Findings revealed that repeat visits to the ED for MH concerns is a complex phenomenon that can be attributed to various demographic, clinical, and MH care access and utilization factors. To further elucidate the strongest predictors, future prospective research should consider prospective designs and include family factors. Investigating recency and frequency outcomes can also inform clinical practice.

The Youth Transition Project was designed to provide youth with mental health and addiction issues with individualized transitional care plans as they transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). Over an 18-month period, a total of 127 (59.1%) youth were transitioned and seen by an AMHS provider, 41 (19.1%) remained on a waitlist for services and 47 (21.8%) canceled services. The average time to transition was 110 days (SD = 100). Youth exhibited a wide range of diagnoses; 100% of the population was identified as having serious psychiatric problems. Findings demonstrate that the Youth Transition Project has been successful in promoting continuity of care by transitioning youth seamlessly from youth to adult services. Inconsistencies in wait times and service delivery suggest that further model development is needed to enhance the long-term sustainability of the Youth Transition Project.

ObjectivesDespite documented increases in emergency department (ED) mental health (MH) presentations, there are inconsistent findings on the characteristics of patients with repeat presentations to pediatric EDs (PEDs) for MH concerns. Our study sought to explore the characteristics of MH patients with repeat PED visits and determine predictors of return visits, of earlier repeat visits, and of more frequent repeat visits.MethodsWe examined data collected prospectively in a clinical database looking at MH presentations to a crisis intervention program housed within a PED from October 2006 to December 2011. Predictive models based on demographic and clinical variables were constructed using logistic, Cox, and negative binomial regression.ResultsA total of 4,080 presentations to the PED were made by the 2,900 children and youth. Repeat visits accounted for almost half (45.8%) of all presentations. Multivariable analysis identified five variables that independently predicted greater odds of having repeat presentations, greater risk of earlier repeat presentations, and greater risk of frequent repeat presentations. The five variables were: female, living in the metropolitan community close to the PED, being in the care of child protective services, taking psychotropic medications, and presenting with an actionable need in the area of mood disturbances.ConclusionsRepeat visits account for a large portion of all MH presentations to the PED. Furthermore, several patient characteristics are significant predictors of repeat PED use and of repeating use sooner and more frequently. Further research is needed to examine interventions targeting this patient group to ensure appropriate MH patient management.

There is a wide variety of mental health care practices in Canadian paediatric EDs. Consideration of which resources are required to ensure evidence-based, effective services are provided to children and youth is necessary.

Background: To examine mental health (MH) presentations to the emergency department (ED) of a paediatric hospital following two highly publicized local teen suicides. Methods: Youths aged 12-18 years with a MH chief complaint and/or diagnosis were included. Differences in frequencies were analyzed using chi-square tests, and relative risks were evaluated using generalized linear modelling. Results: Significant increases in the number of ED presentations were found within the months of the publicized suicides compared to the same months of previous years. No differences were found in symptom acuity, suicidal status and psychiatric hospitalization rates. Significant increases were found in relative risk of presenting to the ED 28 and 90 days post both publicized suicides. Conclusions: Results suggest there was an association between highly publicized suicides and an increase in the number of MH presentations to the local paediatric ED. Considerations of media' s potentially positive role in MH awareness are needed. Résumé Contexte : Examiner les visites pour raison de santé mentale aux services des urgences d'un hôpital pédiatrique suite à deux suicides d' adolescents fortement couverts par les médias locaux. Méthode : Les jeunes de 12 à 18 ans avec un motif de consultation et/ou un diagnostique lié à la santé mentale ont été inclus dans cette étude. Les différences dans la fréquence ont été analysées au moyen du test de chi carré et les risques relatifs ont été évalués par modélisation linéaire généralisée. Résultats : Nous avons observé un accroissement significatif des visites aux services des urgences dans les deux mois qui ont suivi l' annonce des suicides, comparativement aux mêmes mois de l' année précédente. Nous n' avons pas observé de différences dans la gravité des symptômes, le statut suicidaire et les taux d'hospitalisation pour raisons psychiatriques. Nous avons observé un accroissement significatif du risque relatif de se présenter aux services des urgences de 28 à 90 jours après l' annonce des suicides. Conclusions : Les résultats font voir qu'il y a un lien entre les suicides hautement médiatisés et un accroissement du nombre de visites pour des raisons de santé mentale aux services des urgences d'un hôpital pédiatrique local. Il est nécessaire de se pencher sur le rôle potentiellement positif des médias dans la prise de conscience sur la santé mentale.

BackgroundOf the over 1 million reported cases of traumatic brain injuries reported annually in the USA, a sizeable proportion are characterized as mild. Although it is generally well-accepted that most people who suffer a mild traumatic brain injury recover within 1 to 3 months, a proportion of individuals continue to experience physiological, psychological, and emotional symptoms beyond the expected window of recovery. Depression is commonly reported following mild traumatic brain injury; however, its course, consequences, and prognostic factors remain to be well understood.MethodsA systematic review will be conducted of available prospective longitudinal studies of adult mild traumatic brain injury-related depression. The aim of the systematic review is to describe the course of mild traumatic brain injury-related depression, along with its prognostic factors and health consequences. The review will comply with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. A thorough database search of peer-reviewed publications in English and French will be conducted in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, Scopus, Erudit, and Cairn. Independent investigators will perform study selection and data extraction. Risk of bias will be assessed using the Quality in Prognosis Studies tool, and methodological quality will be evaluated using a system inspired by the Scottish Intercollegiate Guidelines Network Methodology. Results will be presented through qualitative description and tabulation.DiscussionThis will be the first systematic review conducted with the aim of describing the course, prognostic factors, and health-related outcomes of depression in adults who have suffered a mild traumatic brain injury. The findings of the planned systematic review have the potential to guide research and clinical practice to effectively develop and implement evidence-based interventions aimed at preventing and alleviating mild traumatic brain injury-related depression.Systematic review registrationPROSPERO CRD42015019214

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