Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents

Abstract

Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. Methods: We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. Results: Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05–0.21, p < 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21–0.37, p < 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65–3.83, p < 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41–0.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p < 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44–0.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04–2.72, p = 0.035). Conclusions: Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group.

The prevalence of off-label use and supratherapeutic blood levels of outpatient psychotropic medication in suicidal adolescents

“…We found that approximately 25% of suicidal adolescents were diagnosed with adjustment disorders. Our results are in line with a Swiss study that described that approximately 20% of adolescents presented to an emergency department with reactions to stress and adjustment disorders ( 29 ).…”

“…Especially in mid-adolescence, girls suffer more often from suicidality and show NSSI than boys. The three times higher proportion of cases in our sample may reflect this fact as well as the fact that adolescent cases with acute suicidality were significantly more likely to be girls than adolescent cases without acute suicidality (28,29). We assume (classification of NSSI is not possible using ICD 10) that the diagnoses of superficial injuries/ lesions, for example, at the forearm, are cutting or scratching and intentional self-inflicted injuries which are also more prevalent in girls than in boys (5-7).…”

Factors Associated with Extended Length of Stay for Paediatric Mental Health Presentations to Emergency Departments in South Western Sydney, Australia

“…Further, we found that 31% of all MH-related ED encounters were DSH-related, of which 37% had extended LOS. Such a high proportion of DSHrelated ED presentations has been reported in several other studies [12,14,28,38]. It is possible that most of the DSH-related presentations would require an urgent triage code (as noted in Table S1, around 81% of DSH-related ED presentations had triage levels 1-3) (Table S1), but it may take longer to organise MH specialist assessments in the ED resulting in extended LOS.…”