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Emergency Department Presentations for Self-harm Among Ontario Youth

  • Quantitative Research
  • Published:
Canadian Journal of Public Health Aims and scope Submit manuscript

Abstract

OBJECTIVES: Self-harm is an important public health issue among youth, including as a major risk factor for suicide (a leading cause of death in this age group). This study used population-based emergency department data to describe clinical and demographic characteristics of emergency department presentations for self-harm among youth (12–17 year-olds) in the province of Ontario, Canada.

METHODS: Administrative data capturing every emergency department visit in Ontario between April 1, 2002 and March 31, 2009 were used to identify and describe self-harm presentations.

RESULTS: Over the 7-year period between 2002/03 and 2008/09, there were 16,835 self-harm presentations by 12,907 youth. Two thirds of self-harm presentations were self-poisonings (almost always with medicinal agents), followed by self-cutting, which accounted for about one quarter. Incidence rates were higher in girls than boys, increased with age, were inversely related to neighbourhood income and were highest in rural areas. Self-harm accounted for about 1 in 100 emergency department presentations by youth, but also a disproportionate number of presentations triaged as high acuity or admitted to hospital (about 1 in 20).

CONCLUSION: Self-harm is an important public health issue, requiring a comprehensive approach to prevention. Ontario has useful data with which to study emergency department presentations for self-harm, and the similarities between self-harm presentations among Ontario youth and those reported from the United States and Europe suggest generalizability of results between populations. Further research is needed to address the reasons for the geographic differences in frequency of self-harm.

Résumé

OBJECTIFS: L’automutilation est un important problème de santé publique chez les jeunes, ainsi qu’un grand facteur de risque de suicide (une des principales causes de mortalité dans ce groupe d’âge). À l’aide des données populationnelles des services d’urgence, nous décrivons le profil clinique et démographique de jeunes (12–17 ans) s’étant présentés aux urgences dans la province de l’Ontario, au Canada, après s’être automutilés.

MÉTHODE: Nous avons utilisé des données administratives saisissant toutes les visites aux urgences en Ontario survenues entre le 1er avril 2002 et le 31 mars 2009 pour repérer et décrire les cas d’automutilation.

RÉSULTATS: Sur les sept années de l’étude (2002–2003 à 2008–2009), il y a eu 16 835 cas d’automutilation chez 12 907 jeunes. Les deux tiers des cas d’automutilation étaient des auto-empoisonnements (presque toujours avec des agents médicinaux), suivis par des coupures autoinfligées (environ le quart des incidents). Les taux d’incidence étaient plus élevés chez les filles que chez les garçons, augmentaient avec l’âge, étaient inversement liés au revenu selon le quartier et atteignaient les plus hauts niveaux en milieu rural. L’automutilation représentait environ 1 cas sur 100 chez les jeunes s’étant présentés aux urgences, mais aussi un nombre démesuré de cas orientés vers les soins aigus ou hospitalisés (environ 1 sur 20).

CONCLUSION: L’automutilation est un important problème de santé publique qui exige une démarche de prévention globale. L’Ontario détient des données utiles pour étudier les cas d’automutilation gérés par les services d’urgence; les ressemblances entre les cas d’automutilation chez les jeunes de l’Ontario et ceux déclarés aux États-Unis et en Europe montrent que les résultats obtenus dans différentes populations pourraient être généralisables. Il faudrait pousser la recherche pour découvrir les raisons des écarts géographiques dans la fréquence de l’automutilation.

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Authors and Affiliations

  1. Suicide Studies Research Unit, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Jennifer Bethell PhD & Anne E. Rhodes PhD (Research Scientist; Associate Professor; Adjunct Scientist)

  2. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Jennifer Bethell PhD, Susan J. Bondy PhD (Associate Professor) & W. Y. Wendy Lou PhD (Canada Research Chair in Statistical Methods for Health Care; Professor)

  3. Department of Paediatrics and Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Astrid Guttmann MDCM, MSc (Associate Professor; Senior Scientist; Staff Physician)

  4. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Astrid Guttmann MDCM, MSc (Associate Professor; Senior Scientist; Staff Physician) & Anne E. Rhodes PhD (Research Scientist; Associate Professor; Adjunct Scientist)

  5. Hospital for Sick Children, Toronto, ON, Canada

    Astrid Guttmann MDCM, MSc (Associate Professor; Senior Scientist; Staff Physician)

  6. Department of Psychiatry and Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Anne E. Rhodes PhD (Research Scientist; Associate Professor; Adjunct Scientist)

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  1. Jennifer Bethell PhD
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  2. Susan J. Bondy PhD
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  4. Astrid Guttmann MDCM, MSc
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Corresponding author

Correspondence to Jennifer Bethell PhD.

Additional information

Disclaimer: The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement is intended or should be inferred.

Acknowledgement: Dr. Bethell was supported by a Studentship from the Ontario Mental Health Foundation. The data were accessed through the Institute for Clinical Evaluative Sciences, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.

Conflict of Interest: None to declare.

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Bethell, J., Bondy, S.J., Lou, W.Y.W. et al. Emergency Department Presentations for Self-harm Among Ontario Youth. Can J Public Health 104, e124–e130 (2013). https://doi.org/10.1007/BF03405675

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