Emergency department presentations for deliberate self-harm and suicidal ideation in 25–39 year olds following agency-notified child maltreatment: results from the Childhood Adversity and Lifetime Morbidity (CALM) study

• Published in: Epidemiology and psychiatric sciences Vol. 33
• Main Authors: Kisely, S., Bull, C., Trott, M., Arnautovska, U., Siskind, D., Warren, N., Najman, J. Moses
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01-01-2024
• Subjects: Adverse childhood experiences; Age; birth cohort; Child abuse & neglect; child maltreatment; Child welfare; Childbirth & labor; Children; deliberate self-harm; Emergency medical care; Emergency services; Emotional abuse; Epidemiology; Family income; Health services; linked data; Longitudinal studies; Morbidity; Original; Original Article; Poisoning; Pregnancy; Regression analysis; Self destructive behavior; Sex crimes; Sexual abuse; Suicidal ideation; Suicide; Suicides & suicide attempts; Trauma; Queensland Australia; Australia; suicidal ideation; child maltreatment; deliberate self-harm; birth cohort; linked data
• ISSN: 2045-7960; 2045-7979
• DOI: 10.1017/S2045796024000192

Abstract
Aims
To compare prospective reports of child maltreatment (CM) with emergency department (ED) presentations for deliberate self-harm (DSH) and suicidal ideation in individuals aged between 25 and 39 years old.
Methods
Linked records between the Mater-University of Queensland Study of Pregnancy birth cohort and Queensland administrative health data were used, which included notifications to child protection agencies for CM. ED presentations for individuals aged between 25 and 39 years of age for suicidal ideation, suicidal behaviour or poisoning by paracetamol or psychotropic medications where the intention was unclear were examined using logistic regression analyses.
Results
A total of 609 (10.1%) individuals were the subject of one or more CM notifications for neglect or physical, sexual or emotional abuse before the age of 15 years. Of these, 250 (4.1%) presented at least once to ED for DSH and/or suicidal ideation between 25 and 39 years of age. In adjusted analysis, any notification of CM was associated with significantly increased odds of presenting to ED for these reasons (aOR = 2.80; 95% CI = 2.04–3.84). In sensitivity analyses, any notification of CM increased the odds of the combined outcome of DSH and suicidal ideation by 275% (aOR = 2.75; 95% CI = 1.96–4.06) and increased the odds of DSH alone by 269% (aOR = 2.69; 95% CI = 1.65–4.41).
Conclusions
All CM types (including emotional abuse and neglect) were associated with ED presentations for DSH and suicidal ideation in individuals between 25 and 39 years of age. These findings have important implications for the prevention of DSH, suicidal ideation and other health outcomes. They also underscore the importance of trauma-informed care in ED for all individuals presenting with DSH and suicidal ideation.