Child Psychiatry & Human Development

, Volume 48, Issue 6, pp 993–1000 | Cite as

Mental Health Visits: Examining Socio-demographic and Diagnosis Trends in the Emergency Department by the Pediatric Population

  • Sharon M. Holder
  • Kenneth Rogers
  • Eunice Peterson
  • Christian Ochonma
Original Article
  • 150 Downloads

Abstract

The emergency department (ED) is increasingly being used for mental health visits by children and adolescents. It is estimated that 21–23% of youth have a diagnosable psychiatric or substance use disorder. Using data from the ED of a tertiary medical center, we examined trends in mental health diagnoses over a 5-year period. In school age children the most prevalent diagnoses were anxiety disorders (28.4%); disorders first usually diagnosed in infancy, childhood, or adolescence (26.5%), and mood disorders (18.6%). High school students were more likely to visit the ED for anxiety disorders (30%). Females (34.5%) presented more for anxiety disorders compared to males (22.7%). Mental health visits and diagnoses were higher during school months (September–May) and lower in the summer months (June–August). The diagnosis trends identified in this study have clinical implications that can contribute to evidence-based restructuring of mental health resources and screenings.

Keywords

Mental health Psychiatric diagnosis Anxiety disorders Mood disorders School age 

References

  1. 1.
    Pittsenbarger ZE, Mannix R (2014) Trends in pediatric visits to the emergency department for psychiatry illnesses. Acad Emerg Med 21:25–30CrossRefPubMedGoogle Scholar
  2. 2.
    Grupp-Phelan J, Harman JS, Kelleher JK (2007) Trends in mental health and chronic condition visit by children presenting for care at U.S. emergency departments. Public Health Rep 122:55–61CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Larkin GL, Claassen CA, Emond JA, Pelletier AJ, Camargo CA (2005) Trends in US emergency department visits for mental health, 1992 to 2001. Psychiatr Serv 56(6):671–677CrossRefPubMedGoogle Scholar
  4. 4.
    Holder, SH, Rogers, K, Peterson, E, Shoenleben, R, Blackhurst, D (2016) The impact of mental health services in a pediatric emergency department: the implications of having trained psychiatric professionals. Pediatr Emerg Care. DOI:10.1097/PEC.0000000000000836 [Epub ahead of print]Google Scholar
  5. 5.
    Chun TH, Duffy SJ, Linakis JG (2013) Emergency department for adolescent mental health disorders: The who, what, when, where, why and how it could and should be done. Clin Pediatr Emerg Med 14(1):3–11CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Substance abuse and mental health services administration, National Institute of Mental Health, Department of Health and Human Services. (1999) Mental health: a report of the Surgeon General-executive summary. U.S. Department of Health and Human Services, RockvilleGoogle Scholar
  7. 7.
    American Academy of Pediatrics (2000) Insurance coverage of mental health and substance abuse services for children and adolescents: a consensus statement. Pediatrics 106 (4):860–862 http://pediatrics.aappublications.org/content/pediatrics/106/4/860.full.pdf
  8. 8.
    Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B et al (2011) Service utilization for lifetime mental disorders in U.S. adolescents: results of the national comorbidity survey adolescent supplement (NCS-A). J Am Acad Child Adolesc Psychiatr 50(1):32–45CrossRefGoogle Scholar
  9. 9.
    Murray CJL, Lopez AD (1996) The global burden of disease: A comprehensive assessment off mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard School of Public Health, on behalf of the World Health organization and the World Bank, Distributed by Harvard university Press. http://apps.who.int/iris/bitstream/10665/41864/1/0965546608_eng.pdf
  10. 10.
    Kataoka SH, Zhang L, Wells KB (2002) Unmet need for mental health care among U.S. children: variation by ethnicity and insurance status. Am J Psychiatr 159:1548–1555CrossRefPubMedGoogle Scholar
  11. 11.
    Bisgaier J, Rhodes KV (2011) Auditing access to specialty care for children with public insurance. N Engl J Med 364:2324–2333CrossRefPubMedGoogle Scholar
  12. 12.
    Gearing RE, Mian IA, Barber J, Ickowicz A (2006) A methodology for conducting retrospective chart review research in child and adolescent psychiatry. J Can Acad Child Adolesc Psychiatr 15(3):126–134Google Scholar
  13. 13.
    Case SD, Case BG, Olfson M, Linakis JG, Laska EM (2011) Length of stay of pediatric mental health emergency department visits in the United States. J Am Acad Child Adolesc Psychiatr 50(11):1110–1119CrossRefGoogle Scholar
  14. 14.
    International classification of diseases (1998) Ninth Revision, US Department of Health & Human Services, WashingtonGoogle Scholar
  15. 15.
    Mapelli E, Black T, Doan Q (2015) Trends in pediatric emergency department utilization for mental health-related visits. J Pediatr 167(4):905–910CrossRefGoogle Scholar
  16. 16.
    Newton AS, Ali S, Johnson DW, Haines C, Rosychuk RJ, Keaschuk RA et al (2010) Who comes back? characteristics and predictors of return to emergency department services for pediatric mental health care. Acad Emerg Med 17:177–186CrossRefPubMedGoogle Scholar
  17. 17.
    Edelsohn GA, Braitman LE, Rabinovich H, Sheves P, Melendez A (2003) Predictors of urgency in a pediatric psychiatric emergency service. J Am Acad Child Adolesc Psychiatr 42(10):1197–1202CrossRefGoogle Scholar
  18. 18.
    Mahajan P, Alpern ER, Grupp-Phelan J, Chamberlain J, Dong L, Holubkov R et al (2009) Epidemiology of psychiatric-related visits to emergency departments in a multicenter collaborative research pediatric network. Pediatr Emerg Care 25(11):715–720CrossRefPubMedGoogle Scholar
  19. 19.
    Simon AE, Schoendorf KC (2014) Emergency department visits for mental health conditions among US children, 2001–2011. Clin Pediatr 53(14):1359–1366CrossRefGoogle Scholar
  20. 20.
    Cloutier P, Kennedy A, Maysenhoelder H, Glennie EJ, Cappelli M, Gray C (2010) Pediatric mental health concerns in the emergency department: caregiver and youth perceptions and expectations. Pediatr Emerg Care 26(2):99–106CrossRefPubMedGoogle Scholar
  21. 21.
    Grupp-Phelan J, Mahajan P, Foltin GL, Jacobs E, Tunik M, Sonnett M et al (2009) Referral and resource use patterns for psychiatric-related visits to pediatric emergency departments. Pediatr Emerg Care 25(4):217–220CrossRefPubMedGoogle Scholar
  22. 22.
    Colasanti A, Natoli A, Moliterno D, Rossattini M, De Gaspari IF, Mauri MC (2008) Psychiatric diagnosis and aggression before acute hospitalization. Eur Psychiatr 23:441–448CrossRefGoogle Scholar
  23. 23.
    Whiteside LK, Ranney ML, Chermack ST, Zimmerman MA, Cunningham RM, Walton MA (2013) The overlap of youth violence among aggressive adolescents with past-year alcohol use—a latent class analysis: aggression and victimization in peer and dating violence in an inner city emergency department sample. J Stud Alcohol Drugs 74(1):125–135CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    James A, Madeley R, Dove A (2006) Violence and aggression in the emergency department. Emerg Med J 23(6):431–434CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L et al (2010) Lifetime prevalence of mental disorders in US adolescents: results from the National Comorbidity Survey Replication-adolescent supplement (NCS-A). J Am Acad Child Adolesc Psychiatr 49(10):980–989CrossRefGoogle Scholar
  26. 26.
    Ali S, Rosychuk RJ, Dong KA, McGrath PJ, Newton AS (2012) Temporal trends in pediatric mental health visits: using longitudinal data to inform emergency department health care planning. Pediatr Emerg Care 28(7):620–625CrossRefPubMedGoogle Scholar
  27. 27.
    Goldstein AB, Silverman MA, Phillips S, Lichenstein R (2005) Mental health visits in a pediatric emergency department and their relationship to the school calendar. Pediatr Emerg Care 21(10):653–657CrossRefPubMedGoogle Scholar
  28. 28.
    American Psychological Association. Stress in America. http://www.apa.org/news/press/releases/stress/2009/signs-stress.pdf. Accessed July 14 2016
  29. 29.
    Dumont M, Provost MA (1999) Resilience in adolescents: protective role of social support, coping strategies, self-esteem, and social activities on experiences of stress and depression. J Youth Adolesc 28:343–363CrossRefGoogle Scholar
  30. 30.
    Barrett S, Heubeck BG (2000) Relationships between school hassles, uplifts, and anxiety and conduct problems in grades 3 and 4. J Appl Dev Psychol 21(5):537–554CrossRefGoogle Scholar
  31. 31.
    Carter JS, Gerber J, Ciesla JA, Cole DA (2006) Modeling relationship between hassles and internalizing and externalizing symptoms in adolescents: a 4-year prospective study. J Abnorm Psychol 115(3):428–442CrossRefPubMedGoogle Scholar
  32. 32.
    Weber EJ, Showstack JA, Hunt KA, Colby DC, Callaham ML (2005) Does lack of a usual source of care or health insurance increase the likelihood of an emergency department visit? Results of a national population-based study. Ann of Emerg Med 45(1):4–12CrossRefGoogle Scholar
  33. 33.
    Asarnow JR, Baraff LJ, Berk M, Grob CS, Devich-Navarro M, Suddath R et al (2011) An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatr Serv 62(11):1303–1309CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Sharon M. Holder
    • 1
    • 2
  • Kenneth Rogers
    • 2
  • Eunice Peterson
    • 2
  • Christian Ochonma
    • 3
  1. 1.Department of Public Health Sciences and the Institute of Family and Neighborhood LifeClemson UniversityClemsonUSA
  2. 2.Department of Psychiatry & Behavioral MedicineGreenville Health SystemGreenvilleUSA
  3. 3.Department of Psychiatry & Behavioral Medicine, Greenville Health System, Arnold School of Public HealthUniversity of South CarolinaGreenvilleUSA

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