Pediatric Emergency Consultations: Prior Mental Health Service Use in Suicide Attempters

Abstract

This study investigated the relationship between presenting complaints and prior mental health encounters in youth seen for emergency psychiatric consultation. Records of youths aged 9-17 years old receiving a psychiatric consultation in a pediatric emergency department from 2002 to 2007 were examined (N=1,900). Youth were classified by presenting complaint: suicide attempt, suicidal ideation, and behavioral problems. Nearly half of the youth presented with behavior problems, and 39% presented with suicidal ideation and/or attempt. Those presenting with both suicide attempt and behavior problems were most likely to have made a prior suicide attempt. Those presenting with suicide attempt alone were least likely to report current mental health treatment, while youth presenting with behavior problems alone were the most likely to report current mental health treatment. Further research is needed to better understand the role that emergency departments play in the course of care and to maximize the opportunity to make lasting and effective community-based care connections.

Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality

“…We were able to show that NSSI and suicidality are the main reasons for presenting to our child and adolescent psychiatric services. This seems in line with former studies on child and adolescent psychiatric services or pediatric services providing emergency mental health care (9,10,14), which also underlined the clinical relevance of these topics for emergency child and adolescent psychiatry. Looking into methods used for suicide attempts, self-poisoning, as well as selfharm with a sharp object and self-hanging was reported.…”

Emergency Department as a First Contact for Mental Health Problems in Children and Youth

“…To our knowledge, our study is the first to evaluate children and youth who first present to the ED with any MH-related condition. Unlike other studies, 12,13,43,44 we minimized selection bias by including all MH diagnoses across a range of hospitals in a universal access health care system. Although administrative datasets provide insights into a large population of patients, they have inherent limitations, including potential coding errors and a lack of data on contributing factors (e.g., substance use), education levels, and use of nonphysician community MH services (e.g., psychologists and social workers).…”

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

“…Prior emergency service use was associated with older age, while prior psychiatric hospitalization was associated with male gender and older age. Frosch et al (22) reported that older age was found to be associated with a greater likelihood of a prior ED visit and a prior psychiatric hospitalization. In a study conducted in an university hospital, it was reported that 69% of patients used outpatient services in the past and approximately 1/4 of the patients presented to the PES for first mental health treatment contact (21).…”

“…Similarly, Frosch et al (22) reported that youth presenting with behavior problems were 2.4 times more likely than youth presenting with other problems to have accessed inpatient or ED services in the past and twice as likely to have identified a current mental health provider. These findings suggest that youth presenting with homicide/violence toward others are likely to access all of the mental health services, and the PES constitutes a continuum of main treatment steps for these youth.…”