialised psychiatric inpatient admissions and outpatient visits and purchases of psychotropic medication at different time points relative to self-harm were estimated using generalised estimation equations, multinomial models and cumulative averages. Socioeconomic differences were assessed based on parental education, controlling for income.ResultsAn educational gradient in specialised treatment and prescription medication was observed, with the highest probabilities of treatment among the adolescents and young adults with the highest educated parents and lowest probabilities among those whose parents had basic education. These differences emerged mostly after self-harm. The probability to not receive any treatment, either in specialised healthcare or psychotropic medication, was highest among youth whose parents had a basic level of education (before self-harm 0.39, 95% CI 0.34–0.43, and after 0.29, 95% CI 0.25–0.33 after) and lowest among youth with higher tertiary educated parents (before self-harm: 0.22, 95% CI 0.18–0.26, and after 0.18, 95% CI 0.14–0.22). The largest differences were observed in inpatient care.ConclusionsThe results suggest that specialised psychiatric care and psychotropic medication use are common among youth who self-harm, but a considerable proportion have no prior or subsequent specialised treatment. The children of parents with lower levels of education are likely to benefit from additional support in initiating and adhering to treatment after an episode of self-harm. Further research on the mechanisms underlying the educational gradient in psychiatric treatment is needed.
Highlights
Estimates from psychological autopsy studies indicate that around 90% of suicide victims have a history of psychiatric disorders [1], and a similar prevalence (80%) has been shown in studies focusing on hospitalpresenting non-lethal self-harm [2]
We examine differences by parental education in the probabilities of specialised psychiatric care and psychotropic medication use before and after an episode of self-harm in adolescence or young adulthood
Adolescents and young adults who self-harmed were more commonly males in the lowest two parental education groups, while females were over-represented in the two highest parental education groups
Summary
Estimates from psychological autopsy studies indicate that around 90% of suicide victims have a history of psychiatric disorders [1], and a similar prevalence (80%) has been shown in studies focusing on hospitalpresenting non-lethal self-harm [2]. A common finding in these studies is that there are negligible differences in general practitioner visits, but individuals in higher socioeconomic positions tend to use more specialist services [8, 10]. In addition to healthcare in general, socioeconomic differences in service use have been documented in mental health care as well [12,13,14,15,16], and again especially in the use of specialised services. Individuals in higher socioeconomic positions tend to utilise more mental health care, especially specialist services, than those in lower positions. Whether these disparities in treatment exist among adolescents and young adults who self-harm is currently unknown
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