Emergency department visits for self-harm in adolescents after release of the Netflix series ‘13 Reasons Why’

Objective: To determine whether the release of the first season of the Netflix series ‘13 Reasons Why’ was associated with changes in emergency department presentations for self-harm. Methods: Healthcare utilization databases were used to identify emergency department and outpatient presentations according to age and sex for residents of Ontario, Canada. Data from 2007 to 2018 were used in autoregressive integrated moving average models for time series forecasting with a pre-specified hypothesis that rates of emergency department presentations for self-harm would increase in the 3-month period following the release of 13 Reasons Why (1 April 2017 to 30 June 2017). Chi-square and t tests were used to identify demographic and health service use differences between those presenting to emergency department with self-harm during this epoch compared to a control period (1 April 2016 to 30 June 2016). Results: There was a significant estimated excess of 75 self-harm-related emergency department visits (+6.4%) in the 3 months after 13 Reasons Why above what was predicted by the autoregressive integrated moving average model (standard error = 32.4; p = 0.02); adolescents aged 10–19 years had 60 excess visits (standard error = 30.7; p = 0.048), whereas adults demonstrated no significant change. Sex-stratified analyses demonstrated that these findings were largely driven by significant increases in females. There were no differences in demographic or health service use characteristics between those who presented to emergency department with self-harm in April to June 2017 vs April to June 2016. Conclusions: This study demonstrated a significant increase in self-harm emergency department visits associated with the release of 13 Reasons Why. It adds to previously published mortality, survey and helpline data collectively demonstrating negative mental health outcomes associated with 13 Reasons Why.

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Resident loneliness, social isolation and unplanned emergency department visits from supportive living facilities: a population-based study in Alberta, Canada

BMC Geriatrics ◽

10.1186/s12877-021-02718-5 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Stephanie A. Chamberlain ◽

Susan E. Bronskill ◽

Zoe Hsu ◽

Erik Youngson ◽

Andrea Gruneir

Keyword(s):

Emergency Department ◽

Health Service ◽

Social Isolation ◽

Service Use ◽

Population Based ◽

Emergency Department Visits ◽

Health Service Use ◽

Care Providers ◽

Ed Visits ◽

Socially Isolated

Abstract Background Supportive living (SL) facilities are intended to provide a residential care setting in a less restrictive and more cost-effective way than nursing homes (NH). SL residents with poor social relationships may be at risk for increased health service use. We describe the demographic and health service use patterns of lonely and socially isolated SL residents and to quantify associations between loneliness and social isolation on unplanned emergency department (ED) visits. Methods We conducted a retrospective cohort study using population-based linked health administrative data from Alberta, Canada. All SL residents aged 18 to 105 years who had at least one Resident Assessment Instrument-Home Care (RAI-HC) assessment between April 1, 2013 and March 31, 2018 were observed. Loneliness and social isolation were measured as a resident indicating that he/she feels lonely and if the resident had neither a primary nor secondary caregiver, respectively. Health service use in the 1 year following assessment included unplanned ED visits, hospital admissions, admission to higher levels of SL, admission to NH and death. Multivariable Cox proportional hazard models examined the association between loneliness and social isolation on the time to first unplanned ED visit. Results We identified 18,191 individuals living in Alberta SL facilities. The prevalence of loneliness was 18% (n = 3238), social isolation was 4% (n = 713). Lonely residents had the greatest overall health service use. Risk of unplanned ED visit increased with loneliness (aHR = 1.10, 95% CI: 1.04–1.15) but did not increase with social isolation (aHR = 0.95, 95% CI: 0.84–1.06). Conclusions Lonely residents had a different demographic profile (older, female, cognitively impaired) from socially isolated residents and were more likely to experience an unplanned ED visit. Our findings suggest the need to develop interventions to assist SL care providers with how to identify and address social factors to reduce risk of unplanned ED visits.

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Using the Past to Predict the Future: Latent Class Analysis of Patterns of Health Service Use of Older Adults in the Emergency Department

Journal of the American Geriatrics Society ◽

10.1111/jgs.12746 ◽

2014 ◽

Vol 62 (4) ◽

pp. 711-715 ◽

Cited By ~ 15

Author(s):

S. Nicole Hastings ◽

Heather E. Whitson ◽

Richard Sloane ◽

Lawrence R. Landerman ◽

Carolyn Horney ◽

...

Keyword(s):

Older Adults ◽

Emergency Department ◽

Health Service ◽

Latent Class Analysis ◽

Service Use ◽

Latent Class ◽

Health Service Use ◽

Class Analysis ◽

The Past ◽

The Future

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Health service use in a randomized clinical trial comparing three methods of emergency department interventions for opioid dependence

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2015.07.1005 ◽

2015 ◽

Vol 156 ◽

pp. e32 ◽

Cited By ~ 2

Author(s):

S. Busch ◽

K. Hawk ◽

D. Fiellin ◽

P. O’Connor ◽

M. Chawarski ◽

...

Keyword(s):

Clinical Trial ◽

Emergency Department ◽

Health Service ◽

Randomized Clinical Trial ◽

Opioid Dependence ◽

Service Use ◽

Health Service Use

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Exploring Patterns of Health Service Use in Older Emergency Department Patients

Academic Emergency Medicine ◽

10.1111/j.1553-2712.2010.00870.x ◽

2010 ◽

Vol 17 (10) ◽

pp. 1086-1092 ◽

Cited By ~ 18

Author(s):

S. Nicole Hastings ◽

Carolyn Horney ◽

Lawrence R. Landerman ◽

Linda L. Sanders ◽

Michael B. Hocker ◽

...

Keyword(s):

Emergency Department ◽

Health Service ◽

Service Use ◽

Health Service Use ◽

Emergency Department Patients

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A Qualitative Study of Home Care Client and Caregiver Experiences With a Complex Cardio-respiratory Management Model

10.21203/rs.3.rs-145167/v1 ◽

2021 ◽

Author(s):

Connie Schumacher ◽

Darly Dash ◽

Fabrice Mowbray ◽

Lindsay Klea ◽

Andrew Costa

Keyword(s):

Health Service ◽

Qualitative Study ◽

Home Care ◽

Service Use ◽

Emergency Department Visits ◽

Management Model ◽

Health Service Use ◽

Self Management ◽

Home Based ◽

Respiratory Management

Abstract BackgroundHome care clients are typically older and have some degree of medical, physical, cognitive or social conditions that require formal or informal support to promote healthy aging in the community. Home care clients contribute a significant proportion of health service use, including emergency department visits. The DIVERT-CARE trial introduced a cardio-respiratory management model to improve patient motivation, symptoms and rates of unwarranted health service use. Our objective was to explore the perceptions and experiences of individuals who participated in the DIVERT-CARE self-management support and education intervention.MethodsA qualitative study was nested within a pragmatic randomized control trial and conducted following a 15-week multicomponent cardio-respiratory intervention. A phenomenological descriptive design was employed using thematic analysis. Post-intervention, clients and their caregivers were invited to participate in a semi-structured telephone interview. Interview questions were designed to elicit the experience with the intervention components.ResultsA total of 29 interviews were completed from June 2018 to March 2020 from participants in Ontario, Newfoundland, and British Columbia. Five themes were identified; self-care trajectory and responsibility, learning and behaviour change, pre-emptive connection to care providers, connection to information and the health system, and connection through therapeutic relationships.ConclusionsHome care clients experience unique challenges in managing chronic disease. Home-based interventions fostered a therapeutic relationship of connectedness while equipping clients with necessary knowledge and skills. These results inform recommendations for community nursing, and home-based self-management supports for older community-residing individuals.

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Impact of an Emergency Department-to-Home Transitional Care Intervention on Health Service Use in Medicare Beneficiaries

Medical Care ◽

10.1097/mlr.0000000000001452 ◽

2020 ◽

Vol 59 (1) ◽

pp. 29-37

Author(s):

Jessica R. Schumacher ◽

Barbara J. Lutz ◽

Allyson G. Hall ◽

Jeffrey S. Harman ◽

Kristen Turner ◽

...

Keyword(s):

Emergency Department ◽

Health Service ◽

Service Use ◽

Transitional Care ◽

Health Service Use ◽

Medicare Beneficiaries ◽

Care Intervention

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Self-harm hospitalised morbidity and mortality risk in Australia using a matched population-based cohort

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.595 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Rebecca Mitchell ◽

Cate Cameron

Keyword(s):

At Risk ◽

Health Service ◽

Mortality Risk ◽

Service Use ◽

Negative Binomial ◽

Population Based ◽

The Self ◽

Health Service Use ◽

Self Harm ◽

Rate Ratios

IntroductionPrior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. Objectives and ApproachTo quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort study of individuals ≥18 years using linked hospitalisation and mortality records from four Australian states. Self-harm was identified using a principal diagnosis of injury (S00-T75 or T79) and an external cause of self-harm (X60-X84). The index self-harm hospitalisation was identified and 12-month pre- and post-index injury health service use was examined. The non-injured comparison cohort was randomly selected from the electoral roll and was matched 1:1 on age, gender, and postcode of residence. Comorbidities were identified using diagnosis classifications with a 1-year lookback. Negative binomial regression was used to quantify associations between self-harm and counts of hospital admissions 12-months post the index hospitalisation using rate ratios and 95%CIs. ResultsThere were 11,597 individuals with a self-harm hospitalisation in New South Wales, South Australia, Queensland or Tasmania with a matched comparison. Mean age was 38.6 years (SD=14.9) and 57.6% were female. The self-harm cohort had a higher proportion of Charlson comorbidities, mental health diagnoses, alcohol misuse and drug-related dependence than their matched counterparts. The self-harm cohort experienced a higher proportion of health service use in the 12-months preceding (20.5% vs 10.1%) and post (21.2% vs 10.6%) the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. The adjusted rate ratios (ARR) for hospital readmission were highest for females (ARR: 2.86; 95% CI: 2.33-3.52) and individuals aged 55-64 years (ARR: 3.96; 95%CI: 2.79-5.64). Conclusion/ImplicationsImproved hospitalisation burden quantification for self-harm can inform resource allocation for intervention and after care services for individuals at-risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity is needed.

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