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Observational Study
. 2019 Nov;64(11):789-797.
doi: 10.1177/0706743719854070. Epub 2019 Jun 11.

Changing Rates of Self-Harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-Sectional Study

William Gardner  1 , Kathleen Pajer  2 , Paula Cloutier  3 , Roger Zemek  4 , Lisa Currie  1 , Simon Hatcher  2 , Ian Colman  1 , Dayna Bell  4 , Clare Gray  2 , Mario Cappelli  5 , Daniel Rodriguez Duque  6 , Isac Lima  7
Affiliations
Observational Study

Changing Rates of Self-Harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-Sectional Study

William Gardner et al. Can J Psychiatry. 2019 Nov.

Abstract
in English, French

Objective: To document the rates of intentional self-harm and mental disorders among youths aged 13 to 17 years visiting Ontario emergency departments (EDs) from 2003-2017.

Methods: This was a repeated cross-sectional observational design. Outcomes were rates of adolescents with (1) at least 1 self-harm ED visit and (2) a visit with a mental disorder code.

Results: Rates of youths with self-harm visits fell 32% from 2.6/1000 in 2003 to 1.8 in 2009 but rose 135% to 4.2 by 2017. The slope of the trend in self-harm visits changed from -0.18 youths/1000/year (confidence interval [CI], -0.24 to -0.13) during 2003 to 2009 to 0.31 youths/1000/year (CI, 0.27 to 0.35) during 2009 to 2017 (P < 0.001). Rates of youths with mental health visits rose from 11.7/1000 in 2003 to 13.5 in 2009 (15%) and to 24.1 (78%) by 2017. The slope of mental health visits changed from 0.22 youths/1000/year (CI, 0.02 to 0.42) during 2003 to 2009 to 1.84 youths/1000/year (CI, 1.38 to 2.30) in 2009 to 2017 (P < 0.001). Females were more likely to have self-harm (P < 0.001) and mental health visits (P < 0.001). Rates of increase after 2009 were greater for females for both self-harm (P < 0.001) and mental health (P < 0.001).

Conclusions: Rates of adolescents with self-harm and mental health ED visits have increased since 2009, with greater increases among females. Research is required on the determinants of adolescents' self-harm and mental health ED visits and how they can be addressed in that setting. Sufficient treatment resources must be supplied to address increased demands for services.

Objectif:: Documenter les taux d’automutilation intentionnelle et des troubles mentaux chez les adolescents de 13 à 17 ans qui se sont présentés aux services d’urgence (SU) de l’Ontario entre 2003 et 2017.

Méthodes:: Il s’agit d’une étude transversale répétée par observation. Les résultats étaient les taux des adolescents ayant a) au moins une visite au SU pour automutilation et b) une visite pour un code de trouble mental.

Résultats:: Les taux des visites d’adolescents pour automutilation ont chuté de 32%, de 2,6/1000 en 2003 à 1,8 en 2009, mais ont augmenté de 135% pour atteindre 4,2 en 2017. La pente de la ligne de tendance des visites pour automutilation est passée de -0,18 adolescents/1000/année (IC = [-0,24 à -0,13]) pour la période de 2003 à 2009, à 0,31 adolescents/1000/année (IC = [0,27 à 0,35]) de 2009 à 2017 (P < 0,001). Les taux des visites d’adolescents pour raison de santé mentale ont augmenté de 11,7/1000 en 2003 à 13,5 en 2009 (15%) et à 24,1 (78%) en 2017. La pente des visites pour santé mentale est passée de 0,22 adolescents/1000/année (IC = [0,02 à 0,42]) pour la période de 2003 à 2009 à 1,84 adolescents/1000/année (IC = [1,38 à 2,30]) de 2009 à 2017 (P < 0,001). Les filles étaient plus susceptibles de présenter l’automutilation (P < 0,001) et des visites pour santé mentale (P < 0,001). Les taux d’augmentation d’après 2009 étaient plus élevés chez les filles tant pour l’automutilation (P < 0,001) que la santé mentale (P < 0,001).

Conclusions:: Les taux des adolescents comptant des visites au SU pour raisons d’automutilation et de santé mentale se sont accrus depuis 2009, et ces augmentations sont plus marquées chez les filles. Il faut une recherche sur les déterminants des visites au SU des adolescents pour raison d’automutilation et de santé mentale et sur la manière de les aborder dans ce contexte. Des ressources de traitement suffisantes doivent être fournies pour répondre aux demandes de services accrues.

Keywords: child and adolescent psychiatry; emergency service; hospital; mental health; self-harm; sex differences; suicide.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Rates of adolescents with self-harm emergency department (ED) visits: 2003 to 2017. (A) Rates of adolescents having a self-harm ED visit, per thousand adolescents in the population, as a function of time. The fitted lines are from the discontinuity regression reported in the “All Youths” columns of Table 3. (B) Rates of adolescents having a self-harm ED visit by sex. The fitted lines are from the regression reported in the “By Sex” columns of Table 3. (C) Rates of adolescents having a mental health ED visit. The fitted lines are from the regression reported in the “All Youths” columns of Table 4. A quadratic term is included in the regression model for mental health visits for year ≥2009. (D) Rates of adolescents having a self-harm ED visit by sex. The fitted lines are from the regression reported in the “By Sex” columns of Table 4.
See this image and copyright information in PMC

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