Authors (including presenting author) :
Wai AKC (1)(9), Ching CJY(1), Li JZ(1), Pui HHH(1), Leung BKH(1), Yamamoto T(2), Lee AYP(2), Tong CK(3), Leung CS(4), Cheung Y(4), Lo HKY(5), Chang WC(5), Ho JWK(6), Wong JYH (7), Yip PSF(8), Rainer TH(1)(9)
Affiliation :
(1) Department of Emergency Medicine, School of Clinical Medicine, HKU.
(2) Accident & Emergency, Yan Chai Hospital
(3) Intensive Care Unit, Tuen Mun Hospital
(4) Accident & Emergency, Princess Margaret Hospital
(5) Department of Psychiatry, Queen Mary Hospital
(6) School of Biomedical Science, HKU
(7) School of Nursing & Health Sciences, Hong Kong Metropolitan University
(8) Department of Social Work & Social Administration, HKU
(9) Accident & Emergency, Queen Mary Hospital
Keyword 1: :
Youth Self-Harm
Keyword 2: :
Suicide Prevention
Keyword 3: :
Emergency Department
Keyword 4: :
School-based Exposure
Keyword 5: :
Adolescent Mental Health
Introduction :
Youth suicide rates in Hong Kong doubled between 2012 and 2022, prompting implementation of a territory-wide Three-Tier School-based Emergency Mechanism (3T-SEM) in December 2023 to help schools identify students with higher suicide risk early and provide appropriate support to these students as quickly as possible, thereby building a stronger safety net for them.
Objectives :
We examined youth non-fatal deliberate self-harm (DSH) presentations to emergency departments during the first year of this prevention initiative.
Methodology :
We conducted a population-based cohort exposure study using Hong Kong's Clinical Data Analysis and Reporting System, capturing emergency department presentations across 18 public hospitals (90% territorial coverage). We included patients aged 11-18 years presenting with non-fatal DSH (ICD-10: X60-X83) between November 2018 and December 2024, which includes 5 years prior to implementation of 3T-SEM (pre-exposure; November 2018-November 2023) and one year under 3T-SEM (exposure period; December 2023-December 2024).
Result & Outcome :
We identified 4,956 episodes: 3,503 pre-exposure and 1,453 during exposure. Most of the patients presented with intentional DSH by unspecified means, which significantly increased by 6.8% in the exposure group (Pre-exposure: 1394, Exposure: 677, p< 0.001). Simultaneously, the number of general physical exams conducted increased from 87 pre-exposure to 108 during exposure (9.8% increase, p< 0.001). The number of patients with co-occurring neuroses (4.3% increase, Pre-exposure: 635, Exposure: 325, p< 0.001) and bipolar affective disorders (2.0% increase, Pre-exposure: 80, Exposure: 63, adjusted p< 0.001) significantly increased. Meanwhile, the hospital length of stay significantly decreased by 1 day (Pre-exposure: 3 days, Exposure: 2 days, p< 0·001). Within half a year after hospitalization, there proportion of patients attending community psychiatric (7.7% increase, Pre-exposure: 928, Exposure: 497, p< 0.001) or community services (3.0% increase, Pre-exposure: 274, Exposure: 157, p< 0.001) was significantly raised.
