Youth with a psychiatric illness who experience at least one adverse social determinant of health—such as child welfare placement, abuse, or neglect—have a significantly increased risk of self-harm, according to a study published this week in Psychiatric Services.
“Self-harm is a key risk factor for youth suicide and is a major public health concern,” wrote Elyse Llamocca, Ph.D., of Ohio State University College of Medicine and colleagues. “A better understanding of [social determinants of health] and suicide risk in pediatric primary care and other health care settings could inform targeted suicide prevention strategies to reduce youth suicide rates.”
Llamocca and colleagues analyzed Ohio Medicaid claims data to identify youth aged 10 to 17 who had at least one claim with a primary psychiatric diagnosis between April 2016 and December 2018. The authors used ICD-10 codes to identify adverse social determinants of health and incidents of self-harm (defined as both nonsuicidal self-injury and suicide attempts). Adverse social determinants of health were classified into 14 categories, including abuse and neglect; housing instability; death of a family member; family disruption by separation or divorce; or other family problems such as inadequate parent supervision, parental overprotection, or needing to care for a dependent relative.
The authors identified a total of 244,958 youth, with the most common psychiatric diagnoses including ADHD (40%), depression (26%), and anxiety disorders (24%). Twenty-one percent of the youth had a documented adverse social determinant of health, the most prevalent of which was abuse and neglect (13%).
Self-harm occurred among 1.3% of the youth. Abuse and neglect, child welfare placement, parent-child conflict, and other family problems significantly increased the risk of self-harm. In particular, the risk of self-harm among youth who experienced abuse and neglect was nearly two times greater than that of youth who had not.
“Our findings suggest that adverse [social determinants of health] provide vital information beyond demographic and clinical factors in understanding risk for self-harm,” the authors wrote. “Use of ICD-10 codes to identify clinical and social factors related to self-harm risk in medical records could help to identify youths for appropriate prevention efforts and may allow health care providers to bill for efforts to address adverse [social determinants of health] in general clinical settings.”
For related information, see the Psychiatric News article “Youth Online Behavior Offers Clues to Suicidality.”
(Image: iStock/xijian)
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