Emergency Department Utilization for Mental Health in American Indian Children

Abstract

Objectives To examine emergency department (ED) visits for mental health concerns by American Indian children in a multi-center cohort. To analyze demographic and clinical factors, the types of MH concerns and repeat mental health visits. Study design Cross-sectional study of children 5 to 18 years old who visited one of six EDs in the Upper Midwest from June 2011 to May 2012 and self-identified as White or American Indian. Mental health visits were identified by primary diagnosis and reasons for visit and were categorized into diagnostic groups. We explored racial differences in ED visits for mental health, diagnostic groups, and repeat mental health visits. Analysis involved Chi-squared tests, Cochran–Mantel–Haenszel tests, and regression models including age, triage, timing, and insurance and their interactions with race. Results We identified 26,004 visits with 1545 (5.94%) for mental health. The proportion of visits for mental health differed by race and age. American Indian children had lower odds of a mental health visit for 5–10 year olds (Odds Ratio (OR) =0.40, 95% Confidence Interval (CI) =0.26–0.60), but higher odds for 11–17 year olds (OR=1.62, 95% CI = 1.34–1.95). In the older age group, American Indian children were primarily seen for depression and trauma- and stressor-related disorders, whereas White children were primarily seen for depression and disruptive, impulse-control, and conduct disorders. Repeat visits were not different by race. Conclusion Differences were noted in mental health visits between American Indian and White children and were influenced by age. These findings warrant further investigation into care seeking patterns and treatment for mental health in American Indian children.

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