Predictors of self-harm emergency department visits in adolescents: A statewide longitudinal study

Objective: This study investigated patient-and area-level characteristics associated with adolescent emergency department (ED) patients' risk of subsequent ED visits for self-harm. Method: Retrospective analysis of adolescent patients presenting to a California ED in 2010 (n=480,706) was conducted using statewide, all-payer, individually linkable administrative data. We examined associations between multiple predictors of interest (patient sociodemographic factors, prior ED utilization, and residential mobility; and area-level characteristics) and odds of a self-harm ED visit in 2010. Patients with any self-harm in 2010 were followed up over several years to assess predictors of recurrent self-harm. Results: Self-harm patients (n=5539) were significantly more likely than control patients (n=16,617) to have prior histories of ED utilization, particularly for mental health problems, substance abuse, and injuries. Residential mobility also increased risk of self-harm, but racial/ethnic minority status and residence in a disadvantaged zipcode decreased risk. Five-year cumulative incidence of recurrent self-harm was 19.3%. Admission as an inpatient at index visit, Medicaid insurance, and prior ED utilization for psychiatric problems or injury all increased recurrent self-harm risk. Conclusions: A range of patient-and area-level characteristics observable in ED settings are associated with risk for subsequent self-harm among adolescents, suggesting new targets for intervention in this clinical context.