Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns
Abstract Expanding clinical strategies to identify high risk groups for psychotic and bipolar disorders is a research priority. Considering that individuals diagnosed with psychotic and bipolar disorder are at high risk of self-harm, we hypothesised the reverse order relationship would also be true...
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Veröffentlicht in: | Schizophrenia bulletin 2021-10, Vol.47 (6), p.1685-1694 |
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creator | Bolhuis, Koen Lång, Ulla Gyllenberg, David Kääriälä, Antti Veijola, Juha Gissler, Mika Kelleher, Ian |
description | Abstract
Expanding clinical strategies to identify high risk groups for psychotic and bipolar disorders is a research priority. Considering that individuals diagnosed with psychotic and bipolar disorder are at high risk of self-harm, we hypothesised the reverse order relationship would also be true (ie, self-harm would predict psychotic/bipolar disorder). Specifically, we hypothesised that hospital presentation for self-harm would be a marker of high risk for subsequent development of psychotic/bipolar disorder and sought to test this hypothesis in a large population sample. This prospective register-based study included everyone born in Finland in 1987, followed until age 28 years (N = 59 476). We identified all hospital records of self-harm presentations, as well as all ICD-10 healthcare registrations of first diagnoses of psychotic and bipolar disorders. Cox proportional hazards models were used to assess the relationship between self-harm and psychotic/bipolar disorders. Of all individuals who presented to hospital with self-harm (n = 481), 12.8% went on to receive a diagnosis of psychosis (hazard ratio [HR] = 6.03, 95% confidence interval [CI] 4.56–7.98) and 9.4% a diagnosis of bipolar disorder (HR = 7.85, 95% CI 5.73–10.76) by age 28 years. Younger age of first self-harm presentation was associated with higher risk—for individuals who presented before age 18 years, 29.1% developed a psychotic or bipolar disorder by age 28 years. Young people who present to hospital with self-harm are at high risk of future psychotic and bipolar disorders. They represent an important cohort for the prevention of serious mental illness. |
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Expanding clinical strategies to identify high risk groups for psychotic and bipolar disorders is a research priority. Considering that individuals diagnosed with psychotic and bipolar disorder are at high risk of self-harm, we hypothesised the reverse order relationship would also be true (ie, self-harm would predict psychotic/bipolar disorder). Specifically, we hypothesised that hospital presentation for self-harm would be a marker of high risk for subsequent development of psychotic/bipolar disorder and sought to test this hypothesis in a large population sample. This prospective register-based study included everyone born in Finland in 1987, followed until age 28 years (N = 59 476). We identified all hospital records of self-harm presentations, as well as all ICD-10 healthcare registrations of first diagnoses of psychotic and bipolar disorders. Cox proportional hazards models were used to assess the relationship between self-harm and psychotic/bipolar disorders. Of all individuals who presented to hospital with self-harm (n = 481), 12.8% went on to receive a diagnosis of psychosis (hazard ratio [HR] = 6.03, 95% confidence interval [CI] 4.56–7.98) and 9.4% a diagnosis of bipolar disorder (HR = 7.85, 95% CI 5.73–10.76) by age 28 years. Younger age of first self-harm presentation was associated with higher risk—for individuals who presented before age 18 years, 29.1% developed a psychotic or bipolar disorder by age 28 years. Young people who present to hospital with self-harm are at high risk of future psychotic and bipolar disorders. They represent an important cohort for the prevention of serious mental illness.</description><identifier>ISSN: 0586-7614</identifier><identifier>ISSN: 1745-1701</identifier><identifier>EISSN: 1745-1701</identifier><identifier>DOI: 10.1093/schbul/sbab061</identifier><identifier>PMID: 33991091</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Adolescent ; Adult ; Bipolar Disorder - epidemiology ; Emergency Service, Hospital - statistics & numerical data ; Female ; Finland - epidemiology ; Humans ; Longitudinal Studies ; Male ; Medicin och hälsovetenskap ; Psychotic Disorders - epidemiology ; Registries - statistics & numerical data ; Regular ; Risk Factors ; Schizophrenia - epidemiology ; Self-Injurious Behavior - epidemiology ; Young Adult</subject><ispartof>Schizophrenia bulletin, 2021-10, Vol.47 (6), p.1685-1694</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c512t-612f57592fc478b278333a658f4359bea3ba4df4c16201b70a6afbf4f580d6993</citedby><cites>FETCH-LOGICAL-c512t-612f57592fc478b278333a658f4359bea3ba4df4c16201b70a6afbf4f580d6993</cites><orcidid>0000-0001-8254-7525</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530384/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8530384/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,727,780,784,885,1584,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33991091$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:148134552$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Bolhuis, Koen</creatorcontrib><creatorcontrib>Lång, Ulla</creatorcontrib><creatorcontrib>Gyllenberg, David</creatorcontrib><creatorcontrib>Kääriälä, Antti</creatorcontrib><creatorcontrib>Veijola, Juha</creatorcontrib><creatorcontrib>Gissler, Mika</creatorcontrib><creatorcontrib>Kelleher, Ian</creatorcontrib><title>Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns</title><title>Schizophrenia bulletin</title><addtitle>Schizophr Bull</addtitle><description>Abstract
Expanding clinical strategies to identify high risk groups for psychotic and bipolar disorders is a research priority. Considering that individuals diagnosed with psychotic and bipolar disorder are at high risk of self-harm, we hypothesised the reverse order relationship would also be true (ie, self-harm would predict psychotic/bipolar disorder). Specifically, we hypothesised that hospital presentation for self-harm would be a marker of high risk for subsequent development of psychotic/bipolar disorder and sought to test this hypothesis in a large population sample. This prospective register-based study included everyone born in Finland in 1987, followed until age 28 years (N = 59 476). We identified all hospital records of self-harm presentations, as well as all ICD-10 healthcare registrations of first diagnoses of psychotic and bipolar disorders. Cox proportional hazards models were used to assess the relationship between self-harm and psychotic/bipolar disorders. Of all individuals who presented to hospital with self-harm (n = 481), 12.8% went on to receive a diagnosis of psychosis (hazard ratio [HR] = 6.03, 95% confidence interval [CI] 4.56–7.98) and 9.4% a diagnosis of bipolar disorder (HR = 7.85, 95% CI 5.73–10.76) by age 28 years. Younger age of first self-harm presentation was associated with higher risk—for individuals who presented before age 18 years, 29.1% developed a psychotic or bipolar disorder by age 28 years. Young people who present to hospital with self-harm are at high risk of future psychotic and bipolar disorders. They represent an important cohort for the prevention of serious mental illness.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Bipolar Disorder - epidemiology</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Female</subject><subject>Finland - epidemiology</subject><subject>Humans</subject><subject>Longitudinal Studies</subject><subject>Male</subject><subject>Medicin och hälsovetenskap</subject><subject>Psychotic Disorders - epidemiology</subject><subject>Registries - statistics & numerical data</subject><subject>Regular</subject><subject>Risk Factors</subject><subject>Schizophrenia - epidemiology</subject><subject>Self-Injurious Behavior - epidemiology</subject><subject>Young Adult</subject><issn>0586-7614</issn><issn>1745-1701</issn><issn>1745-1701</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><sourceid>D8T</sourceid><recordid>eNqFkk9v1DAQxS0EokvhyhH5CIe0dvwnMQekslAWaREVhQMna5LYrNlsHGwHtJ-Ar41LtoUeECePPL_3ZmQ_hB5TckKJYqex3TRTfxobaIikd9CCVlwUtCL0LloQUcuikpQfoQcxfiWEciXL--iIMaWynC7Qz5WPo0vQ44tgohkSJOcHbH3Al6a3xQrCDrsBf_ZT2mCIGPAHF7f4HYStCb-5NaRcXcR9u_HJtRiGDr90o-8h4Fcu-tCZEJ_jM7z0Gx8SvkxTt8feYqEwryQ-d8MQH6J7FvpoHh3OY_Tp_PXH5apYv3_zdnm2LlpBy1RIWlpRCVXalld1U1Y1YwykqC1nQjUGWAO8s7ylsiS0qQhIsI3lVtSkk0qxY1TMvvGHGadGj8HtIOy1B6cPV9tcGc2zAZGZV__kx-C7P6JrIeU1ZVyIMmtfzNoM7EzX5tcN0N-2uNUZ3EZ_8d91LRhhNc8GTw8GwX-bTEx652Jr-h4G46eoS1HWtMoffLXnyYy2wccYjL0ZQ4m-Soqek6IPScmCJ38vd4NfRyMDz2bAT-P_zH4BcGDMMw</recordid><startdate>20211021</startdate><enddate>20211021</enddate><creator>Bolhuis, Koen</creator><creator>Lång, Ulla</creator><creator>Gyllenberg, David</creator><creator>Kääriälä, Antti</creator><creator>Veijola, Juha</creator><creator>Gissler, Mika</creator><creator>Kelleher, Ian</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0001-8254-7525</orcidid></search><sort><creationdate>20211021</creationdate><title>Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns</title><author>Bolhuis, Koen ; Lång, Ulla ; Gyllenberg, David ; Kääriälä, Antti ; Veijola, Juha ; Gissler, Mika ; Kelleher, Ian</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c512t-612f57592fc478b278333a658f4359bea3ba4df4c16201b70a6afbf4f580d6993</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Bipolar Disorder - epidemiology</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Female</topic><topic>Finland - epidemiology</topic><topic>Humans</topic><topic>Longitudinal Studies</topic><topic>Male</topic><topic>Medicin och hälsovetenskap</topic><topic>Psychotic Disorders - epidemiology</topic><topic>Registries - statistics & numerical data</topic><topic>Regular</topic><topic>Risk Factors</topic><topic>Schizophrenia - epidemiology</topic><topic>Self-Injurious Behavior - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bolhuis, Koen</creatorcontrib><creatorcontrib>Lång, Ulla</creatorcontrib><creatorcontrib>Gyllenberg, David</creatorcontrib><creatorcontrib>Kääriälä, Antti</creatorcontrib><creatorcontrib>Veijola, Juha</creatorcontrib><creatorcontrib>Gissler, Mika</creatorcontrib><creatorcontrib>Kelleher, Ian</creatorcontrib><collection>Access via Oxford University Press (Open Access Collection)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Schizophrenia bulletin</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bolhuis, Koen</au><au>Lång, Ulla</au><au>Gyllenberg, David</au><au>Kääriälä, Antti</au><au>Veijola, Juha</au><au>Gissler, Mika</au><au>Kelleher, Ian</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns</atitle><jtitle>Schizophrenia bulletin</jtitle><addtitle>Schizophr Bull</addtitle><date>2021-10-21</date><risdate>2021</risdate><volume>47</volume><issue>6</issue><spage>1685</spage><epage>1694</epage><pages>1685-1694</pages><issn>0586-7614</issn><issn>1745-1701</issn><eissn>1745-1701</eissn><abstract>Abstract
Expanding clinical strategies to identify high risk groups for psychotic and bipolar disorders is a research priority. Considering that individuals diagnosed with psychotic and bipolar disorder are at high risk of self-harm, we hypothesised the reverse order relationship would also be true (ie, self-harm would predict psychotic/bipolar disorder). Specifically, we hypothesised that hospital presentation for self-harm would be a marker of high risk for subsequent development of psychotic/bipolar disorder and sought to test this hypothesis in a large population sample. This prospective register-based study included everyone born in Finland in 1987, followed until age 28 years (N = 59 476). We identified all hospital records of self-harm presentations, as well as all ICD-10 healthcare registrations of first diagnoses of psychotic and bipolar disorders. Cox proportional hazards models were used to assess the relationship between self-harm and psychotic/bipolar disorders. Of all individuals who presented to hospital with self-harm (n = 481), 12.8% went on to receive a diagnosis of psychosis (hazard ratio [HR] = 6.03, 95% confidence interval [CI] 4.56–7.98) and 9.4% a diagnosis of bipolar disorder (HR = 7.85, 95% CI 5.73–10.76) by age 28 years. Younger age of first self-harm presentation was associated with higher risk—for individuals who presented before age 18 years, 29.1% developed a psychotic or bipolar disorder by age 28 years. Young people who present to hospital with self-harm are at high risk of future psychotic and bipolar disorders. They represent an important cohort for the prevention of serious mental illness.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33991091</pmid><doi>10.1093/schbul/sbab061</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-8254-7525</orcidid><oa>free_for_read</oa></addata></record> |
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subjects | Adolescent Adult Bipolar Disorder - epidemiology Emergency Service, Hospital - statistics & numerical data Female Finland - epidemiology Humans Longitudinal Studies Male Medicin och hälsovetenskap Psychotic Disorders - epidemiology Registries - statistics & numerical data Regular Risk Factors Schizophrenia - epidemiology Self-Injurious Behavior - epidemiology Young Adult |
title | Hospital Presentation for Self-Harm in Youth as a Risk Marker for Later Psychotic and Bipolar Disorders: A Cohort Study of 59 476 Finns |
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