Background Epidemiological research has reported strong links between trauma-related hospitalisation and future risks of fatal and nonfatal adverse outcomes. However, some important research questions remain unanswered, including association with hospitalisation occurring specifically during childhood, longer-term follow-up from mid-adolescence through the earlier stages of adulthood, assessment of self-harm versus violence risks in the same study population, and absolute risk estimation. To reduce risk in young people, clinicians and public health experts require a better knowledge of subsequent pathways for individuals who experience trauma-related hospitalisation during childhood.
Methods This national cohort study examined n=1,087,672 persons born in Denmark 1977–1997 with complete linkage to national psychiatric, general hospital and crime registers. Survival analyses (© SAS Institute Inc.) was used to estimate incidence rate ratios (IRRs) for self-harm, violent criminality, interpersonal violence injury, and all-cause mortality between 15th and 35th birthdays among cohort members with and without trauma-related hospitalisation prior to 15th birthday. Accounting for competing risks, cumulative incidence percentage values were estimated to age 35. Estimates were stratified by gender and by reason for hospitalisation during childhood: self-harm, interpersonal violence or accident.
Results Risk for each adverse outcome assessed was raised among young persons who experienced trauma-related hospitalisation at least once during childhood. Confounding by parental socioeconomic status, measured according to income, educational attainment and employment status, explained little of these risk elevations. Individuals hospitalised during childhood following self-harm or interpersonal violence had much higher risks for self-harm and violent criminality aged 15–35 years. Some particularly high cumulative incidence values were observed: subsequent violent offending in males hospitalised following interpersonal violence during childhood, 25.0% (95% CI 21.2–28.9); later self-harm in females hospitalised following interpersonal violence, 18.3% (95% CI 13.5–23.6) and following self-harm during childhood, 21.4% (95% CI 19.8–23.1). More frequent trauma-related hospitalisations, and hospitalisations for multiple trauma types at such an early age, conferred marked risk elevations through young adulthood.
Conclusion Although not all episodes of self-harm and interpersonal violence in the community are routinely captured via hospital records, trauma-related hospitalisation during upbringing may be a clinically useful marker for familial dysfunction and childhood distress that subsequently predicts internalised and externalised destructive behaviours among youths and young adults. Comprehensive national guidelines are needed to tackle the multifaceted vulnerabilities of children hospitalised for injuries or poisonings.Healthcare, social services and educational workers must provide particularly robust support to children hospitalised following self-harm or interpersonal violence, and those who experience multiple trauma-related hospitalisations during upbringing.
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