Burden of Unmet Mental Health Needs in Assault-Injured Youths Presenting to the Emergency Department

Abstract

Objectives To determine if there is a gap between behavioral symptoms and previously recognized mental health conditions in youth victims of peer assault injuries and to describe gender differences in psychological symptoms. Methods A cross-sectional comparison of rates of previously diagnosed mental health conditions and clinical range behavioral symptoms as measured by the Child Behavior Checklist (CBCL) in 168 youth (10-15 years old) presenting to the emergency department (ED) after an interpersonal assault injury. Fisher’s exact test was used for comparisons. Results Mental health symptoms were common among assault-injured youth. More than half of youth demonstrating clinical range symptoms on the attention problems or anxious / depressed scales of the CBCL had no prior diagnosis of these conditions. Females were more likely than males to exhibit clinical range aggressive behavior symptoms (OR 3.61, 95% CI 1.64-7.97). Aggressive behavior was associated with clinical range scores on the other problem scales of the CBCL. Conclusions After an ED visit for an assault-related injury, less than half of 10-15 year olds with significant symptoms of common mental conditions reported having a previously diagnosed disorder, reflecting a burden of unmet psychological needs. An ED visit for an assault injury provides an opportunity to screen for emotional / behavioral symptoms and to refer to appropriate follow-up mental health care. What’s New Assault-injured youth are likely to have unmet mental health needs. This study compares mental health symptoms after an assault injury to previously diagnosed mental health conditions and describes differences in mental health characteristics of assault-injured youth by gender.

Self-harm, Assault, and Undetermined Intent Injuries Among Pediatric Emergency Department Visits

“…Although the perpetrator could not be identified from the current data, this injury category likely includes visits characterized by both child abuse and peer-related violence, who may be high utilizers of ED resources and have unmet mental health needs. 26,27 Further research is needed to distinguish the resource impact of child abuse as compared to peer related assault visits, but new ED-based initiatives have been developed to address the needs of these patient groups. Recent research in abuse-related injuries has supported the use of ED-based screening for increased detection of child abuse.…”

Effects of a brief ED-based alcohol and violence intervention on depressive symptoms

“…(9, 17) The ED therefore represents a unique opportunity to reach youth with limited social, material, and institutional resources. (18, 19)…”

Review: The impact of pediatric mental health care provided outpatient, primary care, community and school settings on emergency department use – a systematic review

“…For example, while the mean difference in ED visits between groups reported by Jones et al., was small (one visit), it could represent a clinically important difference. Childhood conduct disorders and aggressive behaviors have been associated with multiple ED mental health visits as well as assault‐related visits (Anixt, Copeland‐Linder, Haynie, & Cheng, ; Frosch, dosReis, & Maloney, ), and a difference of one visit could represent important change from the perspectives of clinicians, parents, and children. Further investigation of these perspectives in future studies could lend clarity to what results should be considered clinically significant at different time‐points, even if results are not statistically significant, and may change interpretation of the results reported in three studies included in this review (Carlisle et al., ; Gowers et al., ; Richardson et al., ).…”