Medically Treated Self-Injury Among Children and Adolescents: Repeated Attempts and Service Use Over 1 Year

Objective: Clinical, demographic, and service use patterns of youths ages 6-18 years who had a medically treated self-injury were examined to understand factors associated with recurrence of such an injury in the subsequent year. Methods: This retrospective cohort analysis used data from 31,147 youths who were medically treated for self-injury. Data were from IBM/Watson MarketScan commercial claims and encounters databases (2007-2016). The index self-injury was defined as the first event with an ICD code related to self-injury or suicidal ideation combined with a wound code. Cox proportional hazards regression was used to determine the hazard ratios and 95% confidence intervals (Cis) describing associations with subsequent medically treated self-injury for youths who were hospitalized in psychiatric facilities in the seven days before or after the index self-injury versus those who were not. Results: Approximately 2% of the 31,147 youths had another medically treated self-injury in the year following the index self-injury. The hospitalized group had higher service use in the years prior to and following their self-injury, but the mean number of outpatient psychiatric visits before the index self-injury did not differ significantly between groups. Hazard ratios for clinical, demographic, and service use variables indicated that those who were hospitalized in psychiatric facilities for the index event were twice as likely (95% CI=1.7-2.7) as those who were not to have another medically treated self-injury in the year after the index event. Conclusions: In this retrospective, observational study, psychiatric hospitalization after self-injury was strongly associated with recurrence of self-injury in the subsequent year.