Self-Injurious Behavior Among Adults With ASD: Hospitalizations, Length of Stay, and Costs of Resources to Deliver Care

Psychiatr Serv. 2019 Jun 1;70(6):457-464. doi: 10.1176/ Epub 2019 Mar 7.


Objective: Research on hospitalizations related to self-injurious behavior and ideation among adults with autism spectrum disorder (ASD) is limited. This study compared admissions, average length of stay, and costs of resources to deliver care for such hospitalizations between adults with and without ASD.

Methods: The 2014 Healthcare Cost and Utilization Project National Inpatient Sample was used to compare 5,341 discharge records for adults with ASD and 16,023 records for adults without ASD, matched on age and gender in a 1:3 ratio. Hierarchical logistic and linear regressions accounted for clustering by hospital. Covariates included gender, race-ethnicity, age, region, comorbidities, number of procedures, and insurance.

Results: Among hospitalized adults, those with ASD were twice as likely as those without ASD to have a hospitalization related to self-injurious behavior and ideation. Among hospital stays for self-injurious behavior and ideation, adults with ASD had average lengths of stay that were 2.14 days longer (95% confidence interval [CI]=1.20-3.08) compared with adults without ASD. Among adults with a hospitalization related to self-injurious behavior and ideation, unadjusted average costs for those with ASD were 36.8% higher than for adults without ASD. After the analysis accounted for covariates and length of stay, adults with ASD still had 7.48% (95% CI=1.05%-14.32%) higher costs.

Conclusions: Adults with ASD were twice as likely as adults without ASD to have a hospitalization related to self-injurious behavior and ideation. Among adults with such a hospitalization, those with ASD had longer stays and, even after the analysis accounted for length of stay, higher costs.

Keywords: Autism; Hospitalization; Psychiatry; Self-Injury; Suicidal Ideation; Utilization.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Autism Spectrum Disorder / epidemiology*
  • Autism Spectrum Disorder / therapy
  • Comorbidity
  • Databases, Factual
  • Female
  • Health Care Costs / statistics & numerical data*
  • Humans
  • Length of Stay / statistics & numerical data*
  • Linear Models
  • Logistic Models
  • Male
  • Middle Aged
  • Self-Injurious Behavior / epidemiology*
  • Self-Injurious Behavior / therapy
  • United States / epidemiology
  • Young Adult