Teenagers and adolescents admitted to the emergency room following an injury from drugs, alcohol, or violence have a similar risk of suicide ten years later as those admitted with self-harm injuries, according to a study published Thursday in The Lancet. The researchers say their study suggests that mental health professionals should treat these teens with a similar level of concern as those who self-harm.
For the study, researchers from University College London and Leeds University examined anonymous data from more than 1 million adolescents ages 10 to 19 who'd been admitted to emergency rooms in England between April 1997 and March 2012 for injuries that were either purely accidental or the result of some type of "adversity," including self-harm, alcohol, drugs, or violence.
Next, they analyzed patients' risk of death from various causes during the ten years after being discharged. The number of adolescents who died in that time was very low—just 0.5 percent. Still, the ten-year risk of death among kids who visited the ER for injuries related to self-harming, drugs, alcohol, or violence (aka adversity injuries) was more than double that of those admitted after an accident—7.3 deaths per 1,000 girls and 15.6 per 1,000 boys, versus 3.8 per 1,000 girls and 6.0 per 1,000 boys, respectively.
When they analyzed deaths just from suicide, they found that adolescents who were hospitalized due to self-harming, drugs, alcohol, or violence were 5 to 6 times more likely to die within 10 years following their hospital visit compared to those with accidental injuries. Previous studies have shown that kids who self-harm face a higher risk of suicide, so they wanted to tease out the differences among the different adversity injuries.
They found that the risk of suicide among adolescents admitted for self-harm (2.9 deaths per 1,000 girls and 9.8 per 1,000 boys) was very similar to those of adolescents admitted for drug, alcohol, or violence-related injuries (2.5 per 1,000 girls and 7.2 per 1,000 boys). It's important to note that violence-related injuries didn't significantly increase the risk of suicide in girls, though researchers aren't sure why. They also noted that it's possible some injuries and deaths could be wrongly classified as accidental, which means that estimates for risk of deaths from suicide, drugs, or alcohol could be underestimated.
According to researchers and outside evidence used in the study, those adversity-related injuries—self-harm, drug or alcohol abuse, violence—all stem from similar underlying issues like poor mental health or social circumstances. But despite the similar risk of suicide later in life, injuries from drugs, alcohol, and violence, aren't treated with the same level of concern in the UK as self-inflicted ones.
"Currently in England, a psychosocial assessment (aka, the crossroad of social factors and individual thoughts and behaviors) is only mandated in guidelines for adolescents seen with self-inflicted injury," says Annie Herbert, study co-author and research associate at University College London. Guidelines for examining the psychological state of teenagers injured through drinking, drugs, or violence either don't exist or the guidelines don't specifically recommend screening in these groups.
Researchers believe, and the study's findings suggest, that the same standard mental-health evaluation for self-inflicted injuries should also be considered for drug, alcohol, and violence-related injuries. "An adolescent may deal with psychosocial difficulties in different ways, like self-harm, drug or alcohol abuse, and violence, early on, but may all be vulnerable to suicide later on," Herbert says.
But while these study findings could be applied to other countries throughout the UK with similar rates of hospital admissions through adversity-related injuries and suicide, application to other countries (like the US) requires further research. One reason: The drinking, drug, and violence cultures here are so different from the ones in the UK, Herbert says.
If you or someone you know is considering suicide, help is available. Call 1-800-273-8255 to speak with someone now or text START to 741741 to message with the Crisis Text Line.
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