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Joyce LR, Crossin R, Jin S, Young W, Mulder R. Presence of alcohol and other drug use within youth mental health presentations to the emergency department: A single-site retrospective observational study. Emerg Med Australas 2024; 36:213-220. [PMID: 37899072 DOI: 10.1111/1742-6723.14333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
OBJECTIVE Youth mental health is a growing issue, which can be worsened by alcohol and other drug (AOD) use. The present study aimed to characterise the association of AOD use in youth presenting to an ED with a mental health crisis. METHODS A retrospective observational study of paediatric patients presenting with mental health concerns to a tertiary ED in New Zealand in 2019-2020, with an examination of use of alcohol or other drugs before presentation. RESULTS There were 842 ED presentations, made up of 491 unique individuals, examined from the 2-year period. Overdose (63.1%) was the most common reason for presentation, with 39.9% of overdoses involving prescription-only medications, 36.7% over-the-counter, and 20.0% a combination. Seventy-four (8.8%) presentations had documented use of alcohol or other drugs (excluding those taken in overdose) before arrival, with alcohol (51 presentations), followed by cannabis (19 presentations), being the most commonly recorded drugs used. Concurrent AOD use was not associated with any significant difference in triage, length of stay or admission status. CONCLUSION In New Zealand, it is not legal to sell alcohol to persons under 18 years; however, this was the most commonly identified drug impacting on youth mental health presentations. There is a known association between alcohol use and adverse mental health symptoms; therefore, efforts to decrease access to alcohol in this age group must continue, and harm reduction interventions to reduce clinically significant overdoses recommended.
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Affiliation(s)
- Laura R Joyce
- Department of Surgery and Critical Care, University of Otago, Christchurch, New Zealand
- Emergency Department, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Rose Crossin
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - Sangjun Jin
- Resident Medical Officer Unit, Te Whatu Ora, Waikato, New Zealand
| | - William Young
- Specialist Mental Health Services, Te Whatu Ora Waitaha Canterbury, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Manuel MM, Yen K, Feng SY, Patel F. The burden of mental and behavioral health visits to the pediatric ED: A 3-year tertiary care center experience. Child Adolesc Ment Health 2023; 28:488-496. [PMID: 36794694 DOI: 10.1111/camh.12638] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 02/17/2023]
Abstract
BACKGROUND The shortage of mental health services across the United States has turned pediatric emergency departments (PEDs) into safety-nets for the increasing population of children with mental and behavioral health (MBH) needs. This study provides a descriptive characterization of MBH-related PED visits, the trends in visit, ED length of stay (EDLOS), and admission rate. METHODS We reviewed electronic health records of children ≤18 years with MBH needs, who visited the PED of a large tertiary hospital from January 2017 to December 2019. We performed descriptive statistics, chi-square (χ2 ), and logistic regression analyses to evaluate trend in visit, EDLOS, admission rate, and predictors of prolonged EDLOS and inpatient admission. RESULTS Of 10,167 patients, 58.4% were females, median age was 13.8 years, and 86.1% were adolescents. On average, visits increased by 19.7% annually, with a 43.3% increase over 3 years. Common ED diagnoses include, suicidality (56.2%), depression (33.5%), overdose/poisoning, and substance use (18.8%), and agitation/aggression (10.7%). Median EDLOS was 5.3 hr, average admission rate was 26.3%, with 20.7% boarding in the ED for >10 hr. Independent predictors of admission include depression (pOR: 1.5, CI: 1.3-1.7), bipolar disorder (pOR: 3.5, CI: 2.4-5.1), overdose/substance use disorder (pOR: 4.7, CI: 4.0-5.6), psychosis (pOR: 3.3, CI: 1.5-7.3), agitation/aggression (pOR: 1.8, CI: 1.5-2.1), and ADHD (pOR: 2.5, CI: 2.0-3.0). Principal independent driver of prolonged EDLOS was patient admission/transfer status (pOR: 5.3, CI: 4.6-6.1). CONCLUSIONS Given the study results, MBH-related PED visits, ED length-of-stay, and admission rates continue to rise even in recent years. PEDs lack the resources and capability to provide high-quality care for the increasing population of children with MBH needs. Novel collaborative approaches and strategies are urgently needed to find lasting solutions.
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Affiliation(s)
- Matthias M Manuel
- Division of Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Pediatric Emergency Medicine, TeamHealth/Children's Health, Plano, TX, USA
| | - Kenneth Yen
- Division of Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children's Health Dallas, Dallas, TX, USA
| | - Sing-Yi Feng
- Division of Emergency Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Children's Health Dallas, Dallas, TX, USA
- North Texas Poison Center, Parkland Health and Hospital System, Dallas, TX, USA
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Cloutier P, Gray C, Sheridan N, Silverman A, Cappelli M, Zemek R, Jabbour M, Reid S, Kennedy A. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA): a brief group intervention for adolescents with mild-to-moderate suicidal ideation and their caregivers. Child Adolesc Ment Health 2022; 27:343-351. [PMID: 34498386 DOI: 10.1111/camh.12506] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Suicidal Ideation (SI) is common in adolescents and increases the risk of completed suicide. Few brief interventions have been shown to reduce SI in adolescents. The objective of this study was to evaluate the feasibility of a novel brief group intervention, building resilience and attachment in vulnerable adolescents (BRAVA), designed for adolescents and their caregivers to reduce adolescent SI. METHODS The study was a pre-post, noncontrolled trial in which 46 adolescents were enrolled in the BRAVA intervention. Adolescents and caregivers completed an intake assessment, six BRAVA group sessions, and an exit assessment 1-week post-BRAVA. RESULTS Adolescents' SI decreased significantly after completing the BRAVA treatment (pre-post difference = 18.1, 95% CI = 10.01-26.12). Significant improvements in associated symptoms of depression, anxiety, and perceived stress were also observed. Caregivers had reduced perceived stress (pre-post difference = 2.7, 95% CI = 0.30-5.16) and reduction in attachment avoidance (difference = 1.6, 95% CI = 0.29-2.91). Treatment satisfaction was high across the six modules. The rolling entry feature of the intervention allowed participants to begin treatment approximately 2 weeks sooner compared to waiting for the next group cycle. CONCLUSIONS Study results demonstrate that the BRAVA intervention has the potential to reduce SI among adolescents who present to hospital services in crisis. Further studies are required to establish BRAVA's efficacy in a randomized controlled trial.
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Affiliation(s)
- Paula Cloutier
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.,CHEO, Ottawa, ON, Canada
| | - Clare Gray
- CHEO, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Nicole Sheridan
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | - Aaron Silverman
- CHEO, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Mario Cappelli
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, ON, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada.,CHEO, Ottawa, ON, Canada.,Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mona Jabbour
- CHEO, Ottawa, ON, Canada.,Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Reid
- CHEO, Ottawa, ON, Canada.,Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Allison Kennedy
- CHEO, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
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Greenfield B, Jolicoeur-Martineau A, Brown M, Kandiyoti A, Henry M, Sasson T, Ahmadi S, Vivani T, Harnden B, de Castro F, Tran B, Boodaghians L, Weiss M, Atsaidis Z, Wazana A. Frequent follow-up of suicidal youth assessed in the emergency room: Long-term trajectory and predictors of suicidality. Prev Med 2021; 152:106737. [PMID: 34538378 DOI: 10.1016/j.ypmed.2021.106737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
UNLABELLED Suicide was the second‑leading cause of US deaths in 2018 among 15-24-year-olds. Suicide attempts, a risk factor for completions, and suicide ideation have doubled among pediatric emergency room (ER) patients during the past decade. Borderline Personality Disorder (BPD), a comorbid condition, has a 10% suicide rate. We examined the 4-year outcome of a cohort of suicidal adolescents, many also suffering from BPD and having undergone some form of treatment, to identify baseline factors which could inform intervention that would minimize suicidality 4 years post-discharge. METHODS We conducted a prospective longitudinal study of suicidality at twelve points (four assessment occasions) for 286 suicidal youth presenting to a pediatric ER, most suffering from BPD, with 36 suicide ratings from baseline to 2-, 6- and 48-month follow-up evaluations. We examined the trajectory and predictors of persisting suicidality. RESULTS Suicidality rapidly decreased within 2 months post-ER-discharge, subsequently remaining low throughout 48 months. Baseline functioning, female sex, stressful life events and BPD impulsiveness were most predictive of persisting suicidality at 48-month follow-up. CONCLUSION Most suicidal youth, many meeting BPD criteria, no longer feel suicidal 2 months after ER discharge. Management of participants' baseline poor functioning stressful life events and the impulsiveness component of BPD specifically in females could impact suicidality 4 years later, and guide treatment options. The absence of the BPD cognitive and affective subscales as predictors of suicidality at 4-year follow-up may reflect treatment received. Further investigation of treatment effects is warranted and under way.
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Affiliation(s)
- Brian Greenfield
- Department of Psychiatry, Faculty of Medicine, McGill University, Canada
| | - Alexia Jolicoeur-Martineau
- Mila, University of Montréal, Montréal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Maria Brown
- Department of Educational & Counselling Psychology, McGill University, Montréal, QC, Canada
| | - Alegra Kandiyoti
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Melissa Henry
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Gerald Bronfman Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Segal Cancer Centre, Jewish General Hospital, Canada
| | - Tania Sasson
- Department of Physical Medicine & Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Tania Vivani
- Department of Psychology, Universite de Quebec a Montreal, Montréal, QC, Canada
| | - Bonnie Harnden
- Department of Creative Arts Therapies, Faculty of Fine Arts, Concordia University, Montréal, QC, Canada
| | - Filipa de Castro
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Brian Tran
- Department of Anesthesia, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Levon Boodaghians
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Margaret Weiss
- Child Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA
| | - Zoe Atsaidis
- Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
| | - Ashley Wazana
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada; Department of Psychiatry, Faculty of Medicine and Health Sciences, McGill University, Montréal, QC, Canada; Centre for Child Development and Mental Health, Jewish General Hospital, Montréal, QC, Canada.
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Screening for suicide risk - The need, the possibilities, and a call for resources. CAN J EMERG MED 2020; 22:269-270. [PMID: 32456737 DOI: 10.1017/cem.2020.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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