179 - Risk Factors Associated with Deliberate Self-Harm in Youths in the Child Welfare System

Poster Number: 179
Publication Number: 179.1383

Background: Behavioral health accounts for the highest percentage of unmet needs among children living in the child welfare system. Particularly, this population has a higher prevalence of suicidality. Longitudinal studies of deliberate self-harm (DSH) trends following the opening of a child welfare case have not been well-studied. Identifying these associations may inform earlier interventions to reduce self-harm.

Objective: To examine factors associated with DSH in children within the child welfare system.

Design/Methods: This retrospective longitudinal cohort study included youth 5-17 years who had their first child welfare case opened between 2010-2020 within Ohio Medicaid claims and Statewide Automated Child Welfare Information Systems data. Medicaid claims identified youths who were continuously enrolled in Medicaid during the 180 days prior to their open case (pre-period). Youths were followed from the index date of the open case until study outcomes: DSH, death, end of Medicaid enrollment, or one year. Stratified by age, associations between demographic and clinical characteristics and DSH were analyzed descriptively and with Cox proportional-hazard models using SAS Enterprise Guide 8.3.

Results: 98,792 youth met inclusion criteria of whom 70,698 were 5-12 years and 28,094 were 13-17 years during the initial open case. Females had a higher risk of DSH than males regardless of age (HR=2.07 for 5-12; HR=1.65 for 13-17). Children aged 5-12 years with a history of DSH, anxiety, and depression had 12.53, 3.46, and 4.66 times the risk of DSH, respectively (Table 1). Similarly, adolescents 13-17 years with a history of DSH and depression had 9.73 and 4.86 times the risk of DSH, respectively. Anxiety was not significant for adolescents, but ADHD (externalizing disorder) was associated with 1.73 times the risk of DSH. The highest risk period of DSH for adolescents was within the first 15 days after an open case, while the risk among younger children was consistent throughout the follow-up period (Figure 1).

Conclusion(s): Characteristics such as having a history of DSH, anxiety, depression, and ADHD were identified as risk factors associated with DSH. Additionally, the risk of DSH is highest immediately following an open case. Knowledge of these risk factors and high-risk period will drive the development of early intervention strategies to decrease the risk of self-harm.