Association Between Social Determinants of Health and Deliberate Self-Harm Among Youths With Psychiatric Diagnoses

被引:3
作者
Llamocca, Elyse N. [1 ,3 ]
Steelesmith, Danielle L. [4 ]
Ruch, Donna A. [4 ]
Bridge, Jeffrey A. [1 ,2 ,4 ]
Fontanella, Cynthia A. [1 ,4 ]
机构
[1] Ohio State Univ, Coll Med, Dept Psychiat & Behav Hlth, Columbus, OH 43210 USA
[2] Ohio State Univ, Dept Pediat, Coll Med, Columbus, OH USA
[3] Henry Ford Hlth Syst, Ctr Hlth Policy & Hlth Serv Res, Detroit, MI USA
[4] Nationwide Childrens Hosp, Abigail Wexner Res Inst, Ctr Suicide Prevent & Res, Columbus, OH 43205 USA
关键词
NATIONALLY REPRESENTATIVE SAMPLE; SUICIDAL THOUGHTS; MENTAL-HEALTH; RISK;
D O I
10.1176/appi.ps.20220180
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Objective: The authors sought to examine the association between adverse social determinants of health (SDoHs) and risk for self-harm among youths. Methods: The authors performed a retrospective longitu-dinal analysis of Ohio Medicaid claims data (April 1, 2016- December 31, 2018) of 244,958 youths (ages 10-17 years) with a primary psychiatric diagnosis. SDoHs were identified from ICD-10 codes and classified into 14 categories, encompassing abuse and neglect, child welfare placement, educational problems, financial problems, exposure to vio-lence, housing instability, legal issues, disappearance or death of a family member, family disruption by separation or divorce, family alcohol or drug use, parent-child conflict, other family problems, social and environmental problems, and nonspecific psychosocial needs. Cox proportional haz-ards analysis was used to examine the association between SDoHs and self-harm (i.e., nonsuicidal self-injury or suicide attempt). Analyses controlled for demographic characteristics and comorbid psychiatric and general medical conditions. Results: During follow-up after an index claim event, 51,796 youths (21.1%) had at least one adverse SDoH indicator, and 3,262 (1.3%) had at least one self-harm event. Abuse and neglect (hazard ratio [HR]=1.90, 99% CI=1.70-2.12), child welfare placement (HR=1.32, 99% CI=1.04-1.67), parent -child conflict (HR=1.52, 99% CI=1.23-1.87), other family problems (HR= 1.25, 99% CI=1.01-1.54), and nonspecific psychosocial needs (HR=1.41, 99% CI=1.06-1.89) were associated with significantly increased hazard of self -harm. Conclusions: Adverse SDoHs were significantly associated with self-harm, even after controlling for demographic and clinical characteristics, underscoring the need for capturing SDoH information in medical records to identify youths at elevated suicide risk and to inform targeted interventions.
引用
收藏
页码:574 / 580
页数:7
相关论文
共 38 条
  • [1] Youth self-harm in low- and middle-income countries: Systematic review of the risk and protective factors
    Aggarwal, Shilpa
    Patton, George
    Reavley, Nicola
    Sreenivasan, Shreenivas A.
    Berk, Michael
    [J]. INTERNATIONAL JOURNAL OF SOCIAL PSYCHIATRY, 2017, 63 (04) : 359 - 375
  • [2] AHRQ Specification QI ICD-10-CM/PCSv2019 Patient Safety Indicators Appendices, 2019, APPENDIX K SELF INFL
  • [3] Contacts to the health care system prior to suicide: a comprehensive analysis using registers for general and psychiatric hospital admissions, contacts to general practitioners and practising specialists and drug prescriptions
    Andersen, UA
    Andersen, M
    Rosholm, JU
    Gram, LF
    [J]. ACTA PSYCHIATRICA SCANDINAVICA, 2000, 102 (02) : 126 - 134
  • [4] [Anonymous], 2014, Capturing social and behavioral domains and measures in electronic health records: Phase 2
  • [5] [Anonymous], 2019, EXPLORE YOUTH RISK B
  • [6] [Anonymous], 2020, Chronic Condition Indicator Refined (CCIR) for ICD-10-CM
  • [7] [Anonymous], 2022, The social-ecological model: A framework for prevention |violence prevention|injury Center|CDC
  • [8] [Anonymous], 2014, Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1
  • [9] [Anonymous], SOCIAL DETERMINANTS
  • [10] Banegas MP, 2018, Perm J, V22, P18, DOI [DOI 10.7812/TPP/18-095, 10.7812/TPP/18-095]