Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood

Emmanuel S Gnanamanickam; Ha Nguyen; Jason M Armfield; James C Doidge; Derek S Brown; David B Preen; Leonie Segal

doi:10.1016/j.chiabu.2021.105397

Child maltreatment and emergency department visits: a longitudinal birth cohort study from infancy to early adulthood

Child Abuse Negl. 2022 Jan:123:105397. doi: 10.1016/j.chiabu.2021.105397. Epub 2021 Nov 22.

Authors

Emmanuel S Gnanamanickam¹, Ha Nguyen², Jason M Armfield³, James C Doidge⁴, Derek S Brown⁵, David B Preen⁶, Leonie Segal³

Affiliations

¹ Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia. Electronic address: [email protected].
² Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, University of Sydney, Sydney, New South Wales, Australia.
³ Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia.
⁴ Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia; Intensive Care National Audit and Research Centre, London, UK; UCL Great Ormond Institute of Child Health, University College London, London, UK.
⁵ Brown School, Washington University in St. Louis, St. Louis, MO, USA.
⁶ School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia.

PMID: 34823123
DOI: 10.1016/j.chiabu.2021.105397

Abstract

Background: Child maltreatment (CM) is a serious global public health issue, with documented impacts on health.

Objective: To examine the association between different levels of CM concern, and Emergency Department (ED) visits from infancy to early adulthood.

Participants and setting: Individuals born in Adelaide, South Australia from January 1986 to June 2017 (N = 443,754).

Methods: Using linked administrative data, we examined frequency and adjusted rate ratios for all-cause and cause specific ED visits among individuals with varying levels of CM concern.

Results: Cumulative mean ED visits to age 14.5 years were higher for individuals with any CM concern, ranging from 10.2 to 14.8, compared with 6.4 in persons with no recorded CM concern. Adjusted rate ratios for ED visits varied from 1.26 (95% CI: 1.23-1.30) to 1.54 (1.48-1.60) in children (birth to 12 years), 1.98 (CI: 1.92-2.04) to 4.34 (CI: 4.09-4.60) in adolescence and 2.22 (CI: 2.14-3.48) to 3.48 (3.27-3.72) in young adults, increasing with severity of maltreatment concerns. ED visits coded as self-harm or poisoning, injuries, substance use or mental illness were particularly high, with incidence rate ratios mostly 3 to 15 times for mental health/substance related visits and 1.5 to 3.2 for other accidents or injury for individuals with any CM concern versus none.

Conclusions: The high rate ratios for ED visits in children with CM concern, especially for self-harm, substance use and mental health during adolescence and adulthood highlights the enduring mental health needs of victims of child maltreatment, providing further impetus for prevention.

Keywords: Child maltreatment; Child protection; Emergency service use; Mental health.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Birth Cohort
Child
Child Abuse*
Cohort Studies
Emergency Service, Hospital
Humans
Self-Injurious Behavior*
Young Adult