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Adolescent injuries related to self-harm, drugs, alcohol or violence warn of long-term mortality

By Jane Lewis
There are substantial risks of long-term mortality in adolescents hospitalised for injury related to self-harm, drug or alcohol misuse or violence, reports a nationwide UK cohort study published online in The Lancet.

‘Investment is needed in interventions for reducing harm after all types of adversity-related injury, whether self-inflicted, drug or alcohol related, or violent,’ the study authors concluded.

The authors used national data linkage to examine -cause-specific mortality in adolescents (aged 10 to 19 years) admitted to England’s emergency departments for adversity-related (i.e. related to self-harm, drug or alcohol misuse or violence) or accident-related injury between 1997 and 2012. Of 333,009 adolescents admitted with adversity-related injury and 649,818 admitted with accident-related injury, 4782 (0.5%) died in the 10 years after discharge. While suicide, drug- or alcohol-related deaths and homicides accounted for 63.9% of all deaths 10 years after adversity-related injury, they only accounted for 33.6% of deaths after accident-related injury.

The risks of suicide were increased for adolescents after self-inflicted injury, drug- or alcohol-related injury, and after violent injury in boys, with the risks being highest for boys aged 18 to 19 years. The suicide risks were also found to be similar to those of drug- or alcohol-related deaths. This was irrespective of whether the adversity-related index injury was self-inflicted, drug- or alcohol-related or violent. Adolescents with an underlying chronic condition were at increased risk of all causes of death, independent of injury type or age.

According to the authors, their main finding of similar increases in risks of suicide after self-inflicted injury and after drug- or alcohol-related injury has not been previously reported.

Speaking to Medicine Today, Professor Philip Hazell, from the Discipline of Psychiatry, The University of Sydney, said the main findings of the study were ‘not surprising.’ However, while the authors’ recommendations were ‘sensible,’ they were not necessarily supported by the data, which could be used to draw a range of conclusions.

In a comment published with the study, authors Professor George Patton and Dr Rohan Borschmann from the Centre for Adolescent Health, Royal Children’s Hospital in Melbourne, said that a number of new studies were providing more information about the consequences of emotional and behavioural problems arising in adolescence, and that the current study ‘provides valuable and further sobering assessment of the risks.’

‘Healthcare professionals should no longer see an adolescent presenting in distress as a nuisance, wasting valuable clinical time, but as a vulnerable person deserving the second chance that responsive and sustained health care can provide,’ they wrote.
Lancet 2017; http://dx.doi.org/10.1016/S0140-6736(17)31045-0.
Lancet 2017; http://dx.doi.org/10.1016/S0140-6736(17)31331-4.