Past Issues
Emergency Management of Adolescent Self-harm: Patients’
Characteristics and Effect of Case Management
Yu-Hsin Huang, Shu-I Wu, Chen-Ju Lin, Fang-Ju Sun, Shen-Ing Liu
Objective: Data on adolescents visiting emergency departments (ED) in Asia
after acts of self-harm are lacking. This study was to assess characteristics, initial
management, and patient compliance with outpatient follow-up in a series of those
adolescents with episode of self-harm. Methods: We reviewed the records for the
information of demographic and clinical characteristics of adolescents who had
visited the ED of a general hospital for self-injurious behavior from June 2004 to
June 2007. Types of self-harm and precipitating factors were assessed. We started
to implement case management program for suicidal patients in November 2005.
We used a quasi-experimental design, to compare the rate of show-up for outpatient
clinic between those seen before (n = 40) and after (n = 47) the implementing
of this program. Results: Of 87 patients (66 females, mean age: 17.7 years), we
found that the most common form of self-harm was drug overdose, and that the
most common precipitating factor was having interpersonal stressor. Their current
mental disorders were diagnosed in 54 (62%) patients. Those with multiple suicide
attempts were found to be more likely to have psychiatric morbidity than those
with only one attempt. The outpatient attendance rate was poor. Before the implementation
of the case management, only 5 (13%) of those adolescent patients returned
for outpatient psychiatric follow-ups in the subsequent three months compared
with 17 (36%) after case management was implemented (p = 0.016). Logistic
regressions showed that compliance with follow-up was associated with scheduling
a follow-up appointment before ED discharge and with being contacted by
case managers. Conclusion: Adolescents who harmed themselves had a high rate
of psychiatric morbidity, especially those with multiple attempts. Compliance with
follow-up was improved after implementing a case management program.
after acts of self-harm are lacking. This study was to assess characteristics, initial
management, and patient compliance with outpatient follow-up in a series of those
adolescents with episode of self-harm. Methods: We reviewed the records for the
information of demographic and clinical characteristics of adolescents who had
visited the ED of a general hospital for self-injurious behavior from June 2004 to
June 2007. Types of self-harm and precipitating factors were assessed. We started
to implement case management program for suicidal patients in November 2005.
We used a quasi-experimental design, to compare the rate of show-up for outpatient
clinic between those seen before (n = 40) and after (n = 47) the implementing
of this program. Results: Of 87 patients (66 females, mean age: 17.7 years), we
found that the most common form of self-harm was drug overdose, and that the
most common precipitating factor was having interpersonal stressor. Their current
mental disorders were diagnosed in 54 (62%) patients. Those with multiple suicide
attempts were found to be more likely to have psychiatric morbidity than those
with only one attempt. The outpatient attendance rate was poor. Before the implementation
of the case management, only 5 (13%) of those adolescent patients returned
for outpatient psychiatric follow-ups in the subsequent three months compared
with 17 (36%) after case management was implemented (p = 0.016). Logistic
regressions showed that compliance with follow-up was associated with scheduling
a follow-up appointment before ED discharge and with being contacted by
case managers. Conclusion: Adolescents who harmed themselves had a high rate
of psychiatric morbidity, especially those with multiple attempts. Compliance with
follow-up was improved after implementing a case management program.
| Key Word | adolescent, case management, patient compliance, self-injurious behavior |
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