6.144 IS IT OKAY TO ASK? PUBLIC HEALTH SURVEILLANCE OF SELF-HARM IN THE EMERGENCY DEPARTMENT

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 55; no. 10; pp. S249 - S250
• Main Authors: Cloutier, Paula F., MA, Skinner, Robin, MS, Cappelli, Mario, PhD, Zemek, Roger, MD, Langill, Corrine, BS, McFaull, Steven, MS, Ranney, Michael, BS, Thompson, Wendy, MS
• Format: Journal Article
• Language: English
• Published: Baltimore Elsevier Inc 01.10.2016; Elsevier BV
• Subjects: Attitudes; Child & adolescent psychiatry; Data processing; Demography; Departments; Discomfort; Emergency medical care; Emergency services; Ethics; Ethics committees; Injuries; Medical screening; Mental disorders; Mental health care; Mental health services; Non-parametric statistics; Pediatrics; Psychiatry; Psychological distress; Psychosocial factors; Public health; Self destructive behavior; Self injury; Suicidal ideation; Suicide; Suicides & suicide attempts; Surveillance; Worry; Youth; Canada
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2016.09.459

Objectives: Non-fatal self-inflicted injuries are not uncommon in North American youth presenting to the emergency department (ED) for care. However, public health surveillance of self-harm has been challenging given discomfort and worry from clinical staff and Ethics committees that inquiring about self-harm will cause distress or suicidal ideation. The 3 objectives of this study were to 1) ascertain if youth think it is acceptable to be asked whether self-inflicted injuries contributed to their ED presentation; 2) describe the demographic and clinical characteristics of youth who present to the ED with self-inflicted injuries; and 3) compare youth who think it is OK to ask about their intentional injuries to those who do not. Methods: Youth presenting to a pediatric emergency department for mental health care between March 2015 and May 2016 were invited to participate. Demographic and clinical data including the HEADS-ED psychosocial screening tool and a self-injury report form (CHIRPP-SI) developed with the Public Health Agency of Canada was collected. Descriptive and non-parametric statistics were used to analyze the data. Results: 532 youth (M age=14.0, SD=2.8; 66 percent female) consented to the study, 27 percent (n=143) indicated self-harm as a presenting problem of which 71 percent (n=101; M age=14.9; 88 percent female) agreed to provide details about their injury. Presenting problem of self-harm was related to CHIRPP-SI form completion (p=.000), however 29 percent of self-harming youth declined to complete the form and 10 percent (n=40) agreed to provide details about their self-harm when it was not a presenting problem. Suicidality requiring immediate action on the HEADS-ED was the most endorsed item for self-harming youth followed by drugs and alcohol and peer related issues. Views on asking about self-harm in the ED were favorable in 96 percent of youth with 84 percent indicating willingness to be contacted for further information. Given the low number (n=6) of negative views about being asked self-harm questions, group comparisons were not feasible. ED self-harm surveillance is ongoing and numbers will be updated. Conclusions: Self-harming youth who present to the ED for care are open to being asked about it. Importantly, approximately one in 10 youth did not divulge any self-harm at the ED presentation until specifically asked if intentional harm contributed to their ED visit.