Friday, March 8, 2019

Adults With Autism Twice as Likely to Be Hospitalized for Self-Harm

Adults with autism spectrum disorder (ASD) were nearly twice as likely as other adults to be hospitalized for self-injurious behavior and ideation, according to a study published yesterday in Psychiatric Services in Advance. In addition, these patients stayed in the hospital two days longer and incurred more costs even after the longer hospitalizations were taken into account.

“Adults with ASD might lack access to appropriate health care services, have difficulty communicating their symptoms to their health care providers, be more sensitive to stimuli and stressors, and lack a healthy support network,” wrote Morgan C. Shields, M.Sc., M.A., of the Lurie Institute for Disability Policy at the Heller School for Social Policy and Management at Brandeis University, and colleagues.

About 28% of U.S. children with ASD experience self-injurious behavior compared with about 8% of U.S. children without ASD, but less is known about U.S. adults with ASD.

Shields and colleagues used the Healthcare Cost and Utilization Project 2014 National Inpatient Sample to compare rates of hospitalization for adults with and without ASD for self-injurious behavior and ideation. They used ICD-9-CM codes to identify more than 5,000 hospital admissions for adults with ASD and more than 16,000 admissions for adults without ASD, matching them on age and gender. The study compared admissions, average length of stay, and costs of hospital stays for both groups.

Nearly 13% of the hospitalizations of adults with ASD were related to self-injurious behavior and ideation compared with 6% for adults without ASD. Adults with ASD were more likely to be non-Hispanic white, more likely to be on Medicare or Medicaid, and less likely to be uninsured or living in a low-income area.

Adults with ASD were hospitalized more than two days longer for self-injurious behavior or ideation (7.6 days versus 5.4 days) and had 37% higher costs ($6,800 versus $5,000). Even when the analysis was adjusted for comorbidity, number of procedures, and length of stay, adults with ASD still had more than 7% higher costs.

In the general population, age generally has a moderating effect on self-injurious behavior and ideation,with younger adults (aged 18 to 24) at substantially increased risk than older adults, according to the researchers. This held true in the study for adults without ASD. But adults with ASD aged 25 to 35 were no less likely than those aged 18 to 24 to have a hospitalization for self-injurious behavior and ideation.

The researchers further found that adults aged 50 and older with ASD were more likely to be hospitalized for self-injurious behavior and ideation compared with adults in this age range without ASD. “This suggests that self-injurious behavior and ideation, or at least those cases requiring hospitalization, remains a constant phenomenon well into adulthood for those with ASD,” the researchers wrote.

For related information, see the Psychiatric News article “Having a Sibling With ADHD or ASD Increases Risk for Both Disorders.”


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