Pediatric Psychiatric Emergency Department Utilization and Fine Particulate Matter: A Case-Crossover Study

Abstract

Background:Acute exposure to ambient particulate matter <2.5μm in aerodynamic diameter (PM2.5) has been associated with adult psychiatric exacerbations but has not been studied in children.Objectives:Our objectives were to estimate the association between acute exposures to ambient PM2.5 and psychiatric emergency department (ED) utilization and to determine if it is modified by community deprivation.Methods:We used a time-stratified case-crossover design to analyze all pediatric, psychiatric ED encounters at Cincinnati Children’s Hospital Medical Center in Cincinnati, Ohio, from 2011 to 2015 (n=13,176). Conditional logistic regression models adjusted for temperature, humidity, and holiday effects were used to estimate the odds ratio (OR) for a psychiatric ED visit 0–3 d after ambient PM2.5 exposures, estimated at residential addresses using a spatiotemporal model.Results:A 10-μg/m3 increase in PM2.5 was associated with a significant increase in any psychiatric ED utilization 1 [OR=1.07 (95% CI: 1.02, 1.12)] and 2 [OR=1.05 (95% CI: 1.00, 1.10)] d later. When stratified by visit reason, associations were significant for ED visits related to adjustment disorder {e.g., 1-d lag [OR=1.24 (95% CI: 1.02, 1.52)] and suicidality 1-d lag [OR=1.44 (95% CI: 1.03, 2.02)]}. There were significant differences according to community deprivation, with some lags showing stronger associations among children in high versus low deprivation areas for ED visits for anxiety {1-d lag [OR=1.39 (95% CI: 0.96, 2.01) vs. 0.85 (95% CI: 0.62, 1.17)] and suicidality same day [OR=1.98 (95% CI: 1.22, 3.23) vs. 0.93 (95% CI: 0.60, 1.45)]}. In contrast, for some lags, associations with ED visits for adjustment disorder were weaker for children in high-deprivation areas {1-d lag [OR=1.00 (95% CI: 0.76, 1.33) vs. 1.50 (95% CI: 1.16, 1.93)]}.Discussion:These findings warrant additional research to confirm the associations in other populations. https://doi.org/10.1289/EHP4815

The association between ozone and fine particles and mental health-related emergency department visits in California, 2005–2013

“…While there are limited findings for the other mental health outcomes examined in our study, risk of increased psychotic disorders among adolescents is of particular importance partly because adolescents who experience psychotic symptoms are at an increased risk of other mental health conditions such as suicidal behavior or bipolar disorder [ 52 , 53 ]. Another recent study based in Cincinnati, Ohio found that short-term exposure to PM 2.5 was associated with increased risks of psychiatric emergency department visits related to schizophrenia, suicidality, adjustment, and anxiety disorders among adolescents [ 54 ]. The study found stronger associations for suicidality and anxiety-related ED visits among children who lived in socioeconomically deprived neighborhoods, which suggests that chronic exposure to neighborhood-level stressors may modify the relationship between air pollutants and mental health among children.…”

Research Review: Pediatric anxiety disorders – what have we learnt in the last 10 years?

“…A relatively neglected area concerning the risk of developing anxiety disorders includes environmental exposures, including air pollution (Brokamp, Strawn, Beck, & Ryan, 2019). Mercury and other toxicants are associated with an increased risk of developing anxiety disorders, even when correcting for maternal age at delivery, fish intake, maternal ethnicity, household income, maternal education, and marital status (Patel et al, 2019).…”

“…More recently, specific components of air pollution that induce inflammation and oxidative stress in the brain (e.g., particulate matter with an aerodynamic diameter < 2.5 µm (PM 2.5 )) have been linked to exacerbations of anxiety disorders. Greater PM 2.5 exposure is associated with an increased risk of psychiatric emergency department visits for anxiety disorders in children and adolescents, and community deprivation mediates this association (Brokamp et al, 2019).…”

Racial Disparities in the Health Effects From Air Pollution: Evidence From Ports

“…A growing number of economic studies use quasi-experimental methods to estimate the causal effects of air pollution exposure on human health, using health metrics such as infant mortality and birth outcomes (e.g., Chay and Greenstone, 2003b;Currie and Neidell, 2005;Currie et al, 2009;Currie and Walker, 2011;Sanders and Stoecker, 2015;Arceo et al, 2016;Alexander and Schwandt, 2019), adult mortality (e.g., Deryugina et al, 2019;Anderson, 2020), respiratory problems (e.g., Moretti and Neidell, 2011;, and cardiovascular diseases (e.g., Halliday et al, 2019). While the focus of much of the literature has been on physical health, there is growing epidemiological work showing an association between air pollution and mental health (e.g., Sass et al, 2017;Kim et al, 2018;Brokamp et al, 2019).…”