Journal of the American Academy of Child & Adolescent Psychiatry
Volume 51, Issue 2 , Pages 213-222.e1, February 2012

Outpatient Care of Young People After Emergency Treatment of Deliberate Self-Harm

  • Jeffrey A. Bridge, Ph.D.

      Affiliations

    • Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, The Ohio State University
    • ,
  • Steven C. Marcus, Ph.D.

      Affiliations

    • Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, and the School of Social Policy and Practice, University of Pennsylvania
    • ,
  • Mark Olfson, M.D., M.P.H.

      Affiliations

    • New York State Psychiatric Institute and the College of Physicians and Surgeons of Columbia University
    • Corresponding Author InformationCorrespondence to Mark Olfson, M.D., M.P.H., Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032

Accepted 10 November 2011. published online 26 December 2011.

Objective

Little is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm.

Method

A retrospective longitudinal cohort analysis was conducted of national 2006 Medicaid claims data supplemented with the Area Resource File and a Substance Abuse and Mental Health Services Administration Medicaid policy survey of state policy characteristics focusing on ED treatment episodes by youth 10 to 19 years old for deliberate self-harm (n = 3,241). Rates and adjusted risk ratios (ARR) of discharge to the community, mental health assessments in the ED, and outpatient visits during the 30 days after the ED visit were assessed.

Results

Most patients (72.9%) were discharged to the community. Discharge was inversely related to recent psychiatric hospitalization (ARR 0.75, 99% confidence interval [CI] 0.63–0.90). Thirty-nine percent of discharged patients received a mental health assessment in the ED and a roughly similar percentage (43.0%) received follow-up outpatient mental health care. Follow-up mental health care was directly related to recent outpatient (ARR 2.58, 99% CI 2.27–2.94) and inpatient (ARR 1.33, 99% CI 1.14–1.56) mental health care and inversely related to Hispanic ethnicity (ARR 0.78, 99% CI 0.64–0.95) and residence in a county with medium-to-high poverty rates (ARR 0.84, 99% CI 0.73–0.97).

Conclusions

A substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care.

Key Words:  deliberate self-harm , emergency care , outpatient mental health care , young people , suicide

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 This research was funded by a grant to Columbia University from the American Foundation for Suicide Prevention (MO).

 Dr. Marcus had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation or approval of the manuscript.

 Disclosure: Dr. Olfson has received research grants to Columbia University from Eli Lilly and Co. and Bristol-Myers Squibb. Dr. Marcus has received grant support from Ortho-McNeil Janssen and has served as a consultant to AstraZeneca. Dr. Bridge reports no biomedical financial interests or potential conflicts of interest.

 Supplemental material cited in this article is available online.

 An interview with the author is available by podcast at www.jaacap.org.

PII: S0890-8567(11)00996-8

doi:10.1016/j.jaac.2011.11.002

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 51, Issue 2 , Pages 213-222.e1, February 2012

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