Algorithm may help doctors figure out which kids more likely to seriously hurt themselves

Researchers from a recent research discovered four different types of mental comorbidities that may aid medical practitioners in identifying youngsters who are more likely to engage in self-harm.

The journal Paediatrics released the findings on May 1, 2023, in an online publication.

Senior author James Antoon, MD, PhD, MPH, assistant professor of paediatrics and hospital medicine at Monroe Carell Jr. Children's Hospital, Vanderbilt University Medical Centre, said that it is extremely difficult to predict which children in the emergency room are at risk for serious self-harm events, such as suicide attempts or self-injurious behaviours. "Our research offers a crucial step in assessing the complete kid with regard to risk assessment for self-harm. These profiles may be used to more accurately measure the total risk of self-harm, which will help clinical decision-making

One of the most significant risk factors for self-harm behaviour in children and adolescents is a past mental diagnosis. Traditional analyses independently of other comorbidities relate a person's mental diagnosis to likelihood of self-harm. Unknown is the total risk for a group of disorders.

Antoon and colleagues enrolled 1098 children aged 5 to 18 who were hospitalised with a neuropsychiatric event (NPE) between April 2016 and March 2020 at Monroe Carell Jr. Children's Hospital or Children's Hospital of Colorado in Aurora in order to identify profiles of psychiatric comorbidity and their association with serious self-harm events in youth.

Self-harm, mood disorders, psychosis/ hallucination, altered mental state, ataxia /movement disorders, encephalitis, seizures, dizziness, headache, sleeping problems, and visual alterations were the 12 NPE categories that researchers found among the study participants.

According to the research, age, sex, and 30 mental health diagnostic categories were utilised as 32 factors to identify various clinical profiles of risk for self-harm episodes.

The median age of the 1098 participants was 14, and a total of 406 (37%) kids had a significant self-harm episode. Researchers found that kids who committed self-harm were more likely to be older, be admitted to a mental health institution, and self-identify as "White" or "other" race/ethnicity.

Researchers categorised the four different profiles as follows:

Low-risk: Consisting mostly of children aged 5 to 9 who did not have a mental health diagnosis and who did not have any mood, behavioural, psychotic, developmental, or trauma- or substance-related problems.

When there are no depressive illnesses present, there is a moderate risk of many mood disorders.

High-risk group: females aged 14 to 17 who had anxiety and depression as well as substance- and trauma-related disorders. Additionally important for this profile were personality traits and eating problems.

Boys aged 10 to 13 with emotional and developmental issues (such as autism spectrum disorder or intellectual impairment) were included in the very-high risk group.

Researchers discovered that the low-risk profile (n=494, 45%) had the lowest median risk of 0.04 (interquartile range [IQR] 0.03-0.04; odds ratio [OR] 0.08, 95% CI 0.04-0.15), compared to the average outcome risk of the overall research population. "Even though they constituted the lowest risk profile, it should be noted that our study population included individuals hospitalised for an NPE and therefore likely represents a population with a greater risk of self-harm events than that of the general population," said Antoon et al in their paper.

The moderate-risk group (n=88, 8%) served as the reference group and had a median risk of 0.30 (IQR 0.27-0.33), which was the same as the baseline risk for the overall cohort (37%). The very-high risk group (n=123, 11%) had the greatest median risk of 0.79 (IQR 0.73-0.79; OR 7.21, 95% CI 3.69-15.20), whereas the high-risk profile (n=393, 36%) had a median risk of 0.69 (IQR 0.67-0.71; OR 5.09, 95% CI 3.11-8.38).

The research offers a unique method for determining what overall constellations of characteristics are related to impending self-harm by considering the child's full medical and psychological profile. The results show different and distinctive patterns of comorbidity that may be separated by sex and age.

The profiles were created using information from 1000 children at two academic children's hospitals who had neuropsychiatric issues, thus the results are preliminary. Future research should concentrate on verifying these risk profiles in a wider, more diverse group of kids and teenagers.

Reference:

Antoon JW, Sekmen M, Zhu Y, et al. Characteristics associated with serious self-harm events in children and adolescents. Pediatrics. Published online May 1, 2023. doi:10.1542/peds.2022-059817