Citation

Cutler GJ, Rodean J, Zima BT, Doupnik SK, Zagel AL, Bergmann KR, Hoffmann JA, Neuman MI. Acad. Pediatr. 2019; ePub(ePub): ePub.

Affiliation

Division of Emergency Medicine, Department of Medicine, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Main South, Boston, MA. Electronic address: Mark.Neuman@childrens.harvard.edu.

Copyright

(Copyright © 2019, Academic Pediatric Association, Publisher Elsevier Publishing)

DOI

10.1016/j.acap.2019.05.132

PMID

31175994

Abstract

OBJECTIVE: To examine trends in mental health (MH) visits to pediatric emergency departments (EDs) and identify whether ED disposition varies by presence of a hospital inpatient psychiatric unit (IPU). STUDY DESIGN: Cross-sectional study of 8,479,311 ED visits to 35 children's hospitals from 2012 to 2016 for patients aged 3 to 21 years with a primary MH or non-MH diagnosis. Multivariable generalized estimating equations and bivariate Rao-Scott chi-square tests were used to examine trends in ED visits and ED disposition by IPU status, adjusted for clustering by hospital.

RESULTS: From 2012 to 2016, hospitals experienced a greater increase in ED visits with a primary MH vs. non-MH diagnosis (50.7% vs. 12.7% cumulative increase, P<.001). MH visits were associated with patients who were older, female, white non-Hispanic, and privately insured compared with patients of non-MH visits (all P<.001). 44% of MH visits in 2016 had a primary diagnosis of depressive disorders or suicide or self-injury, and the increase in visits was highest for these diagnosis groups (depression: 109.8%; suicide or self-injury: 110.2%). Among MH visits, presence of a hospital IPU was associated with increased hospitalizations (34.6% vs. 22.5%, P<.001) and less transfers (9.3% vs. 16.2%, P<.001).

CONCLUSION: The increase in ED MH visits from 2012 to 2016 was four times greater than non-MH visits at US children's hospitals, and was primarily driven by patients diagnosed with depressive disorders and suicide or self-injury. Our findings have implications for strategic planning in tertiary children's hospitals dealing with a rising demand for acute MH care.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

Pediatric mental health; depression; discharge disposition; emergency department; suicide or self-injury