Deliberate Self-Harm Among Youth in the Child Welfare System

Mica Goulbourne MD , Farah W. Brink MD , Xueting Xia MS , Danielle L. Steelesmith PhD , Donna Ruch PhD , Jeffrey A. Bridge PhD , Charmaine B. Lo PhD, MPH , Cynthia A. Fontanella PhD
{"title":"Deliberate Self-Harm Among Youth in the Child Welfare System","authors":"Mica Goulbourne MD ,&nbsp;Farah W. Brink MD ,&nbsp;Xueting Xia MS ,&nbsp;Danielle L. Steelesmith PhD ,&nbsp;Donna Ruch PhD ,&nbsp;Jeffrey A. Bridge PhD ,&nbsp;Charmaine B. Lo PhD, MPH ,&nbsp;Cynthia A. Fontanella PhD","doi":"10.1016/j.jaacop.2025.04.002","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>Youth in the child welfare system are at high-risk for self-harm and suicide attempts; yet little is known about factors associated with deliberate self-harm (DSH) following their initial child protective services (CPS) investigation. This study examined factors associated with DSH among youth in the child welfare system.</div></div><div><h3>Method</h3><div>A retrospective longitudinal cohort analysis was performed using merged data from Ohio Medicaid claims and the Statewide Automated Child Welfare Information Systems for youth ages 5 to 17 with their first CPS investigation between 2010 and 2020 (N = 104,700). Cox proportional hazards analyses were used to examine associations between demographic and clinical factors and DSH within 1 year of the first CPS investigation.</div></div><div><h3>Results</h3><div>During follow-up, 236 youths experienced a DSH claim. Adolescents (ages 13-17) were more likely to have DSH (odds ratio = 7.51, 99% CI: 5.10-11.06) than young children, with the greatest risk within 15 days of a CPS investigation. There was an increased hazard of DSH for adolescents (vs young children; hazard ratio [HR] = 7.20, 99% CI: 4.88-10.60); girls (vs boys; HR = 2.09, 99% CI: 1.45-3.02); and youth with prior DSH (HR = 26.37, 99% CI: 16.36-42.51), ADHD (HR = 2.59, 99% CI: 1.18-3.77), anxiety (HR = 3.71, 99% CI: 2.58-5.34), depression (HR = 7.38, 99% CI: 5.09-10.70), substance use disorder (HR = 2.66, 99% CI: 1.62-4.36), and thought disorders (HR = 7.14, 99% CI: 2.80-18.22).</div></div><div><h3>Conclusion</h3><div>Significant risk factors associated with DSH after the first CPS investigation were prior DSH, mental health disorders, female sex, and older youth. Risk of DSH was highest for adolescents in the first 2 weeks of a CPS investigation. Identification of risk factors and high-risk period can inform early intervention to decrease DSH.</div></div><div><h3>Plain language summary</h3><div>This study highlights the risk of deliberate self-harm (DSH) among children aged 5 to 17 years involved in child welfare investigations by using data from Ohio Medicaid claims and the Statewide Automated Child Welfare Information Systems (SACWIS). Adolescents aged 13 to 17 years were 7.5 times more likely to harm themselves compared to younger children, particularly within the first two weeks of a Child Protective Services investigation. These findings emphasize the need for early identification of at-risk youth, prompt mental health screenings, and linkage to support services that can help reduce self-harm behaviors.</div></div>","PeriodicalId":73525,"journal":{"name":"JAACAP open","volume":"3 3","pages":"Pages 506-515"},"PeriodicalIF":0.0000,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"JAACAP open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2949732925000420","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

Abstract

Objective

Youth in the child welfare system are at high-risk for self-harm and suicide attempts; yet little is known about factors associated with deliberate self-harm (DSH) following their initial child protective services (CPS) investigation. This study examined factors associated with DSH among youth in the child welfare system.

Method

A retrospective longitudinal cohort analysis was performed using merged data from Ohio Medicaid claims and the Statewide Automated Child Welfare Information Systems for youth ages 5 to 17 with their first CPS investigation between 2010 and 2020 (N = 104,700). Cox proportional hazards analyses were used to examine associations between demographic and clinical factors and DSH within 1 year of the first CPS investigation.

Results

During follow-up, 236 youths experienced a DSH claim. Adolescents (ages 13-17) were more likely to have DSH (odds ratio = 7.51, 99% CI: 5.10-11.06) than young children, with the greatest risk within 15 days of a CPS investigation. There was an increased hazard of DSH for adolescents (vs young children; hazard ratio [HR] = 7.20, 99% CI: 4.88-10.60); girls (vs boys; HR = 2.09, 99% CI: 1.45-3.02); and youth with prior DSH (HR = 26.37, 99% CI: 16.36-42.51), ADHD (HR = 2.59, 99% CI: 1.18-3.77), anxiety (HR = 3.71, 99% CI: 2.58-5.34), depression (HR = 7.38, 99% CI: 5.09-10.70), substance use disorder (HR = 2.66, 99% CI: 1.62-4.36), and thought disorders (HR = 7.14, 99% CI: 2.80-18.22).

Conclusion

Significant risk factors associated with DSH after the first CPS investigation were prior DSH, mental health disorders, female sex, and older youth. Risk of DSH was highest for adolescents in the first 2 weeks of a CPS investigation. Identification of risk factors and high-risk period can inform early intervention to decrease DSH.

Plain language summary

This study highlights the risk of deliberate self-harm (DSH) among children aged 5 to 17 years involved in child welfare investigations by using data from Ohio Medicaid claims and the Statewide Automated Child Welfare Information Systems (SACWIS). Adolescents aged 13 to 17 years were 7.5 times more likely to harm themselves compared to younger children, particularly within the first two weeks of a Child Protective Services investigation. These findings emphasize the need for early identification of at-risk youth, prompt mental health screenings, and linkage to support services that can help reduce self-harm behaviors.
儿童福利制度中青少年的故意自残
目的:儿童福利系统青少年自残和自杀倾向高;然而,在最初的儿童保护服务(CPS)调查之后,人们对故意自残(DSH)的相关因素知之甚少。本研究调查了儿童福利系统中青少年患DSH的相关因素。方法回顾性纵向队列分析使用俄亥俄州医疗补助索赔和全州范围内5至17岁青少年的自动儿童福利信息系统的合并数据,并在2010年至2020年期间进行首次CPS调查(N = 104,700)。Cox比例风险分析用于检查首次CPS调查后1年内人口统计学和临床因素与DSH之间的关系。结果随访期间,236名青少年出现DSH。青少年(13-17岁)比幼儿更容易患DSH(优势比= 7.51,99% CI: 5.10-11.06),在CPS调查的15天内风险最大。青少年患DSH的风险增加(与幼儿相比;风险比[HR] = 7.20, 99% CI: 4.88-10.60);女孩(相对于男孩;HR = 2.09, 99% CI: 1.45-3.02);既往有DSH (HR = 26.37, 99% CI: 16.36-42.51)、ADHD (HR = 2.59, 99% CI: 1.18-3.77)、焦虑(HR = 3.71, 99% CI: 2.58-5.34)、抑郁(HR = 7.38, 99% CI: 5.09-10.70)、物质使用障碍(HR = 2.66, 99% CI: 1.62-4.36)和思维障碍(HR = 7.14, 99% CI: 2.80-18.22)的青少年。结论首次CPS调查后与DSH相关的重要危险因素为既往DSH、精神健康障碍、女性和年龄较大的青年。在CPS调查的前两周,青少年患DSH的风险最高。识别危险因素和高危期可以为早期干预降低DSH提供信息。本研究通过使用来自俄亥俄州医疗补助申请和全州自动儿童福利信息系统(SACWIS)的数据,强调了参与儿童福利调查的5至17岁儿童故意自残(DSH)的风险。13至17岁的青少年伤害自己的可能性是年幼儿童的7.5倍,尤其是在儿童保护服务机构调查的头两周内。这些发现强调了早期识别高危青少年、及时进行心理健康筛查以及与有助于减少自残行为的支持服务联系的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
JAACAP open
JAACAP open Psychiatry and Mental Health
自引率
0.00%
发文量
0
审稿时长
16 days
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信