{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T01:57:57Z","timestamp":1789696677248,"version":"4.0.1"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,7,13]],"date-time":"2025-07-13T00:00:00Z","timestamp":1752364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Tommy Fuss Center Research Fellowship"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Hypothesis<\/jats:title>\n                    <jats:p>We examined associations between medical presentation for self-harm and subsequent diagnosis of a psychotic or bipolar disorder in a sample from the United States. Nordic registry studies have identified hospital (inpatient\/emergency department) presentation of self-harm as a risk factor for developing psychotic or bipolar disorder, but it is unknown if this relationship exists within the United States and whether this relationship extends to outpatient settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>We extracted electronic health records of individuals aged 8\u201329 years from Boston Children\u2019s Hospital (October 2015\u2013August 2023), which included 155 590 individuals (mean age\u2005=\u200512.67 years, 52.6% female). We used Kaplan\u2013Meier and Cox Proportional Hazard analyses to assess time-to-event associations between medical presentation for self-harm and a subsequent new diagnosis of a psychotic or bipolar disorder.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Results<\/jats:title>\n                    <jats:p>Self-harm presentation to any type of medical setting was associated with increased likelihood of developing a psychotic or bipolar disorder (Hazard Ratio [HR]\u2005=\u20054.99, 95% confidence interval (CI), 3.33\u20137.47, P\u2005=\u20055.65e\u221215). 5.8% of those who presented at an outpatient setting with self-harm were later diagnosed with psychotic or bipolar disorder (HR\u2005=\u20053.60, 95% CI, 2.12\u20136.09, P\u2005=\u20051.88e\u221206). Among individuals who presented to inpatient\/emergency department settings with self-harm, 19.6% were later diagnosed with a psychotic or bipolar disorder (HR\u2005=\u200510.8, 95% CI, 5.98\u201319.6, P\u2005=\u20053.47e\u221215).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Presentations with self-harm to a medical setting is a robust predictor of psychotic and bipolar disorders in the United States. It is essential to consider a broad range of psychiatric outcomes when evaluating youth presenting to medical settings with self-harm and refrain from limiting clinical focus to diagnoses of depression or borderline personality disorder.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/schbul\/sbaf098","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T07:30:17Z","timestamp":1748331017000},"source":"Crossref","is-referenced-by-count":2,"title":["Using Electronic Health Records to Identify Medical Presentation for Self-harm as a Predictor of Psychotic or Bipolar Disorders: A Systems-level Alternative to the Clinical High-risk Approach"],"prefix":"10.1093","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7056-5141","authenticated-orcid":false,"given":"Rebecca","family":"Cooper","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, Boston Children\u2019s Hospital , Boston, 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