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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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Kim H, Lee YJ, Jung SJ. Trends in Depressive Symptoms and Suicidality of South Korean Adolescents: Comparison of Expected and Observed Prevalence During the COVID-19 Pandemic. J Adolesc Health 2023; 73:79-87. [PMID: 37029047 PMCID: PMC10075317 DOI: 10.1016/j.jadohealth.2023.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 01/06/2023] [Accepted: 02/08/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE Depressive symptoms and suicidality of adolescents during the COVID-19 pandemic are emerging public health issues. However, there is a lack of representative studies on adolescents' mental health that considers the preceding secular trends. METHODS This descriptive study used nationally representative cross-sectional data of Korean adolescents from the Korea Youth Risk Behavior Survey from 2005 to 2020 (N = 1,035,382). We utilized joinpoint regression analysis to explore the temporal prevalence trends of depressive symptoms, suicidal ideation, and suicide attempts. Based on the annual percentage change until 2019, the expected and actual prevalence in 2020 (N = 54,948) was compared to describe departures of prevalence from the trend line. These trends between sex, school level, ethnic status, and socioeconomic status were also compared. RESULTS Considering the recent increase in secular trends until 2019, the actual observed values in 2020 were lower than expected by 13% in depressive symptoms, 20% in suicidal ideation, and 40% in suicide attempts. The gap between sexes, school levels, ethnic status, and socioeconomic groups was similar or narrowed in 2020 compared to previous trends. DISCUSSION We observed a lower prevalence of depressive symptoms and suicidality among Korean adolescents than expected about 9 months from the beginning of the COVID-19 pandemic despite the recent increase in secular trends.
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Affiliation(s)
- Hyejin Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea
| | - Yu Jin Lee
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Sun Jae Jung
- Department of Public Health, Graduate School, Yonsei University, Seoul, South Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, South Korea.
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Lee J, Song K, Jeon S, Lee HS, Lee S, Kim HS, Chae HW. Association of maternal mental health and drinking/smoking with adolescents' mental health based on the Korea National Health and Nutrition Examination Survey. Front Psychiatry 2023; 14:1087300. [PMID: 37415692 PMCID: PMC10321712 DOI: 10.3389/fpsyt.2023.1087300] [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: 11/02/2022] [Accepted: 05/05/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Depression is one of the major concerns in adolescence, with a global prevalence of approximately 5%. Diverse environmental factors can affect the development of depression depending on the individual developmental stage. Methods Using data from the Korea National Health and Nutrition Examination Survey (KNHANES), we aimed to investigate the association between socioeconomic factors and mental health in a population of non-clinically ill adolescents in Korea totaling 6,261 adolescents aged 12-18 years. Results Drinking, smoking, stress, depressed mood, suicidal ideation in adolescents, and stress, depressed mood, and suicidal ideation in mothers were identified as factors associated with adolescent depression. In addition to depressed mood and suicidal ideation, the higher perception of stress in mothers was related to higher stress perception, depressed mood, and suicidal ideation in adolescents. The association of adolescents' mental health with fathers' mental health was weaker than that with mothers' mental health. Additionally, increased smoking and drinking were commonly reported in adolescents with higher stress perception, depressed mood, and suicidal ideation. Discussion We conclude that close monitoring of mental health is required for adolescents with drinking and smoking habits and mothers with mental health problems.
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Affiliation(s)
- Junghan Lee
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyungchul Song
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soyoung Jeon
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - San Lee
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea
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Park JH, Seo YW, Chae S. Impact of the COVID-19 Pandemic on Adolescent Self-Harm: Based on a National Emergency Department Information System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4666. [PMID: 36901676 PMCID: PMC10001448 DOI: 10.3390/ijerph20054666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/27/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Republic of Korea's suicide rate is the highest among Organization for Economic Co-operation and Development countries. In Republic of Korea, suicide is the leading cause of death among young people aged 10-19 years. This study aimed to identify changes in patients aged 10-19 years who visited the emergency department in Republic of Korea after inflicting self-harm over the past five years and to compare the situations before and after the outbreak of the COVID-19 pandemic. Analysis of government data revealed that the average daily visits per 100,000 were 6.25, 8.18, 13.26, 15.31, and 15.71 from 2016 to 2020, respectively. The study formed four groups for further analysis, with the population divided by sex and age (10-14 and 15-19 years old). The late-teenage female group showed the sharpest increase and was the only group that continued to increase. A comparison of the figures 10 months before and after the outbreak of the pandemic revealed a statistically significant increase in self-harm attempts by only the late-teenage female group. Meanwhile, visits (per day) in the male group did not increase, but the rates of death and ICU admission increased. Additional studies and preparations that account for age and sex are warranted.
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Affiliation(s)
- Ju-Hyeon Park
- Department of Emergency Medicine, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
| | - Young-Woo Seo
- Department of Emergency Medicine, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
| | - Seungbum Chae
- Department of Orthopedic Surgery, School of Medicine, Daegu Catholic University, Daegu 42472, Republic of Korea
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Kim SJ, Lee J. Introduction of Child and Adolescent Mental Health Services in Korea and Their Role During the COVID-19 Pandemic: Focusing on the Ministry of Education Policy. Soa Chongsonyon Chongsin Uihak 2023; 34:4-14. [PMID: 36636492 PMCID: PMC9815998 DOI: 10.5765/jkacap.220034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/08/2022] [Accepted: 12/08/2022] [Indexed: 01/05/2023] Open
Abstract
This study aimed to discuss mental health services for children and adolescents that are being implemented as initiatives of the Korean government and to review the functions and roles of these projects during the COVID-19 pandemic. Three government departments are in charge of providing mental health services for children and adolescents: Ministry of Education, Ministry of Gender Equality and Family, and Ministry of Health and Welfare. The Ministry of Education has implemented several policies to facilitate the early detection of mental health issues among school students (from preventive interventions to selective interventions for high-risk students). The Ministry of Gender Equality and Family additionally serves out-of-school children and adolescents by facilitating early identification of adolescents in crises and providing temporary protection or emergency assistance (as required) through the Community Youth Safety-Net Project. Furthermore, the Ministry of Health and Welfare operates relevant mental health agencies for individuals of all ages including children and adolescents. Any high-risk students who have been screened through the projects of the Ministry of Education are supported through referrals to the following institutions for appropriate treatment of their symptoms: specialized hospitals, the Youth Counseling and Welfare Center operated by the Ministry of Gender Equality and Family, the National Youth Healing Center, the Mental Health Welfare Center operated by the Ministry of Health and Welfare, the Suicide Prevention Center, and the Child Welfare Center. To assist students who are facing any psychological difficulties because of the COVID-19 pandemic, the Ministry of Education has established a psychiatric support group for providing emergency mental health care; furthermore, schools are promoting psychological surveillance (e.g., provision of non-face-to-face counseling services that are centered around the Wee Center). The Ministry of Education, Ministry of Gender Equality and Family, and Ministry of Health and Welfare have provided varied mental health support services in order to address the challenges faced by children and adolescents during the pandemic. Nevertheless, the mental health services operated by each ministry do show some limitations because their service provision system is insufficiently collaborative. The present study discussed the positive effects of each initiative as well as its limitations; furthermore, it suggested improvements for facilitating the healthy development of children and adolescents' mental health.
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Affiliation(s)
- Seo Jung Kim
- Department of Education, Ewha Womans University, Seoul, Korea
| | - Jongha Lee
- Department of Psychiatry, Korea University Ansan Hospital, Ansan, Korea
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Lee KS, Lim D, Paik JW, Choi YY, Jeon J, Sung HK. Suicide attempt-related emergency department visits among adolescents: a nationwide population-based study in Korea, 2016-2019. BMC Psychiatry 2022; 22:418. [PMID: 35733111 PMCID: PMC9215032 DOI: 10.1186/s12888-022-04043-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The incidence of adolescent suicide in Korea is increasing; however, nationwide data regarding short-term prediction of suicide attempts (SAs) is still limited. Therefore, this study aimed to investigate the incidence of SA-related annual emergency department (ED) visits among adolescents in Korea from 2016 to 2019 and to summarize the corresponding demographic and clinical characteristics based on the dispositions of SA-related ED visits. METHODS Most referral hospitals provide relevant essential ED information to the National Emergency Medical Center through the National Emergency Department Information System (NEDIS). We analyzed NEDIS data on adolescent visits (aged < 20 years) for a 4-year period from 2016 to 2019. Patients were classified into the discharge and hospitalization groups for comparison, and jointpoint regression analysis was used to identify the years in which there was a change in annual percentage change (APC) in age- and sex-standardized incidence rates of SA-related ED visits. The characteristics of patients in the discharge group and hospitalization group subgroups were also compared. RESULTS The APC in the incidence rate of SA-related ED visits in the 4-year study period revealed a 35.61% increase. The incidence rate increase was higher among females (APC: 46.26%) than among males (APC: 17.95%). Moreover, the incidence rate increased faster in mid-adolescence patients (APC: 51.12%) than in late-adolescence patients (APC: 26.98%). The proportion of poisoning as the SA method was 69.7% in the hospitalization group and 34.5% in the discharge group (p < 0.001). DISCUSSION Our findings suggest that an increase in the number of SA-related ED visits among female and mid-adolescent patients represented the largest increase in SA-related ED visits from 2016 to 2019. Accordingly, evidence-based suicide prevention programs need to be customized based on sex and age, and further diversification of health care systems is needed through analysis of the characteristics of the dispositions of SA-related ED visits.
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Affiliation(s)
- Kyung-Shin Lee
- grid.415619.e0000 0004 1773 6903Research Institute for Public Health, National Medical Center, Seoul, Korea
| | - Daesung Lim
- Department of Emergency Medicine, Gyeongsang National University College of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Jong-Woo Paik
- grid.411231.40000 0001 0357 1464Department of Psychiatry, Kyung Hee University Medical Center, Seoul, Korea
| | - Youn Young Choi
- grid.415619.e0000 0004 1773 6903Research Institute for Public Health, National Medical Center, Seoul, Korea ,grid.415619.e0000 0004 1773 6903Department of Pediatrics, National Medical Center, Seoul, Korea
| | - Jaehyun Jeon
- grid.415619.e0000 0004 1773 6903Research Institute for Public Health, National Medical Center, Seoul, Korea ,grid.415619.e0000 0004 1773 6903Division of Infectious Diseases, National Medical Center, Seoul, Korea
| | - Ho Kyung Sung
- Research Institute for Public Health, National Medical Center, Seoul, Korea. .,National Emergency Medical Center, National Medical Center, 245 Eulgi-ro, Jung-gu, 04564, Seoul, Korea.
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Lee JY, Kim H, Kim SY, Kim JM, Shin IS, Kim SW. Non-suicidal self-injury is associated with psychotic like experiences, depression, and bullying in Korean adolescents. Early Interv Psychiatry 2021; 15:1696-1704. [PMID: 33461244 DOI: 10.1111/eip.13115] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 12/16/2020] [Accepted: 01/04/2021] [Indexed: 11/28/2022]
Abstract
AIM Non-suicidal self-injury (NSSI) is common among adolescents, and several different factors can affect its prevalence. The present study examined the associated characteristics predicting NSSI among adolescents in South Korea. METHODS In total, 1674 high school students were recruited for a cross-sectional survey. They completed self-reported assessments, including the Deliberate Self-Harm Inventory (DSHI), the Center for Epidemiological Studies Depression Scale (CESD), the State-Trait Anxiety Inventory for Children (STAIC), and the Prodromal Questionnaire-16 (PQ-16), as well as their bullying experience. The NSSI group was defined as the sample group with at least one NSSI behaviour on the DSHI scale. A logistic regression analysis was performed using the NSSI group as the dependent variable. RESULTS The prevalence of NSSI was 28.3% (boys, 30.4%; girls, 24.4%) among adolescents. The most common type of NSSI behaviour among adolescents was interference with wound healing and sex differences in the method were examined. The CES-D, STAIC-trait, and PQ-16 scores were significantly higher and the RSES score was significantly lower in the NSSI group than those in the non-NSSI group. Participants' experience with bullying, such as being victims, bullies, bully-victims, and witness to bullying, were more likely to be in the NSSI group. In a logistic regression analysis, NSSI was significantly associated with male sex, low academic achievement, higher depression, psychotic-like experiences, being bullied, and witnessing bullying. CONCLUSION The results of this study suggest the need to identify and manage related psychologic factors in adolescents with NSSI, including psychotic-like symptoms.
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Affiliation(s)
- Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Seon-Young Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
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