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Chong S, Achat HM, Stubbs JM, Murphy M. Factors associated with mental health representations to the emergency department within six months. Int Emerg Nurs 2024; 75:101480. [PMID: 38936272 DOI: 10.1016/j.ienj.2024.101480] [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: 05/16/2023] [Revised: 04/24/2024] [Accepted: 06/08/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/OBJECTIVE ED representation places a tremendous drain on resources with mental health (MH) representation among the most common. This study aimed to identify patient and clinical factors associated with 28-day and six-month ED MH representation of an index MH ED presentation. METHOD All MH related ED presentations from 1 January 2017 to 30 June 2019 were extracted from routinely collected administrative data. Cox regression and multinomial logistic regression models tested associations between patient characteristics and risk of representation. RESULTS For the 8,010 patients, 28-day and six-month representations were 8 % and 16 % respectively. Self-identifying with a MH problem at index presentation (28-day hazard ratio (HR) = 1.48, 95 % CI = 1.19-1.84; six-month HR = 1.52, 95 % CI = 1.29-1.78), leaving ED before completing treatment (28-day HR = 4.13, 95 % CI = 3.36-5.08; six-month HR = 2.52, 95 % CI = 2.12-2.99), no private health insurance (six-month HR = 1.34, 95 % CI = 1.08-1.66), and hospital admission within one year prior to index (six month MH-related admission vs non-MH, HR = 1.59, 95 % CI = 1.19-2.13) were associated with increased risk of representation. Being uninsured was associated with frequent six-month representation among adults aged 16-39 years (OR = 3.16, 95 %CI = 1.59-6.25). CONCLUSION Self-identifying with a MH problem, leaving ED prematurely, being uninsured and prior hospitalisation are areas for in-depth investigation for improved understanding of unplanned representations.
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Affiliation(s)
- Shanley Chong
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, North Parramatta, NSW, Australia.
| | - Margaret Murphy
- Western Sydney Local Health District Emergency Services, Westmead, NSW, Australia.
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Wilson R, Jennings A, Redaniel MT, Samarakoon K, Dawson S, Lyttle MD, Savović J, Schofield B. Factors associated with repeat emergency department visits for mental health care in adolescents: A scoping review. Am J Emerg Med 2024; 81:23-34. [PMID: 38631148 DOI: 10.1016/j.ajem.2024.04.018] [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: 11/24/2023] [Revised: 03/06/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVES The aim of this review was to identify factors associated with multiple visits to emergency department (ED) services for mental health care in adolescents. METHODS Electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, Web of Science and ProQuest Dissertations & Thesis Global) were searched for evidence that presented an association between risk factors or correlates of multiple visits to the emergency departmental for mental health care by 10-24 year olds. High impact use was defined as at least one return ED visit for mental health care. Primary studies of any quantitative design were included, with no exclusions based on language or country and all possible risk factors were considered. Data were extracted and synthesised using quantitative methods; frequencies of positive, negative and null associations were summarised for categories of potential risk factors. RESULTS Sixty-five studies were included in the review. Most studies were from North America and reported a wide range of measures of high impact ED use, the most common being a binary indicator of multiple ED visits. Sex/gender and age were the most frequently reported risk factors. Measure of previous or concurrent access to mental health care was consistently positively associated with high impact use. Having private health insurance, compared with public or no insurance, was generally negatively associated with high impact use. Proxy measures of socioeconomic position (SEP) showed associations between lower SEP and more high impact use in a small number of studies. No other factors were consistently or uniformly associated with high impact use. CONCLUSIONS The review identified a substantial evidence base but due to the variability in study design and measurement of both risk factors and outcomes, no consistent risk factors emerged. More research is needed, particularly outside North America, using robust methods and high quality routinely collected data.
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Affiliation(s)
- Rebecca Wilson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | | | - Maria Theresa Redaniel
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Kithsiri Samarakoon
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Sarah Dawson
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
| | - Mark D Lyttle
- University of the West of England, Bristol, UK; Bristol Royal Hospital for Children, Bristol, UK.
| | - Jelena Savović
- NIHR Applied Research Collaboration West (ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK; University of Bristol, Bristol, UK.
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Dellazoppa A, Porada K, Zaspel JA, Bourgeois S, Vepraskas SH. Impact of COVID-19 on Acute Care Hospitalizations for Suicidality. Hosp Pediatr 2024; 14:376-384. [PMID: 38655630 DOI: 10.1542/hpeds.2023-007666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic contributed to the public health crisis for pediatric mental health. We characterized our local patient population presenting with suicidality or suicide attempts before and after the pandemic by examining: 1. frequencies of hospitalizations for suicidality to determine whether they differed by age, legal sex, race and ethnicity, or socioeconomic status; 2. average length of stay and discharge disposition; 3. 7-, 30-, and 365-day reutilization rates; and 4. admission trends during COVID-19 surges. METHODS Retrospective data between March 2018 and March 2022 was analyzed, including patients ages 10 to 17 years hospitalized for either suicidality or a suicide attempt at 1 freestanding tertiary care pediatric medical hospital in the Midwest. Encounters were divided into 2 categories on the basis of the COVID-19 pandemic: "Prelockdown" (March 1, 2018-March 12, 2020) and "postlockdown" (March 13, 2020-March 31, 2022). Patients were limited to 1 presentation pre- and postlockdown. We analyzed frequencies using means and SDs, categorical data using χ2 and Fisher's exact tests, and continuous data with t tests. RESULTS A total of 1017 encounters were included, stratified into pre- and postlockdown groups for analysis (909 encounters, 889 unique patients). There was a significant difference in 365-day reutilization pre- and postlockdown when analyzing re-presentation to the emergency department (P = .025) and hospital readmission (P = .006). Admissions incrementally increased after the COVID-19 alpha variants in September 2020 and again after the delta variant in August 2021. CONCLUSIONS The COVID-19 pandemic further intensified the already critical issue of pediatric mental health, demonstrating increased reutilization in the year after their initial presentation and an increase in admissions after the alpha variant.
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Affiliation(s)
- Alicia Dellazoppa
- Medical College of Wisconsin, Milwaukee, Wisconsin, and University of Chicago Medicine, Chicago, Illinois
| | - Kelsey Porada
- Medical College of Wisconsin, Milwaukee, Wisconsin, and University of Chicago Medicine, Chicago, Illinois
| | - Jennifer A Zaspel
- Medical College of Wisconsin, Milwaukee, Wisconsin, and University of Chicago Medicine, Chicago, Illinois
| | - Shay Bourgeois
- Medical College of Wisconsin, Milwaukee, Wisconsin, and University of Chicago Medicine, Chicago, Illinois
| | - Sarah H Vepraskas
- Medical College of Wisconsin, Milwaukee, Wisconsin, and University of Chicago Medicine, Chicago, Illinois
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Halladay J, Georgiades K, MacKillop J, Lipman E, Pires P, Duncan L. Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis. Eur Child Adolesc Psychiatry 2024; 33:739-747. [PMID: 36947251 PMCID: PMC10031175 DOI: 10.1007/s00787-023-02188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 03/23/2023]
Abstract
Though mental health and substance use concerns often co-occur, few studies have characterized patterns of co-occurrence among adolescents in clinical settings. The current investigation identifies and characterizes these patterns among adolescents presenting to an outpatient mental health service in Ontario, Canada. Data come from cross-sectional standardized patient intake assessments from 916 adolescents attending an outpatient mental health program (January 2019-March 2021). Latent profile analysis identified patterns of substance use (alcohol, cannabis, (e-) cigarettes) and emotional and behavioral disorder symptoms. Sociodemographic and clinical correlates of these patterns were examined using multinomial regression. Three profiles were identified including: 1) low substance use and lower frequency and/or severity (relative to other patients in the sample) emotional and behavioral disorder symptoms (26.2%), 2) low substance use with higher emotional and behavioral disorder symptoms (48.2%), and 3) high in both (25.6%). Profiles differed in sociodemographic and clinical indicators related to age, gender, trauma, harm to self, harm to others, and service use. Experiences of trauma, suicide attempts, and thoughts of hurting others increased the odds of adolescents being in the profile high in both substance use and symptoms compared to other profiles. These findings further document the high rates of substance use in adolescents in mental health treatment and the profiles generally map onto three out of four quadrants in the adapted four-quadrant model of concurrent disorders, indicating the importance of assessing and addressing substance use in these settings.
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Affiliation(s)
- Jillian Halladay
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Australia Level 6, Jane Foss Russell Building, G02, Camperdown, NSW, 2006, Australia.
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada.
| | - Katholiki Georgiades
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- The Peter Boris Centre for Addictions Research, McMaster University/St. Joseph's Healthcare Hamilton, 100 West 5Th St, Hamilton, ON, L8N 3K7, Canada
| | - Ellen Lipman
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Paulo Pires
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
| | - Laura Duncan
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4S4, Canada
- Offord Centre for Child Studies, McMaster University, Hamilton, Canada
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Grover P, Kumar M. Pediatric Psychiatric Emergencies. Emerg Med Clin North Am 2024; 42:151-162. [PMID: 37977747 DOI: 10.1016/j.emc.2023.06.017] [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] [Indexed: 11/19/2023]
Abstract
Pediatric psychiatric emergencies account for 15% of emergency department visits and are on the rise. Psychiatric diagnoses in the pediatric population are difficult to make, due to their variable presentation, but early diagnosis and treatment improve clinical outcome. Medical reasons for the patient's presentation should be explored. Both physical and emotional safety must be ensured. A multidisciplinary approach, utilizing local primary care and psychiatric resources, is recommended.
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Affiliation(s)
- Purva Grover
- Cleveland Clinic, 6780 Mayfield Road, Mayfield Heights, OH 44124, USA.
| | - Manya Kumar
- Vardhman Mahavir Medical College, Safdarjung Hospital, Ansari Nagar East, New Delhi, Delhi 110029, India
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6
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Papalia N, Simmons M, Trood M, McEwan T, Spivak B. Police-reported family violence victimisation or perpetration and mental health-related emergency department presentations: an Australian data-linkage study. BMC Public Health 2024; 24:131. [PMID: 38195457 PMCID: PMC10777561 DOI: 10.1186/s12889-023-17570-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Family violence is a leading social determinant of mental ill-health but its link to mental health-related emergency department presentations is poorly understood. Existing research has largely used retrospective designs with a focus on victimisation, typically among women. We examined whether police-reported family violence victimisation and perpetration were prospectively associated with mental health emergency department presentations in women and men. We also identified family violence risk and vulnerability characteristics associated with such presentations. METHODS Demographics, prior police involvement, and individual and relationship vulnerabilities were provided by Victoria Police for 1520 affected family members (i.e., primary victims) and 1470 respondents (i.e., persons alleged to have perpetrated family violence) from family violence reports in 2016-17. Emergency mental health presentations 22-30 months post-family-violence report were determined through linkage with the Victorian Emergency Minimum Dataset and compared to statewide presentations. RESULTS Emergency mental health presentations during follow-up were identified in 14.3% of the family violence sample, with 1.9% presenting for self-harm. Mental health presentation rates per 1,000 people were markedly higher among affected family members and respondents of both sexes and all ages than in the general population, except for male affected family members aged 45 + . Adjusting for age and sex, the mental health presentation rate was 6 and 11 times higher among affected family members and respondents, respectively, than in the general population. Individual vulnerabilities were more closely related to risk of emergency mental health presentations than relationship characteristics. CONCLUSIONS Police-recorded family violence is associated with increased mental health-related emergency department presentations over the short-to-medium term. Strengthened cross-sector collaboration is needed to identify, address, and refer individuals with overlapping family violence and mental health needs and to improve victims' and perpetrators' access to community mental health and related services. This should help prevent individuals from reaching a crisis point in their mental health.
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Affiliation(s)
- Nina Papalia
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia.
| | - Melanie Simmons
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
| | - Michael Trood
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
| | - Troy McEwan
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
| | - Benjamin Spivak
- Centre for Forensic Behavioural Science, Swinburne University of Technology and Victorian Institute of Forensic Mental Health (Forensicare), Level 1/582 Heidelberg Road, Alphington, VIC, 3078, Australia
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Hutchison M, Theriault KM, Seng K, Vanderploeg J, Conner KR. Youth Mobile Response and Stabilization Services: Factors Associated with Multiple Episodes of Care. Community Ment Health J 2023; 59:1619-1630. [PMID: 37347420 DOI: 10.1007/s10597-023-01153-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
Mobile response and stabilization services (MRSS) provide short-term, community-based, care to individuals in crisis. Minimal studies have explored which factors are associated with multiple episodes of MRSS care. We used a retrospective cohort design of MRSS electronic health records to explore demographic and clinical characteristics associated with multiple episodes of care among 2,641 youth ages 5-21 years old in New York, USA. Youth with multiple episodes of care (n = 585; 22.2%) were more likely to be non-Hispanic, have treatment histories including presenting problems related to adjustment, conduct, mood, or suicidal thoughts and behaviors, have high-level mental health visits, and more follow-up visits. Future research should examine the unmet needs of non-Hispanic populations and whether characteristics associated with multiple MRSS episodes are consistent across populations to inform procedures targeting unmet needs that prevent or minimize repeated use during crises.
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Affiliation(s)
- Morica Hutchison
- Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, United States.
| | - Kayla M Theriault
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Kagnica Seng
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Jeffrey Vanderploeg
- Child Health and Development Institute, 270 Farmington Avenue #367, 06032, Farmington, CT, United States
| | - Kenneth R Conner
- Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY, 14642, United States
- Department of Emergency Medicine, University of Rochester Medical Center, 265 Crittenden Boulevard, Rochester, NY, 14642, United States
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Pederson CA, Dir AL, Schwartz K, Ouyang F, Monahan PO, Tu W, Wiehe SE, Aalsma MC. Associations between outpatient treatment and the use of intensive psychiatric healthcare services. Clin Child Psychol Psychiatry 2023; 28:1380-1392. [PMID: 36737059 DOI: 10.1177/13591045231154106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.
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Affiliation(s)
- Casey A Pederson
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Allyson L Dir
- Indiana University School of Medicine, Department of Psychiatry, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Katherine Schwartz
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
| | - Fangqian Ouyang
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Patrick O Monahan
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Wanzhu Tu
- Indiana University School of Medicine, Department of Biostatistics & Health Data Sciences, Indianapolis, IN, USA
| | - Sarah E Wiehe
- Indiana University School of Medicine, Department of Pediatrics, Indiana Clinical and Translational Sciences Institute, Indianapolis, IN, USA
| | - Matthew C Aalsma
- Indiana University School of Medicine, Department of Pediatrics, Adolescent Behavioral Health Research Program, Indianapolis, IN, USA
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Iorfino F, McHugh C, Richards M, Skinner A, Prodan A, Occhipinti JA, Song YJC, Chiu S, Judkins S, Scott E, Hickie IB. Patterns of emergency department presentations for a youth mental health cohort: data-linkage cohort study. BJPsych Open 2023; 9:e170. [PMID: 37706294 PMCID: PMC10594097 DOI: 10.1192/bjo.2023.521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Primary youth mental health services in Australia have increased access to care for young people, yet the longer-term outcomes and utilisation of other health services among these populations is unclear. AIMS To describe the emergency department presentation patterns of a help-seeking youth mental health cohort. METHOD Data linkage was performed to extract Emergency Department Data Collection registry data (i.e. emergency department presentations, pattern of re-presentations) for a transdiagnostic cohort of 7024 youths (aged 12-30 years) who presented to mental health services. Outcome measures were pattern of presentations and reason for presentations (i.e. mental illness; suicidal behaviours and self-harm; alcohol and substance use; accident and injury; physical illness; and other). RESULTS During the follow-up period, 5372 (76.5%) had at least one emergency department presentation. The presentation rate was lower for males (IRR = 0.87, 95% CI 0.86-0.89) and highest among those aged 18 to 24 (IRR = 1.117, 95% CI 1.086-1.148). Almost one-third (31.12%) had an emergency department presentation that was directly associated with mental illness or substance use, and the most common reasons for presentation were for physical illness and accident or injury. Index visits for mental illness or substance use were associated with a higher rate of re-presentation. CONCLUSIONS Most young people presenting to primary mental health services also utilised emergency services. The preventable and repeated nature of many presentations suggests that reducing the ongoing secondary risks of mental disorders (i.e. substance misuse, suicidality, physical illness) could substantially improve the mental and physical health outcomes of young people.
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Affiliation(s)
- Frank Iorfino
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Catherine McHugh
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Matthew Richards
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Adam Skinner
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Ante Prodan
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; Translational Health Research Institute, Western Sydney University, Sydney, New South Wales, Australia; and School of Computer, Data and Mathematical Sciences, Western Sydney University, Sydney, New South Wales, Australia
| | - Jo-an Occhipinti
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; and Computer Simulation & Advanced Research Technologies, Sydney, New South Wales, Australia
| | | | - Simon Chiu
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | | | - Elizabeth Scott
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia; and St Vincent's Private Hospital, Sydney, New South Wales, Australia
| | - Ian B. Hickie
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
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Brown SA, Moeketsi TD, Musekiwa A, Moodley SV. Readmission of adolescent psychiatric patients to a specialised unit in Gauteng, South Africa. S Afr J Psychiatr 2023; 29:2018. [PMID: 38860147 PMCID: PMC11163387 DOI: 10.4102/sajpsychiatry.v29i0.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 06/02/2023] [Indexed: 06/12/2024] Open
Abstract
Background Readmission rates to child and adolescent psychiatric units among the youth have been reported to be increasing. Aim The study aimed to determine the readmission rate and factors associated with readmission of adolescent psychiatric patients at a child and adolescent psychiatric unit. Setting A specialised psychiatric hospital in Gauteng province, South Africa. Methods This retrospective cohort study utilised data from the records of patients admitted to the adolescent inpatient unit over a period of five years. The cumulative incidence and incidence rate of readmission within one year of discharge from the index admission was calculated using survival analysis methods. Characteristics significantly associated with readmission were determined by applying the multivariable Cox proportional hazards regression model. Results Among the 189 patients included in the analysis, the cumulative incidence of readmission within one year of discharge was 17.5%. The incidence rate was 5.31 readmissions per 10 000 person-days. The final multivariable model showed that a diagnosis of schizophrenia (p = 0.015), a diagnosis of attention deficit hyperactivity disorder (p = 0.039), and coming from a child and youth care centre or temporary safe care (p = 0.018) increased the risk of readmission while having a medical condition (p = 0.008) reduced the risk. Conclusion Psychiatric diagnosis and residential care could be potential risk markers for readmission. Improving the collaboration between health and social services in residential care would be beneficial. Contribution Identifying factors that predispose adolescent psychiatric patients to readmission can inform and improve management and risk assessments.
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Affiliation(s)
- Sarah-Anne Brown
- Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tshepiso D. Moeketsi
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Saiendhra V. Moodley
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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11
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Sritharan P, Dyce L, Hughes D, Cometto J, Debono T, Boylan K. Acute mental health service use in adolescents with suicidal thoughts and behaviours: Impact on outpatient care. Clin Child Psychol Psychiatry 2023; 28:697-706. [PMID: 35765954 DOI: 10.1177/13591045221106575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Youth with suicidal thoughts and behaviours often present to acute emergency care settings for assessment. Timely outpatient follow up may reduce return acute care visits. The primary aim of our study was to describe clinical and contextual differences between youth who do and do not use acute care once connected to outpatient services. METHODS A 24-month retrospective chart review of suicidal youth aged 13-16 (n = 45) presenting for outpatient mental health treatment. Youth who used acute services during the study period (ASU) or did not (non-ASU) were compared on demographic, risk profile, and mental health service use. RESULTS The mean age of participants was 14.6 years (73% female). Suicide risk profile at baseline did not differ between groups, but was significantly higher in ASU youth at 24 months. There were more youth in service at the end of the study period in the ASU group compared to the non-ASU group (11% vs 55%). CONCLUSION Youth who do continue to access acute services may be at higher risk of suicidality even after outpatient treatment. Although it is unclear whether this is linked to outpatient engagement, it raises further questions about this population and how they respond to community based mental healthcare.
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Affiliation(s)
- Praveen Sritharan
- Faculty of Health Sciences, 3710McMaster University, Hamilton, ON, Canada
| | - Lisa Dyce
- Faculty of Health Sciences, 3710McMaster University, Hamilton, ON, Canada
| | - Deborah Hughes
- Faculty of Health Sciences, 3710McMaster University, Hamilton, ON, Canada
| | - Jennifer Cometto
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, 3710McMaster University, Hamilton, ON, Canada
| | - Tony Debono
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, 3710McMaster University, Hamilton, ON, Canada
| | - Khrista Boylan
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, 3710McMaster University, Hamilton, ON, Canada
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Hoffmann JA, Krass P, Rodean J, Bardach NS, Cafferty R, Coker TR, Cutler GJ, Hall M, Morse RB, Nash KA, Parikh K, Zima BT. Follow-up After Pediatric Mental Health Emergency Visits. Pediatrics 2023; 151:e2022057383. [PMID: 36775807 PMCID: PMC10187982 DOI: 10.1542/peds.2022-057383] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 02/14/2023] Open
Abstract
OBJECTIVES To examine how outpatient mental health (MH) follow-up after a pediatric MH emergency department (ED) discharge varies by patient characteristics and to evaluate the association between timely follow-up and return encounters. METHODS We conducted a retrospective study of 28 551 children aged 6 to 17 years with MH ED discharges from January 2018 to June 2019, using the IBM Watson MarketScan Medicaid database. Odds of nonemergent outpatient follow-up, adjusted for sociodemographic and clinical characteristics, were estimated using logistic regression. Cox proportional hazard models were used to evaluate the association between timely follow-up and risk of return MH acute care encounters (ED visits and hospitalizations). RESULTS Following MH ED discharge, 31.2% and 55.8% of children had an outpatient MH visit within 7 and 30 days, respectively. The return rate was 26.5% within 6 months. Compared with children with no past-year outpatient MH visits, those with ≥14 past-year MH visits had 9.53 odds of accessing follow-up care within 30 days (95% confidence interval [CI], 8.75-10.38). Timely follow-up within 30 days was associated with a 26% decreased risk of return within 5 days of the index ED discharge (hazard ratio, 0.74; 95% CI, 0.63-0.91), followed by an increased risk of return thereafter. CONCLUSIONS Connection to outpatient care within 7 and 30 days of a MH ED discharge remains poor, and children without prior MH outpatient care are at highest risk for poor access to care. Interventions to link to outpatient MH care should prioritize follow-up within 5 days of an MH ED discharge.
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Affiliation(s)
- Jennifer A. Hoffmann
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Polina Krass
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA
| | | | - Naomi S. Bardach
- Department of Pediatrics and Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco
| | - Rachel Cafferty
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Tumaini R. Coker
- Department of Pediatrics, University of Washington School of Medicine and Seattle Children’s Research Institute, Seattle, Washington
| | - Gretchen J. Cutler
- Children’s Minnesota Research Institute, Children’s Minnesota, Minneapolis, MN
| | | | - Rustin B. Morse
- Department of Pediatrics, The Ohio State University, Columbus, Ohio
- Nationwide Children’s Hospital, Center for Clinical Excellence, Columbus, Ohio
| | - Katherine A. Nash
- Department of Pediatrics, New York Presbyterian Morgan Stanley Childrens Hospital, Columbia University, New York City, New York
| | - Kavita Parikh
- Division of Hospital Medicine, Children’s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Bonnie T. Zima
- Center for Health Services and Society, UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, California
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13
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Cushing AM, Liberman DB, Pham PK, Michelson KA, Festekjian A, Chang TP, Chaudhari PP. Mental Health Revisits at US Pediatric Emergency Departments. JAMA Pediatr 2023; 177:168-176. [PMID: 36574251 PMCID: PMC9856860 DOI: 10.1001/jamapediatrics.2022.4885] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/11/2022] [Indexed: 12/29/2022]
Abstract
Importance Pediatric emergency department (ED) visits for mental health crises are increasing. Patients who frequently use the ED are of particular concern, as pediatric mental health ED visits are commonly repeat visits. Better understanding of trends and factors associated with mental health ED revisits is needed for optimal resource allocation and targeting of prevention efforts. Objective To describe trends in pediatric mental health ED visits and revisits and to determine factors associated with revisits. Design, Setting, and Participants In this cohort study, data were obtained from 38 US children's hospital EDs in the Pediatric Health Information System between October 1, 2015, and February 29, 2020. The cohort included patients aged 3 to 17 years with a mental health ED visit. Exposures Characteristics of patients, encounters, hospitals, and communities. Main Outcomes and Measures The primary outcome was a mental health ED revisit within 6 months of the index visit. Trends were assessed using cosinor analysis and factors associated with time to revisit using mixed-effects Cox proportional hazards regression. Results There were 308 264 mental health ED visits from 217 865 unique patients, and 13.2% of patients had a mental health revisit within 6 months. Mental health visits increased by 8.0% annually (95% CI, 4.5%-11.4%), whereas all other ED visits increased by 1.5% annually (95% CI, 0.1%-2.9%). Factors associated with mental health ED revisits included psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and presence of an inpatient psychiatric unit at the presenting hospital. Patients with psychotic disorders (hazard ratio [HR], 1.42; 95% CI, 1.29-1.57), disruptive or impulse control disorders (HR, 1.36; 95% CI, 1.30-1.42), and neurodevelopmental disorders (HR, 1.22; 95% CI, 1.14-1.30) were more likely to revisit. Patients with substance use disorders (HR, 0.60; 95% CI, 0.55-0.66) were less likely to revisit. Conclusions and Relevance Markers of disease severity and health care access were associated with mental health revisits. Directing hospital and community interventions toward identified high-risk patients is needed to help mitigate recurrent mental health ED use and improve mental health care delivery.
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Affiliation(s)
- Anna M. Cushing
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Danica B. Liberman
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Phung K. Pham
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Kenneth A. Michelson
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Ara Festekjian
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Todd P. Chang
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Department of Pediatrics, Keck School of Medicine of the University of Southern California, Los Angeles
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14
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Scott J, Khanom A, Straw J, Strickland A, Porter A, Snooks H. Paediatric frequent use of emergency medical services: a systematic review. Emerg Med J 2022; 40:emermed-2021-211701. [PMID: 36600465 DOI: 10.1136/emermed-2021-211701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS. METHODS Four electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis. RESULTS The search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use. CONCLUSION The broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Joanne Straw
- Emergency Operations Centre, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Annette Strickland
- Emergency Operations Centre, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
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15
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Farquharson W, Schwartz JE, Klein DN, Carlson GA. Factors Associated With Police Bringing Children to a Psychiatric Emergency Room. Psychiatr Serv 2022; 74:488-496. [PMID: 36300282 DOI: 10.1176/appi.ps.202200028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sensational headlines describing police entanglements with young children have prompted questions about how often these incidents occur and why. The authors of this cross-sectional study examined the factors associated with police versus nonpolice arrivals to the psychiatric emergency room and those predicting subsequent police arrivals. METHODS Electronic medical records of children ages 5.0-12.9 years brought to a comprehensive psychiatric emergency program (CPEP) at a university hospital were reviewed to determine whether a child was brought by police ("police arrival") in response to a 911 call by school personnel, a mental health or other medical professional, or a caregiver. Extracted data included the child's age, sex, race-ethnicity, family makeup, insurance status, arrival status, referral source, diagnosis, disposition, treatment, number of CPEP and police encounters, and occurrences of aggression and suicidality. Multilevel and ordinary logistic regression models were used to identify factors associated with a first and subsequent police arrival. RESULTS Of 339 children with CPEP encounters from September 2017 to April 2018, 103 (30%) had had at least one police arrival. Children brought by police were more likely than peers brought by caregivers to be Black or Latinx, have Medicaid, come from families without two parents, and have aggressive outbursts or suicidal behavior. Results from multilevel logistic regression indicated that aggressive outbursts and suicidality were most significantly and consistently associated with experiencing both a first and subsequent police arrival. CONCLUSIONS Clinical and sociodemographic differences in police arrivals highlight the need for a comprehensive systems approach for children, especially marginalized youths, who need psychiatric emergency care.
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Affiliation(s)
- Wilfred Farquharson
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Joseph E Schwartz
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Daniel N Klein
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
| | - Gabrielle A Carlson
- Renaissance School of Medicine (Farquharson, Schwartz, Carlson) and Department of Psychology (Klein), Stony Brook University, Stony Brook, New York
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16
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Flury RM, Brockhus L, Müller M, Henssler J, Exadaktylos AK, Klukowska-Rötzler J. Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13196. [PMID: 36293777 PMCID: PMC9602638 DOI: 10.3390/ijerph192013196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. METHODS We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. RESULTS Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05-0.21, p < 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21-0.37, p < 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65-3.83, p < 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41-0.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p < 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44-0.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04-2.72, p = 0.035). CONCLUSIONS Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group.
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Affiliation(s)
- Raffaela M. Flury
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Lara Brockhus
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Jonathan Henssler
- Department of Psychiatry and Psychotherapy, University of Cologne Medical School, DE-50937 Cologne, Germany
- Charité University Medicine, St Hedwig-Krankenhaus, Clinic for Psychiatry and Psychotherapy, DE-10117 Berlin, Germany
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, CH-3010 Bern, Switzerland
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17
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Cancilliere MK, Ramanathan A, Hoffman P, Jencks J, Spirito A, Donise K. Characteristics of a Pediatric Emergency Psychiatric Telephone Triage Service. Pediatr Emerg Care 2022; 38:494-501. [PMID: 35981327 DOI: 10.1097/pec.0000000000002831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Caregivers of youth in psychiatric crisis often seek treatment from hospital emergency departments (EDs) as their first point of entry into the mental health system. Emergency departments have struggled over the last decade with growing numbers and now, because of the pandemic, have experienced a deluge of mental health crises. As one approach to divert unnecessary ED admissions, pediatric emergency psychiatric telephone triage services have been created. This study aimed to define the characteristics and utilization of a pediatric triage service and to examine clinician documentation of calls to identify the assessment of risk and disposition. METHODS This study included 517 youth (2-18 years; mean, 12.42 years; SD, 3.40 years) who received triage services in the winter of 2 consecutive years. Triage calls were received from caregivers (>75%), schools (17.0%), and providers (6.6%) regarding concerns, including suicidal ideation (28.6%), school issues (28.6%), and physical aggression (23.4%). RESULTS Dispositions were for acute, same-day evaluation (9.7%), direct care service (28.8%), further evaluation (within 48-72 hours, 40.0%), and resource/service update information (21.5%). Findings revealed that most clinical concerns were referred for further evaluation. Both adolescent females and males were referred for emergency evaluations at high rates. CONCLUSIONS A dearth of information on pediatric crisis telephone triage services exists; thus, developing an evidence base is an important area for future work. This information assists not only in our understanding of which, why, and how many youths are diverted from the ED but allows us to extrapolate significant costs that have been saved because of the utilization of the triage service.
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Affiliation(s)
| | | | | | | | - Anthony Spirito
- From the Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University
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18
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Hoge MA, Vanderploeg J, Paris M, Lang JM, Olezeski C. Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda. Community Ment Health J 2022; 58:1225-1239. [PMID: 35038073 PMCID: PMC8762987 DOI: 10.1007/s10597-022-00937-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022]
Abstract
There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use. The authors' interpretation of the literature is that it offers compelling evidence that children and youth in the U.S. are being sent to EDs for mental health conditions at increasing rates for reasons frequently judged as clinically inappropriate. As a major health inequity, it is infrequent that such children and youth are seen in EDs by a behavioral health professional or receive evidence-based assessment or treatment, even though they are kept in EDs far longer than those seen for reasons unrelated to mental health. The rate of increase in these referrals to EDs appears much greater for African American and Latinx children and youth than White children and is increasing for the publicly insured and uninsured while decreasing for the privately insured. A comprehensive set of strategies are recommended for improving healthcare quality and health equity. A fact sheet is provided for use by advocates in pressing this agenda.
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Affiliation(s)
- Michael A. Hoge
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jeffrey Vanderploeg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Child Health and Development Institute, Farmington, CT USA
- Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Manuel Paris
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Jason M. Lang
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Child Health and Development Institute, Farmington, CT USA
- Department of Psychiatry, UConn Health, Farmington, CT USA
| | - Christy Olezeski
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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19
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Walker N, Medlow S, Georges A, Steinbeck K, Ivers R, Perry L, Skinner SR, Kang M, Cullen P. Emergency Department Initiated Mental Health Interventions for Young People: A Systematic Review. Pediatr Emerg Care 2022; 38:342-350. [PMID: 34620805 DOI: 10.1097/pec.0000000000002551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Young people (10-24 years old) with mental health concerns are increasingly presenting to hospital emergency departments (EDs). The purpose of this review was to identify the core components and outcomes of mental health interventions for young people that are initiated in the ED, such that they are delivered in the ED and/or by ED health workers. METHODS Six electronic databases were systematically searched. Primary peer-reviewed qualitative or quantitative studies describing an ED-initiated mental health intervention for young people published between 2009 and 2020 were included. RESULTS Nine studies met the inclusion criteria. The included studies demonstrated that compared with traditional ED care, ED-initiated mental health interventions lead to improved efficiency of care and decreased length of stay, and a core component of this care was its delivery by allied health practitioners with mental health expertise. The studies were limited by focusing on service efficiencies rather than patient outcomes. Further limitations were the exclusion of young people with complex mental health needs and/or comorbidities and not measuring long-term positive mental health outcomes, including representations and whether young people were connected with community health services. CONCLUSIONS This systematic review demonstrated that ED-initiated mental health interventions result in improved service outcomes, but further innovation and robust evaluation are required. Future research should determine whether these interventions lead to better clinical outcomes for young people and staff to inform the development of best practice recommendations for ED-initiated mental health care for young people presenting to the ED.
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Affiliation(s)
| | | | | | | | | | - Lin Perry
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Ultimo
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20
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Cullen P, Leong RN, Liu B, Walker N, Steinbeck K, Ivers R, Dinh M. Returning to the emergency department: a retrospective analysis of mental health re-presentations among young people in New South Wales, Australia. BMJ Open 2022; 12:e057388. [PMID: 35640990 PMCID: PMC9171221 DOI: 10.1136/bmjopen-2021-057388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This study aimed to describe mental health emergency department (ED) presentations among young people aged 8-26 years in New South Wales, Australia, and to identify key characteristics associated with higher risk of ED mental health re-presentation. DESIGN, SETTING AND PARTICIPANTS Retrospective analysis of linked ED data records for mental health presentations between 1 January 2015 and 30 June 2018. MAIN OUTCOME MEASURES The main outcome was the total number of mental health ED re-presentations within 1 year, following initial presentation. Count regression models were fitted to estimate factors associated with higher likelihood of re-presentations. RESULTS Forty thousand two hundred and ninety patients were included in the analyses, and 9713 (~25%) re-presented during the following year; 1831 (20%) presented at least three times. On average, patients re-presented 0.61 times per 365 person-days, with average time until first re-presentation of ~92 days but greatest risk of re-presentation within first 30-60 days. Young people with self-harm or suicidal diagnoses at initial presentation were more likely to re-present. Re-presentations were highest among young people <15 years (IRR 1.18 vs ≥20 years old), female (IRR=1.13 vs male), young people residing outside of major cities (IRR 1.08 vs major cities) and Aboriginal and Torres Strait Islander young people (IRR 1.27 vs non-Indigenous). CONCLUSIONS ED mental health re-presentation is high among young people. We demonstrate factors associated with re-presentation that EDs could target for timely, high-quality care that is youth friendly and culturally safe, with appropriate referral pathways into community-based primary and mental healthcare services.
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Affiliation(s)
- Patricia Cullen
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Ngarruwan Ngadju, First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robert Neil Leong
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Natasha Walker
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Rebecca Ivers
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Dinh
- NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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21
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Portley R, North CS. Are There Differences in Pediatric Psychiatric Emergency Department Patients Related to Utilization Frequency? Pediatr Emerg Care 2021; 37:e1296-e1298. [PMID: 32011552 DOI: 10.1097/pec.0000000000002010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The increasing frequency of visits to the pediatric psychiatric emergency department in the United States signals a need for a better understanding of factors contributing to more frequent utilization. This study examined characteristics of patients associated with higher utilization of the pediatric psychiatric emergency department to increase understanding of this group of patients. METHODS This was a retrospective observational study. Data were abstracted from the electronic medical record system from January 2012 to December 2017 for patients with a completed mental health consultation. There were 8504 total encounters for 6950 unique patients during this period. Analyses were conducted to test associations between maximum number of visits in any 1-year period for each patient and demographic and clinical factors. RESULTS Younger age was independently associated with greater mean number of visits within any 1 year. No independent associations were found between maximum number of visits within 1 year and sex, race, language, insurance type, distance from emergency department, time spent in the emergency department, or reason for visit. CONCLUSIONS The greater emergency department use by younger children found in this study may be an indicator of insufficient treatment at other levels of care. Additional research examining more demographic variables and demographic characteristics in greater detail is needed to fully characterize the most frequent users of costly pediatric psychiatric emergency department care.
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Affiliation(s)
- Robert Portley
- From the Department of Psychiatry, The University of Texas Southwestern Medical Center
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22
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Sheridan DC, Baker S, Dehart R, Lin A, Hansen M, Tereshchenko LG, Le N, Newgard CD, Nagel B. Heart Rate Variability and Its Ability to Detect Worsening Suicidality in Adolescents: A Pilot Trial of Wearable Technology. Psychiatry Investig 2021; 18:928-935. [PMID: 34555890 PMCID: PMC8542751 DOI: 10.30773/pi.2021.0057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/27/2021] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Suicide is the 2nd leading cause of death in adolescence, and acute pediatric mental health emergency department (ED) visits have doubled in the past decade. The objective of this study was to evaluate physiologic parameters relationship to suicide severity. METHODS This was a prospective, observational study from April 2018 thru November 2019 in a tertiary care pediatric emergency department (ED) and inpatient pediatric psychiatric unit enrolling acutely suicidal adolescent patients. Patients wore a wrist device that used photoplethysmography for 7 days during their acute hospitalization to measure heart rate variability (HRV). During that time, Columbia Suicide Severity Scores (CSSRS) were assessed at 3 time points. RESULTS There was complete device data and follow-up for 51 patients. There was an increase in the high frequency (HF) component of HRV in patients that had a 25% or greater decrease in their CSSRS (mean difference 11.89 ms/ Hz ; p-value 0.005). Patients with a CSSRS≥15 on day of enrollment had a lower, although not statistically significant, HF component (mean difference -8.34 ms/ Hz; p-value 0.071). CONCLUSION We found an inverse correlation between parasympathetic activity measured through the HF component and suicidality in an acutely suicidal population of adolescents. Wearable technology may have the ability to improve outpatient monitoring for earlier detection and intervention.
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Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Oregon, USA.,Center of Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, USA
| | - Steven Baker
- Department of Emergency Medicine, Oregon Health & Science University, Oregon, USA.,Alpha Bravo Connectivity, LLC, Oregon, USA
| | - Ryan Dehart
- Department of Emergency Medicine, Oregon Health & Science University, Oregon, USA
| | - Amber Lin
- Department of Emergency Medicine, Oregon Health & Science University, Oregon, USA.,Center of Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, USA
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health & Science University, Oregon, USA.,Center of Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, USA
| | - Larisa G Tereshchenko
- Department of Medicine, Division of Cardiology, Oregon Health & Science University, Oregon, USA
| | - Nancy Le
- Department of Emergency Medicine, Oregon Health & Science University, Oregon, USA.,Center of Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, USA
| | - Craig D Newgard
- Department of Emergency Medicine, Oregon Health & Science University, Oregon, USA.,Center of Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, USA
| | - Bonnie Nagel
- Department of Psychiatry, Oregon Health & Science University, Oregon, USA.,Department of Behavioral Neuroscience, Oregon Health & Science University, Oregon, USA
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Sheridan DC, Domingo KN, Dehart R, Baker SD. Heart Rate Variability Duration: Expanding the Ability of Wearable Technology to Improve Outpatient Monitoring? Front Psychiatry 2021; 12:682553. [PMID: 34211411 PMCID: PMC8239131 DOI: 10.3389/fpsyt.2021.682553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
Heart rate variability (HRV) evaluates beat-to-beat interval (BBI) differences and is a suggested marker of the autonomic nervous system with diagnostic/monitoring capabilities in mental health; especially parasympathetic measures. The standard duration for short-term HRV analysis ranges from 24 h down to 5-min. However, wearable technology, mainly wrist devices, have large amounts of motion at times resulting in need for shorter duration of monitoring. The objective of this study was to evaluate the correlation between 1 and 5 min segments of continuous HRV data collected simultaneously on the same patient. Subjects wore a patch electrocardiograph (Cardea Solo, Inc.) over a 1-7 day period. For every consecutive hour the patch was worn, we selected a 5-min, artifact-free electrocardiogram segment. HRV metric calculation was performed to the entire 5-min segment and the first 1-min from this same 5-min segment. There were 492 h of electrocardiogram data collected allowing calculation of 492 5 min and 1 min segments. 1 min segments of data showed good correlation to 5 min segments in both time and frequency domains: root mean square of successive difference (RMSSD) (R = 0.92), high frequency component (HF) (R = 0.90), low frequency component (LF) (R = 0.71), and standard deviation of NN intervals (SDNN) (R = 0.63). Mental health research focused on parasympathetic HRV metrics, HF and RMSSD, may be accomplished through smaller time windows of recording, making wearable technology possible for monitoring.
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Affiliation(s)
- David C Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States.,Center of Policy and Research in Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Karyssa N Domingo
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Ryan Dehart
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
| | - Steven D Baker
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
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24
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Lee DP, Simpson SA. A Three-Step, Single Session Therapy Intervention for COVID-Related Anxiety in a Pediatric Emergency Department. Cureus 2020; 12:e12371. [PMID: 33527052 PMCID: PMC7842244 DOI: 10.7759/cureus.12371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The novel Coronavirus disease (COVID-19) pandemic has led to increases in anxiety and depression, and mental health-related emergency department visits remain frequent despite overall changes in ED utilization. Here, we present a case of COVID-related anxiety and demonstrate the utility of a brief, single-session therapy intervention delivered in the ED. The growing mental health burden of COVID-19 suggests that pediatric health care providers will treat patients with COVID-related anxiety during this pandemic. This case demonstrates a common presentation of somatization of anxiety and outlines a three-step, cognitive-behavioral intervention that can be particularly effective in treating COVID-related anxiety in the context of a single ED or medical visit.
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Affiliation(s)
- Diane P Lee
- Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Scott A Simpson
- Psychiatric Emergency Services, Denver Health Medical Center, Denver, USA
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25
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Randall MM, Parlette K, Reibling E, Chen B, Chen M, Randall F, Brown L. Young children with psychiatric complaints in the pediatric emergency department. Am J Emerg Med 2020; 46:344-348. [PMID: 33059988 DOI: 10.1016/j.ajem.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Children are increasingly diagnosed with mental illnesses and self-harm behaviors. They present frequently to the emergency department (ED) for evaluation. The aim of this study is to describe the youngest children in the ED with psychiatric issues. METHODS This is a retrospective chart review of all consecutive children less than 10 years of age with a psychiatric complaint who received a psychiatric consultation in the pediatric emergency department in the last four years. RESULTS The number of children with psychiatric issues increased over the study period. The ED length of stay also increased. Violent behavior and aggression were the most common chief complaints, and some children required chemical or physical restraint in the ED. Many children had pre-existing psychiatric issues and a history of adverse childhood experiences. Half of patients were deemed safe for discharge home by psychiatric consultation. CONCLUSION The number of young children with psychiatric complaints presenting to the ED has increased. However, a large number are found to be stable for discharge home. Increase in urgent outpatient psychiatric resources could help decrease ED utilization.
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Affiliation(s)
- Melanie M Randall
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Karli Parlette
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Ellen Reibling
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Brian Chen
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
| | - Miryah Chen
- Pediatrics Department, Kaiser Permanente Medical Group Moreno Valley, 12815 Heacock St, Moreno Valley, CA 92553, USA
| | - Frank Randall
- Psychiatry Department, Kaiser Permanente Medical Group Fontana, 1301 California St, Redlands, CA 92374, USA
| | - Lance Brown
- Emergency Department, Loma Linda University Medical Center and Children's Hospital, 11234 Anderson Street, Loma Linda, CA 92354, USA.
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26
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Porturas T, Taylor RA. Forty years of emergency medicine research: Uncovering research themes and trends through topic modeling. Am J Emerg Med 2020; 45:213-220. [PMID: 33059985 DOI: 10.1016/j.ajem.2020.08.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 08/05/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022] Open
Abstract
STUDY OBJECTIVE Topic identification can facilitate knowledge curation, discover thematic relationships, trends, and predict future direction. We aimed to determine through an unsupervised, machine learning approach to topic modeling the most common research themes in emergency medicine over the last 40 years and summarize their trends and characteristics. METHODS We retrieved the complete reference entries including article abstracts from Ovid for all original research articles from 1980 to 2019 within emergency medicine for six widely-cited journals. Abstracts were processed through a natural language pipeline and analyzed by a latent Dirichlet allocation topic modeling algorithm for unsupervised topic discovery. Topics were further examined through trend analysis, word associations, co-occurrence metrics, and two-dimensional embeddings. RESULTS We retrieved 47,158 articles during the defined time period that were filtered to 20,528 articles for further analysis. Forty topics covering methodologic and clinical areas were discovered. These topics separated into distinct clusters when embedded in two-dimensional space and exhibited consistent patterns of interaction. We observed the greatest increase in popularity in research themes involving risk factors (0.4% to 5.2%), health utilization (1.2% to 5.0%), and ultrasound (0.7% to 3.3%), and a relative decline in research involving basic science (8.9% to 1.1%), cardiac arrest (6.5% to 2.2%), and vitals (6.3% to 1.3%) over the past 40 years. Our data show only very modest growth in mental health and substance abuse research (1.0% to 1.6%), despite ongoing crises. CONCLUSIONS Topic modeling via unsupervised machine learning applied to emergency medicine abstracts discovered coherent topics, trends, and patterns of interaction.
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Affiliation(s)
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, United States.
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27
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Gonzalez K, Patel F, Cutchins LA, Kodish I, Uspal NG. Advocacy to Address Emergent Pediatric Mental Health Care. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2020. [DOI: 10.1016/j.cpem.2020.100778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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28
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Edgcomb JB, Sorter M, Lorberg B, Zima BT. Psychiatric Readmission of Children and Adolescents: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:269-279. [PMID: 31822241 DOI: 10.1176/appi.ps.201900234] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate predictors of psychiatric hospital readmission of children and adolescents, a systematic review and meta-analysis was conducted. METHODS Following PRISMA statement guidelines, a systematic literature search of articles published between 1997 and 2018 was conducted in PubMed/MEDLINE, Google Scholar, and PsycINFO for original peer-reviewed articles investigating predictors of psychiatric hospital readmission among youths (<18 years old). Effect sizes were extracted and combined by using random-effects meta-analysis. Covariates were investigated with meta-regression and subgroup analyses. RESULTS Thirty-three studies met inclusion criteria, containing information on 83,361 children and adolescents, of which raw counts of readmitted vs. non-readmitted youths were available for 76,219. Of these youths, 13.2% (N=10,076) were readmitted. The mean±SD study follow-up was 15.9±15.0 months, and time to readmission was 13.1±12.8 months. Readmission was associated with, but not limited to, suicidal ideation at index hospitalization (pooled odds ratio [ORpooled]=2.35, 95% confidence interval [CI]=1.64-3.37), psychotic disorders (ORpooled=1.87, 95% CI=1.53-2.28), prior hospitalization (ORpooled=2.51, 95% CI=1.76-3.57), and discharge to residential treatment (ORpooled=1.84, 95% CI=1.07-3.16). There was evidence of moderate study bias. Prior investigations were methodologically and substantively heterogeneous, particularly for measurement of family-level factors. CONCLUSIONS Interventions to reduce child psychiatric readmissions should place priority on youths with indicators of high clinical severity, particularly with a history of suicidality, psychiatric comorbidity, prior hospitalization, and discharge to residential treatment. Standardization of methods to determine prevalence rates of readmissions and their predictors is needed to mitigate potential biases and inform a national strategy to reduce repeated child psychiatric hospital readmissions.
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Affiliation(s)
- Juliet Beni Edgcomb
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
| | - Michael Sorter
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
| | - Boris Lorberg
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
| | - Bonnie T Zima
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles (Edgcomb, Zima); Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati, Cincinnati (Sorter); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Lorberg)
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29
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Hiscock H, Connolly AS, Dunlop K, Perera P, O'Loughlin R, Brown SJ, Krieser DM, West A, Chapman P, Lawford R, Cheek JA. Understanding parent-reported factors that influence children and young people's anxiety and depression presentations to emergency departments: A multi-site study. Emerg Med Australas 2020; 32:724-730. [PMID: 32096307 DOI: 10.1111/1742-6723.13486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Victorian ED data show increased presentations for anxiety and depression in children. We aimed to determine parent-reported factors contributing to these presentations. METHODS Qualitative study with parents of children and young people aged 0-17 years who attended one of four EDs across Victoria between October 2017 and September 2018 and received a primary diagnosis of anxiety or depression (excluding self-harm or suicide attempt). Eligible parents completed semi-structured phone interviews, which were audio-recorded and transcribed. Transcripts were coded and qualitatively analysed using thematic analysis. RESULTS Seventy parents completed interviews. The average age of children and young people was 14 years (standard deviation 2.4) and 63% (n = 44) identified as female. Thirty (43%) children received a primary diagnosis of depression, compared to 40 (57%) children who received a primary diagnosis of anxiety. The majority of respondents were mothers (n = 59; 84%). Key themes as to why families presented to EDs included: listening to trusted professionals, desperation, a feeling of no alternative, respecting their child's need to feel safe and to rule out a potentially serious medical condition. CONCLUSIONS Parents bring their children to the ED for many reasons. Policy makers, managers and clinicians should work with parents to develop alternative approaches that provide families with community-based support, particularly for younger children and after hours, in order to provide an appropriate source of care for children and young people with anxiety and depression.
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Affiliation(s)
- Harriet Hiscock
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Ann-Siobhan Connolly
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Katie Dunlop
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Prescilla Perera
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Rachel O'Loughlin
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Stephanie J Brown
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - David M Krieser
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatric Emergency Medicine, Sunshine Hospital, Melbourne, Victoria, Australia
| | - Adam West
- Department of Paediatric Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Pauline Chapman
- Department of Emergency Medicine, Ballarat Base Hospital, Ballarat, Victoria, Australia
| | - Robyn Lawford
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - John A Cheek
- Health Services, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Health Services Research Unit, The Royal Children's Hospital, Melbourne, Victoria, Australia
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30
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Blackburn J, Sharma P, Corvey K, Morrisey MA, Menachemi N, Sen B, Caldwell C, Becker D. Assessing the Quality Measure for Follow-up Care After Children's Psychiatric Hospitalizations. Hosp Pediatr 2019; 9:834-843. [PMID: 31636126 DOI: 10.1542/hpeds.2019-0137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Medicaid and Children's Health Insurance Program plans publicly report quality measures, including follow-up care after psychiatric hospitalization. We aimed to understand failure to meet this measure, including measurement definitions and enrollee characteristics, while investigating how follow-up affects subsequent psychiatric hospitalizations and emergency department (ED) visits. METHODS Administrative data representing Alabama's Children's Health Insurance Program from 2013 to 2016 were used to identify qualifying psychiatric hospitalizations and follow-up care with a mental health provider within 7 to 30 days of discharge. Using relaxed measure definitions, follow-up care was extended to include visits at 45 to 60 days and visits to a primary care provider. Logit regressions estimated enrollee characteristics associated with follow-up care and, separately, the likelihood of subsequent psychiatric hospitalizations and/or ED visits within 30, 60, and 120 days. RESULTS We observed 1072 psychiatric hospitalizations during the study period. Of these, 356 (33.2%) received follow-up within 7 days and 566 (52.8%) received it within 30 days. Relaxed measure definitions captured minimal additional follow-up visits. The likelihood of follow-up was lower for both 7 days (-18 percentage points; 95% confidence interval [CI] -26 to -10 percentage points) and 30 days (-26 percentage points; 95% CI -35 to -17 percentage points) regarding hospitalization stays of ≥8 days. Meeting the measure reduced the likelihood of subsequent psychiatric hospitalizations within 60 days by 3 percentage points (95% CI -6 to -1 percentage point). CONCLUSIONS Among children, receipt of timely follow-up care after a psychiatric hospitalization is low and not sensitive to measurement definitions. Follow-up care may reduce the need for future psychiatric hospitalizations and/or ED visits.
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Affiliation(s)
- Justin Blackburn
- Department of Health Policy and Managment, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana;and
| | - Pradeep Sharma
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama;and
| | - Kathryn Corvey
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama;and
| | - Michael A Morrisey
- Department of Health Policy and Management, School of Public Health, Texas A&M University, College Station, Texas; and
| | - Nir Menachemi
- Department of Health Policy and Managment, Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana;and
| | - Bisakha Sen
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama;and
| | - Cathy Caldwell
- Children's Rehabilitation Services, Alabama Department of Rehabilitation Services, Montgomery, Alabama
| | - David Becker
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama;and
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31
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Lynch S, Pines J, Mutter R, Teich JL, Hendry P. Characterizing behavioral health-related emergency department utilization among children with Medicaid: Comparing high and low frequency utilizers. SOCIAL WORK IN HEALTH CARE 2019; 58:807-824. [PMID: 31422764 DOI: 10.1080/00981389.2019.1653418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 06/10/2023]
Abstract
While the frequency of children's behavioral health (BH)-related visits to the emergency department (ED) is rising nationwide, few studies have examined predictors of high rates of ED use. This study examines Florida Medicaid claims (2011-2012) for children age 0-18 who were seen in an emergency department (ED) for behavioral health (BH) conditions. A logistic regression model was used to explore factors associated with frequent ED use and patterns of psychotropic medication utilization. The majority (95%) of patients with at least one BH-related ED visit had three or fewer of these visits, but 5% had four or more. Seventy-four percent of ED visits were not associated with psychotropic medication, including over half (54%) of visits for attention deficit hyperactivity disorder (ADHD). Frequent ED use was higher among older children and those with substance use disorders. The implementation of interventions that reduce non-emergent ED visits through the provision of care coordination, social work services, and/or the use of community health workers as care navigators may address these findings.
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Affiliation(s)
- Sean Lynch
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Jesse Pines
- Department of Emergency Medicine, George Washington University , Washington , DC , USA
| | - Ryan Mutter
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Judith L Teich
- U.S. Department of Health & Human Services, Substance Abuse & Mental Health Services Administration, Center for Behavioral Health Statistics & Quality , Rockville , MD , USA
| | - Phyllis Hendry
- Department of Emergency Medicine, University of Florida-Jacksonville , Jacksonville , FL , USA
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32
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Tran QN, Lambeth LG, Sanderson K, Graaff B, Breslin M, Tran V, Huckerby EJ, Neil AL. Trends of emergency department presentations with a mental health diagnosis by age, Australia, 2004–05 to 2016–17: A secondary data analysis. Emerg Med Australas 2019; 31:1064-1072. [DOI: 10.1111/1742-6723.13323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/17/2019] [Accepted: 04/20/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Quang Nhat Tran
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Leonard G Lambeth
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Kristy Sanderson
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
- School of Health SciencesUniversity of East Anglia East Anglia UK
| | - Barbara Graaff
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Monique Breslin
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Viet Tran
- Emergency Department, Royal Hobart HospitalTasmanian Health Service Hobart Tasmania Australia
- School of Medicine, College of Health and MedicineUniversity of Tasmania Hobart Tasmania Australia
| | - Emma J Huckerby
- Emergency Department, Royal Hobart HospitalTasmanian Health Service Hobart Tasmania Australia
| | - Amanda L Neil
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
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33
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Kalb LG, Stapp EK, Ballard ED, Holingue C, Keefer A, Riley A. Trends in Psychiatric Emergency Department Visits Among Youth and Young Adults in the US. Pediatrics 2019; 143:e20182192. [PMID: 30886112 PMCID: PMC6564072 DOI: 10.1542/peds.2018-2192] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Visits to the emergency department (ED) for psychiatric purposes are an indicator of chronic and acute unmet mental health needs. In the current study, we examined if psychiatric ED visits among individuals 6 to 24 years of age are increasing nationwide. METHODS ED data came from the 2011-2015 National Hospital Ambulatory Medical Care Survey, a national survey of ED visits across the United States. Psychiatric ED visits were identified by using the International Classification of Diseases, Ninth Revision and reason-for-visit codes. Survey-weighted logistic regression analyses were employed to examine trends in as well as correlates of psychiatric ED visits. Data from the US Census Bureau were used to examine population rates. RESULTS Between 2011 and 2015, there was a 28% overall increase (from 31.3 to 40.2) in psychiatric ED visits per 1000 youth in the United States. The largest increases in psychiatric ED visits per 1000 US youth were observed among adolescents (54%) and African American (53%) and Hispanic patients (91%). A large increase in suicide-related visits (by 2.5-fold) was observed among adolescents (4.6-11.7 visits per 1000 US youth). Although psychiatric ED visits were long (51% were ≥3 hours in length), few (16%) patients were seen by a mental health professional during their visit. CONCLUSIONS Visits to the ED for psychiatric purposes among youth are rising across the United States. Psychiatric expertise and effective mental health treatment options, particular those used to address the rising suicide epidemic among adolescents, are needed in the ED.
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Affiliation(s)
- Luther G Kalb
- Departments of Mental Health and
- Kennedy Krieger Institute, Baltimore, Maryland; and
| | | | - Elizabeth D Ballard
- Experimental Therapeutics and Pathophysiology Branch, National Institute of Mental Health, Bethesda, Maryland
| | | | - Amy Keefer
- Kennedy Krieger Institute, Baltimore, Maryland; and
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Anne Riley
- Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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34
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Leon SL, Polihronis C, Cloutier P, Zemek R, Newton AS, Gray C, Cappelli M. Family Factors and Repeat Pediatric Emergency Department Visits for Mental Health: A Retrospective Cohort Study. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2019; 28:9-20. [PMID: 31001347 PMCID: PMC6457444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Approximately 45% of youth presenting to the emergency department (ED) for mental health (MH) concerns will have a repeat ED visit. Since youth greatly depend on their caregivers to access MH services, the objective of this study was to determine if family characteristics were associated with repeat ED visits. METHODS A retrospective cohort study of youth aged 6-18 years (62% female) treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Family factor contribution was analyzed using a multivariable logistic regression model controlling for demographic, clinical and service utilization factors. Variables associated with earlier and more frequent visits were determined using cox regression and negative binomial regression. RESULTS Of 266 participants, 70 (26%) had a repeat visit. While caregiver history of MH treatment decreased the odds of having a repeat ED visit, family functioning and perceived family burden were not associated with repeat visits. Post-visit MH services, prior psychiatric hospitalization, higher severity of symptoms, and living closer to the hospital increased the odds of repeat visits. CONCLUSIONS This study examined the contribution of multiple family factors in predicting repeat MH visits to the ED. Results suggest caregiver characteristics may impact the decision to return. Healthcare providers should therefore consider caregiver and youth service utilization factors to inform patient management and discharge planning.
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Affiliation(s)
- Stephanie L Leon
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- University of Ottawa, Faculty of Social Sciences, School of Psychology, Ottawa, Ontario
| | | | - Paula Cloutier
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Roger Zemek
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
- University of Ottawa, Faculty of Medicine, Department of Pediatrics, Ottawa, Ontario
| | - Amanda S Newton
- University of Alberta, Department of Pediatrics, Faculty of Medicine and Dentistry, Edmonton, Alberta
| | - Clare Gray
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mario Cappelli
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
- Children's Hospital of Eastern Ontario, Ottawa, Ontario
- University of Ottawa, Faculty of Graduate and Postdoctoral Studies, Ottawa, Ontario
- Ontario Centre of Excellence for Child and Youth Mental Health, Ottawa, Ontario
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Abstract
Mental illness among children and adolescents is an increasing burden, projected to become one of the world's leading disabilities in near future. A dearth of specialized services and personnel to provide optimal care affects the disease burden, prevalence, health care services, and health care costs. The increasing demand weighs down on generalized systems of care such as emergency department (ED) services, in which the lack of specific training, personnel, and specialized protocols tends to prolong length of stay, recidivism, and suboptimal care. This article reviews outcomes and trends of overburdened ED systems in the context of pediatric mental health care management, guidelines of care, and strategies to manage common pediatric mental health emergencies and expand services within the ED. [Pediatr Ann. 2018;47(8):e328-e333.].
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Roman SB, Matthews-Wilson A, Dickinson P, Chenard D, Rogers SC. Current Pediatric Emergency Department Innovative Programs to Improve the Care of Psychiatric Patients. Child Adolesc Psychiatr Clin N Am 2018; 27:441-454. [PMID: 29933793 DOI: 10.1016/j.chc.2018.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Emergency departments (EDs) across North America have become a safety net for patients seeking mental health (MH) services. The prevalence of families seeking treatment of children in MH crisis has become a national emergency. To address MH access and improve quality and efficient management of children with MH conditions, the authors describe ED projects targeting this vulnerable population. Five North American health care systems volunteered to feature projects that seek to reduce ED visits and/or improve the care of MH patients: Allina Health, Nationwide Children's Hospital, Children's Hospital of Eastern Ontario, Connecticut Children's Medical Center, and Rhode Island Hospital.
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Affiliation(s)
- Susan B Roman
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA.
| | - Allison Matthews-Wilson
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Patricia Dickinson
- Center for Care Coordination, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Danielle Chenard
- Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT 06106, USA
| | - Steven C Rogers
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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An Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions. Child Adolesc Psychiatr Clin N Am 2018; 27:413-425. [PMID: 29933791 DOI: 10.1016/j.chc.2018.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Children and youth presenting to the emergency department with mental health concerns present a challenge for clinicians and system capacity. Addressing a significant system gap and sparse strategies in the literature, representative leaders from hospital and community agencies developed a novel pathway to guide efficient and doable risk assessment and ensure timely transition to appropriate community mental health services. This article describes and reflects on our innovative Emergency Department Clinical Pathway for Children and Youth with Mental Health Conditions that bridges traditional barriers between hospital and community settings to address mental health needs for this population.
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Evaluating mental health service use during and after emergency department visits in a multisite cohort of Canadian children and youth. CAN J EMERG MED 2017; 21:75-86. [DOI: 10.1017/cem.2017.416] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AbstractObjectivesThe goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed.MethodsA 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher’s exact test to compare sites.ResultsThe cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed.ConclusionsChildren and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.
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