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OBJECTIVES: Self-harm is an important public health issue among youth, including as a major risk factor for suicide(a leading cause of death in this age group). This study used population-based emergency department data to describe clinical and demographic characteristics of emergency department presentations for self-harm among youth(12-17 year- olds) in the province of Ontario, Canada. METHODS: Administrative data capturing every emergency department visit in Ontario between April 1, 2002 and March 31, 2009 were used to identify and describe self-harm presentations. RESULTS: Over the 7-year period between 2002/03 and 2008/09, there were 16,835 self-harm presentations by 12,907 youth. Two thirds of self-harm presentations were self-poisonings (almost always with medicinal agents), followed by self- cutting, which accounted for about one quarter. Incidence rates were higher in girls than boys, increased with age, were inversely related to neighbourhood income and were highest in rural areas. Self-harm accounted for about 1 in 100 emergency department presentations by youth, but also a disproportionate number of presentations triaged as high acuity or admitted to hospital (about 1 in 20). CONCLUSION: Self-harm is an important public health issue, requiring a comprehensive approach to prevention. Ontario has useful data with which to study emergency department presentations for self-harm, and the similarities between self-harm presentations among Ontario youth and those reported from the United States and Europe suggest generalizability of results between populations. Further research is needed to address the reasons for the geographic differences in frequency of self-harm. KEY WORDS: Self-injurious behavior; emergency medical services; child; adolescent; epidemiology OBJECTIFS : L'automutilation est un important probleme de sante publique chez les jeunes, ainsi qu'un grand facteur de risque de suicide (une des principales causes de mortalite dans ce groupe d'age). A l'aide des donnees populationnelles des services d'urgence, nous decrivons le profil clinique et demographique de jeunes (12-17 ans) s'etant presentes aux urgences dans la province de l'Ontario, au Canada, apres s'etre automutiles. METHODE : Nous avons utilise des donnees administratives saisissant toutes les visites aux urgences en Ontario survenues entre le 1er avril 2002 et le 31 mars 2009 pour reperer et decrire les cas d'automutilation. RESULTATS : Sur les sept annees de l'etude (2002-2003 a 2008-2009), il y a eu 16 835 cas d'automutilation chez 12 907 jeunes. Les deux tiers des cas d'automutilation etaient des auto-empoisonnements (presque toujours avec des agents medicinaux), suivis par des coupures autoinfligees (environ le quart des incidents). Les taux d'incidence etaient plus eleves chez les filles que chez les garcons, augmentaient avec l'age, etaient inversement lies au revenu selon le quartier et atteignaient les plus hauts niveaux en milieu rural. L'automutilation representait environ 1 cas sur 100 chez les jeunes s'etant presentes aux urgences, mais aussi un nombre demesure de cas orientes vers les soins aigus ou hospitalises (environ 1 sur 20). CONCLUSION : L'automutilation est un important probleme de sante publique qui exige une demarche de prevention globale. L'Ontario detient des donnees utiles pour etudier les cas d'automutilation geres par les services d'urgence; les ressemblances entre les cas d'automutilation chez les jeunes de l'Ontario et ceux declares aux Etats-Unis et en Europe montrent que les resultats obtenus dans differentes populations pourraient etre generalisables. Il faudrait pousser la recherche pour decouvrir les raisons des ecarts geographiques dans la frequence de l'automutilation. MOTS CLES : comportement automutilatoire; secours medicaux d'urgence; enfant; adolescent; epidemiologie, Self-harm refers to non-fatal self-poisoning or self-injury, irrespective of the apparent purpose. (1) Similar to non-fatal suicide-related behaviours, (2) self-harm encompasses suicide attempts as well as non-suicidal self-injury. Self-harm is [...]

Objectives: We examined whether established sex differences in suicide rates persist when adjustments are made for potential misclassification of deaths in children and youth. Methods: This is a retrospective, descriptive study of 1,294 suicides, 961 accidental and 254 undetermined deaths occurring between January 1, 2000 and December 31, 2007, among persons aged 10 to 25 years in Ontario, Canada. Using data from Coroner's records, causes of death were reclassified based on two different misclassification criteria. Actual and reclassified suicide rates were calculated by sex and age group (with 95% confidence intervals) and by year of death. Results: Males aged 16-25 years accounted for the majority of suicides (68.9%). Asphyxia was the most common cause of suicide in both sexes. While suicides by shooting were almost exclusive to males, suicides due to alcohol/drug toxicity were significantly higher in females. Both before and after reclassification of suicide deaths, sex differences in suicide rates emerged in the 16-25 years age group. In each study year, both actual and reclassified suicide rates were higher in males than females. Conclusions: Sex differences in suicide rates emerging in adolescence are unlikely to be due to misclassification. Other proposed explanations for sex differences in youth suicide rates should be investigated further. Key words: Suicide; adolescent; child; cause of death; sex differences; suicide misclassification La traduction du resume se trouve a la fin de l'article. Objectifs : Determiner si les differences attestees dans les taux de suicide des hommes et des femmes subsistent lorsqu'on les corrige pour d'eventuelles erreurs de classification des deces chez les enfants et les jeunes. Methode : Cette etude retrospective descriptive porte sur 1 294 suicides, 961 deces accidentels et 254 deces indetermines survenus entre le 1er janvier 2000 et le 31 decembre 2007 chez les personnes de 10 a 25 ans en Ontario, au Canada. A l'aide des donnees des dossiers des coroners, nous avons reclassifie les causes de deces en fonction de deux criteres de classification erronee differents. Les taux de suicide actuels et reclassifies ont ete calcules selon le sexe et le groupe d'age (avec des intervalles de confiance de 95 %) et selon l'annee du deces. Resultats : Les hommes de 16 a 25 ans representaient la majorite des suicides (68,9 %). L'asphyxie etait la cause de suicide la plus courante chez les deux sexes. Les suicides par balle etaient presque exclusivement le fait des hommes, mais les suicides par intoxication a l'alcool, aux drogues ou aux medicaments etaient sensiblement plus eleves chez les femmes. Avant et apres la reclassification des deces par suicide, des differences entre les sexes dans les taux de suicide ont ete observees dans le groupe des 16 a 25 ans. Pour chaque annee de l'etude, les taux de suicide actuels et reclassifies etaient plus eleves chez les hommes que chez les femmes. Conclusions : Les differences observees a l'adolescence dans les taux de suicide des hommes et des femmes ne sont probablement pas dues a des erreurs de classification. D'autres explications proposees des differences entre les sexes dans les taux de suicide des jeunes meriteraient des etudes plus poussees. Mots cles : suicide; adolescent; enfant; cause de deces; differences entre les sexes; classification erronee du suicide, Suicide is the second leading cause of death among persons aged 15-24 in Canada. (1) Suicide is a rare event in children/youth; (2) however, it contributes substantially to premature mortality [...]