Associations between self-harm and chronic disease among adolescents: Cohort study using statewide emergency department data

Cristina Lidón-Moyano, Deborah Wiebe, Paul Gruenewald, Magdalena Cerda, Paul Brown, Sidra Goldman-Mellor

Research output: Contribution to journalArticle

1 Scopus citations


Introduction: We sought to understand the association between youthful self-harm and subsequent chronic disease-related healthcare utilization and whether self-harm reflects unique vulnerability in comparison with severe psychiatric disorders. Methods: We used a retrospective matched cohort design with statewide, all-payer, individually linked emergency department (ED) data from California, USA. Risk of future ED visits for common chronic conditions in adolescence (headaches, asthma, epilepsy, diabetes, and gastrointestinal disorders, assessed using ICD-9 diagnoses) were compared between three adolescent study groups presenting to an ED in 2010: self-harm patients (n = 5,484), patients with psychiatric complaints but no self-harm (n = 14,235), and patients with other complaints (n = 16,452). Cohort follow-up ended on Sept. 30, 2015. Analyses were adjusted for patients’ prior histories of ED utilization for chronic conditions as well as patient- and area-level sociodemographic characteristics. Results: Risk of subsequent ED visits was higher among self-harm patients compared to non-psychiatric control patients for subsequent epilepsy- (aRR = 1.77, 95% CI [1.42, 2.21]). Risk of subsequent ED visits was higher among psychiatric patients compared to non-psychiatric control patients for subsequent headache- (aRR = 1.31, 95% CI [1.21, 1.42]), and epilepsy-related problems (aRR = 1.85, 95% CI [1.55, 2.21]). Self-harm patients were at higher risk than psychiatric patients for subsequent gastrointestinal disorder (aRR = 1.76, 95% CI [1.03, 3.01]). Conclusions: Findings suggest that self-harm behavior and psychiatric disorders are associated with increased ED utilization for subsequent chronic disease-related ED utilization. Chronic disease among adolescent psychiatric patients should be attended to, potentially involving new models of clinical follow-up care.

Original languageEnglish (US)
Pages (from-to)132-140
Number of pages9
JournalJournal of Adolescence
StatePublished - Apr 1 2019



  • Adolescent
  • Chronic disease
  • Emergency service
  • Mental disorders
  • Self-injurious behavior

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Social Psychology
  • Developmental and Educational Psychology
  • Psychiatry and Mental health

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