Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Pittsenbarger, Zachary E.; Mannix, Rebekah

doi:10.1111/acem.12282

Cited by 125 publications

(124 citation statements)

References 32 publications

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“…Also, they reported that the most frequent disorders in adolescence were psychoactive substance use disorders (25.2%) for boys and mood disorders (33.6%) for girls. In a large, nationally representative ED database including data from 2001 to 2011, the most common primary ICD-9 diagnoses were anxiety states/panic disorder (14%) and depression (13%) (15). The rate of conduct disorder in our sample was higher than the rates of conduct or disruptive disorders (range 6.3-14%) found in other studies conducted at universities or general hospitals (9,10,13,20,32,33).…”

Section: Discussioncontrasting

confidence: 61%

“…Pediatric EDs have been shown to serve as an entry point into the healthcare system for children and adolescents seeking psychiatric care and are considered a safe area for the lack of inpatient and outpatient mental health services (7,9). Several studies reported a marked increase in the number of children and adolescents seeking care for mental health problems in emergency settings (10)(11)(12)(13)(14)(15). Also, the prevalence of mental health problems in pediatric EDs has been found to be much higher (1).…”

Section: Introductionmentioning

confidence: 99%

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Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

Mutlu¹,

Kılıçoğlu²,

Güneş³

et al. 2015

EAJEM

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Aim: We aimed to investigate the characteristics of children and adolescents presented to the psychiatric emergency service (PES) of a mental health hospital. Materials and Methods:Medical records of patients under 18 years of age were reviewed for the first psychiatric emergency visit during a 1-year period. Results:The mean age was 15.82 years and 65.8% (n=711) were female. The most presenting symptoms were suicidal ideation (21.0%; most for girls) and homicide/violence toward others (20.7%; most for boys). The mean duration of symptoms was 265.36 days. The most common diagnoses were conduct disorder (16.7%; most for boys) and conversion disorder (15.5%; most for girls). Of the patients, 51.7% never used any mental health services before. The rate of prior use of mental health service was significantly higher in patients presenting with homicide/violence toward others and self-harm and lower in patients presenting with anxiety and somatic symptoms (p<0.05). Of the patients, 292 (27.0%) took no treatment and 271 (25.1%) were admitted to the psychiatric inpatient unit.Conclusion: PES can be used by half of the families as a first-line therapy unit. PES seems to serve an important role in the continuum of pediatric mental health care, particularly for youths with homicide/violence toward others, and to be a point of access to mental healthcare, particularly for youths with anxiety and somatic symptoms. (Eurasian J Emerg Med 2015; 14: 123-30)

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Section: Discussioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 99%

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

Mutlu¹,

Kılıçoğlu²,

Güneş³

et al. 2015

EAJEM

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“…During the study period BH-related ED visits for children rose (32, 33). Evidence also suggests that psychotropic medication use and outpatient mental health treatment for children increased between 1996-1998 and 2010-2012 (34).…”

Section: Discussionmentioning

confidence: 99%

The Impact of the Massachusetts Behavioral Health Child Screening Policy on Service Utilization

Hacker¹,

Penfold²,

Arsenault³

et al. 2017

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Objective In 2008, Massachusetts Medicaid implemented a pediatric BH screening mandate. This study conducted a population level, longitudinal policy analysis to determine the impact of the policy on ambulatory, emergency, and inpatient BH care in comparison to California where no similar policy existed. Methods Using Medicaid Analytic Extract (MAX) data, an interrupted time series with control series design was performed to assess changes in service utilization in the 18 months (January 2008-June 2009) following a BH screening policy compared with California. Outcomes included population rates of: BH screening; BH-related outpatient visits; BH-related emergency department visits; BH-related hospitalizations; and psychotropic drug use. Medicaid eligible children from January 1, 2006 to December 31, 2009 with at least 10 months of Medicaid eligibility who were aged greater than 4.5 years to less than 18 years were included. Results Compared to California, Massachusetts rates of BH screening and BH-related outpatient visits rose significantly following the screening policy. BH screening rose about 13 per 1000 youth per month during the first 9 months and BH-related outpatient visits rose about 4.5 per 1000 youth per month (p<0.001). While BH-related emergency department visits, hospitalization and psychotropic drug use increased, there was no difference in rate of increase in Massachusetts compared to California. Conclusions The goal of BH screening is to identify previously unidentified children with BH issues and provide earlier treatment options. The short-term outcomes of the Massachusetts policy suggest that screening at preventive care visits led to more BH-related outpatient visits among vulnerable children.

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“…Recent studies suggest that 3–8 % of pediatric mental health ED presentations in the United States and Canada are for psychotic symptoms [11–14]. ED visits are considered an important contact point to reduce the duration of untreated psychosis through assessment and referral to early intervention programs [5, 15, 16].…”

Section: Introductionmentioning

confidence: 99%

Predicting time to emergency department re-visits and inpatient hospitalization among adolescents who visited an emergency department for psychotic symptoms: a retrospective cohort study

2016

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BackgroundAdolescents experiencing psychosis may enter the mental health system by a pathway to care that includes or is initiated at the emergency department (ED). However, a better understanding of the pathway to care involving EDs is required to ensure these patients receive the care they require. This study explores physician-based care factors associated with adolescent ED re-visits and inpatient hospitalization following an index ED visit for psychotic symptoms.MethodsUsing administrative data from Alberta, Canada, we identified a cohort of adolescents aged 13–17 years who were discharged after an ED visit for psychotic symptoms between April 1, 2002 and September 29, 2010. Multivariable models estimated times to ED re-visit and inpatient hospitalization for mental health care in a 90-day period after ED discharge.ResultsThe cohort was comprised of 208 adolescents. Reduced times to ED re-visit and inpatient hospitalization were associated with: 1) multiple physician visits after discharge (ED re-visit: hazard ratio [HR] 5.93, 95 % confidence interval [CI] 2.09–16.82; inpatient hospitalization: HR 9.43, 95 % CI 1.24–72.00), and 2) post-ED physician care provided in a hospital-based outpatient clinic (ED re-visit: HR 3.07, 95 % CI 1.77–5.29; inpatient hospitalization: HR 3.48, 95 % CI 1.54–7.88). A follow-up visit to a pediatrician, compared to other physician specialties, was associated with earlier inpatient hospitalization (HR 4.45, 95 % CI 1.43–13.87). There was a significant interaction between sex and First Nations status in both models. Females with First Nations status re-visited the ED sooner (HR 3.19; 95 % CI 1.41–7.22) and were hospitalized sooner (HR 4.18; 95 % CI 1.24–14.06).ConclusionsThis study identifies predictors of time to care for adolescents with psychotic symptoms that are worthy of additional investigation. To ensure the pathway to care for these adolescents reduces the duration of untreated problems, health care aspects that require urgent investigation include the type assessments and clinical decisions made during post-ED physician visits.

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Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Cited by 125 publications

References 32 publications

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital

The Impact of the Massachusetts Behavioral Health Child Screening Policy on Service Utilization

Predicting time to emergency department re-visits and inpatient hospitalization among adolescents who visited an emergency department for psychotic symptoms: a retrospective cohort study

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