Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, The Ohio State University, USA.
J Am Acad Child Adolesc Psychiatry. 2012 Feb;51(2):213-222.e1. doi: 10.1016/j.jaac.2011.11.002. Epub 2011 Dec 23.
Little is known about the mental health care received by young people after an episode of deliberate self-harm. This study examined predictors of emergency department (ED) discharge, mental health assessments in the ED, and follow-up outpatient mental health care for Medicaid-covered youth with deliberate self-harm.
A retrospective longitudinal cohort analysis was conducted of national 2006 Medicaid claims data supplemented with the Area Resource File and a Substance Abuse and Mental Health Services Administration Medicaid policy survey of state policy characteristics focusing on ED treatment episodes by youth 10 to 19 years old for deliberate self-harm (n = 3,241). Rates and adjusted risk ratios (ARR) of discharge to the community, mental health assessments in the ED, and outpatient visits during the 30 days after the ED visit were assessed.
Most patients (72.9%) were discharged to the community. Discharge was inversely related to recent psychiatric hospitalization (ARR 0.75, 99% confidence interval [CI] 0.63-0.90). Thirty-nine percent of discharged patients received a mental health assessment in the ED and a roughly similar percentage (43.0%) received follow-up outpatient mental health care. Follow-up mental health care was directly related to recent outpatient (ARR 2.58, 99% CI 2.27-2.94) and inpatient (ARR 1.33, 99% CI 1.14-1.56) mental health care and inversely related to Hispanic ethnicity (ARR 0.78, 99% CI 0.64-0.95) and residence in a county with medium-to-high poverty rates (ARR 0.84, 99% CI 0.73-0.97).
A substantial proportion of young Medicaid beneficiaries who present to EDs with deliberate self-harm are discharged to the community and do not receive emergency mental health assessments or follow-up outpatient mental health care.
对于经历过故意自伤的年轻人，他们在急诊部（ED）接受的心理健康护理情况知之甚少。本研究旨在考察医疗保险覆盖的青少年故意自伤后 ED 出院、ED 心理健康评估和后续门诊心理健康治疗的预测因素。
对 2006 年全国医疗保险索赔数据进行回顾性纵向队列分析，同时补充使用区域资源文件和物质滥用和心理健康服务管理局的 Medicaid 政策调查，该调查侧重于青少年（10-19 岁）故意自伤的 ED 治疗情况（n=3241）。评估了社区出院率、ED 心理健康评估率和 ED 就诊后 30 天内的门诊就诊率，以及调整后的风险比（ARR）。
大多数患者（72.9%）出院到社区。出院率与近期精神科住院呈负相关（ARR 0.75，99%置信区间[CI] 0.63-0.90）。39%出院患者在 ED 接受了心理健康评估，大致相同比例（43.0%）接受了后续门诊心理健康治疗。后续心理健康治疗与近期门诊（ARR 2.58，99%CI 2.27-2.94）和住院（ARR 1.33，99%CI 1.14-1.56）心理健康治疗直接相关，与西班牙裔种族（ARR 0.78，99%CI 0.64-0.95）和居住在中-高贫困率县（ARR 0.84，99%CI 0.73-0.97）呈负相关。
大量接受故意自伤的医疗保险受益青少年被送往社区，并未接受急诊心理健康评估或后续门诊心理健康治疗。
