Changing Rates of Self-Harm and Mental Disorders by Sex in Youths Presenting to Ontario Emergency Departments: Repeated Cross-Sectional Study

Abstract

Objective: To document the rates of intentional self-harm and mental disorders among youths aged 13 to 17 years visiting Ontario emergency departments (EDs) from 2003-2017. Methods: This was a repeated cross-sectional observational design. Outcomes were rates of adolescents with (1) at least 1 self-harm ED visit and (2) a visit with a mental disorder code. Results: Rates of youths with self-harm visits fell 32% from 2.6/1000 in 2003 to 1.8 in 2009 but rose 135% to 4.2 by 2017. The slope of the trend in self-harm visits changed from –0.18 youths/1000/year (confidence interval [CI], –0.24 to –0.13) during 2003 to 2009 to 0.31 youths/1000/year (CI, 0.27 to 0.35) during 2009 to 2017 ( P < 0.001). Rates of youths with mental health visits rose from 11.7/1000 in 2003 to 13.5 in 2009 (15%) and to 24.1 (78%) by 2017. The slope of mental health visits changed from 0.22 youths/1000/year (CI, 0.02 to 0.42) during 2003 to 2009 to 1.84 youths/1000/year (CI, 1.38 to 2.30) in 2009 to 2017 ( P < 0.001). Females were more likely to have self-harm ( P < 0.001) and mental health visits ( P < 0.001). Rates of increase after 2009 were greater for females for both self-harm ( P < 0.001) and mental health ( P < 0.001). Conclusions: Rates of adolescents with self-harm and mental health ED visits have increased since 2009, with greater increases among females. Research is required on the determinants of adolescents’ self-harm and mental health ED visits and how they can be addressed in that setting. Sufficient treatment resources must be supplied to address increased demands for services.

Sex-differences in determinants of suicide risk preceding psychiatric admission: An electronic medical record study

“…40 Similarly, from 2003-2017 increased rates of Ontario emergency department visits for self-harm and mental health were found for all youth aged 13-17 years, but especially among females. 41 Herein we report that both female sex and younger age were associated with elevated suicide risk, supporting these emerging trends. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.…”

Temporal trends in incidence of hospital-treated self-harm among adolescents in Denmark: national register-based study

“…We estimated self-harm incidence rates among adolescents aged 10-19 years, in line with the World Health Organization's definition of adolescence [24]. We examined incidence separately in the following age groups: preteenager (10-12 years), younger teenager (13)(14)(15)(16) and older teenager (17)(18)(19). We calculated annual incidence rates per 10,000 person-years, stratified by age, sex and parental income tertile.…”

“…Evidence from a study of ED presentations in Ireland [5] and also from a primary care patient cohort in the UK [13] indicate that self-harm incidence rates among adolescent females increased from around the time of the 2008 economic recession and through the era of subsequent austerity measures. Similarly, rates of ED presentation following self-harm and mental health concerns both increased rapidly among adolescents between 2009 and 2017 in Ontario, Canada, with particularly pronounced increases seen in girls [14]. Comparing temporal trends in mental health between countries is an important step in understanding possible risk and protective factors at population level [15].…”

Denmark’s success in reducing adolescent self-harm

“…I will focus on the contrast between Denmark and Canada, two prosperous Northern social democracies with extensive social safety nets, and high levels of personal happiness and social trust. However, in contrast to Denmark, in the Canadian province of Ontario, the rates of adolescents presenting at emergency departments (EDs) for self-harm fell 32% from 2003 to 2009, while Danish levels of youth self-harm were rising, but then rose 135% from 2009 to 2017, when Danish levels were falling [3]. Therefore, what does the Danish finding suggest about the causes of adolescent self-harm and about how Canadians might prevent it?…”