Disparities in Psychiatric Emergency Department Visits among Youth in Hawai'i, 2000-2010

doi:10.1016/j.jpeds.2012.09.006

The Journal of Pediatrics

Volume 162, Issue 3, March 2013, Pages 618-623

https://doi.org/10.1016/j.jpeds.2012.09.006 Get rights and content

Objective

To describe the frequency and patient characteristics of emergency department encounters for mental health among youth, and to examine differences in utilization and treatment patterns.

Study design

Data were obtained from the Hawai'i Health Information Corporation database of emergency department records between January 1, 2000, and December 31, 2010. Analyses were limited to records of visits by patients aged <18 years with a diagnosis of mental disorder or a suicide attempt.

Results

The annual average rate was 49.7 emergency department visits related to mental health issues per 10 000 youth, accounting for 2.1% of all emergency department visits among youth. Rates of mental health–related visits significantly and steadily increased, from a low of 25.8 in 2000 to a high of 67.4 in 2010. Rural areas consistently exhibited higher rates and acceleration at a steeper incline across time. Rural youth were more likely to be discharged or transferred for inpatient care or outpatient services compared with urban youth (6.3% vs 12.4%; χ² = 61.42; df = 3; P < .001).

Conclusion

The trend in emergency department utilization for mental health–related issues in adolescents is apparently increasing, with significantly higher rate and morbidity for youth in rural areas. Several recommendations are described for creating a responsive and integrated system of mental health care for youth, covering training, consultation, screening, and brief interventions.

Section snippets

Methods

The Hawai'i Health Information Corporation (HHIC), a private, not-for-profit entity, was established in 1994 to collect, analyze, and disseminate statewide health information to improve the quality and cost efficiency of healthcare services provided to the people of Hawai'i. Organizations may apply to access specific datasets collected by the HHIC and, for a fee, may be allowed access to such information as demographic data, average length of stay, insurance, International Classification of

Results

Analyses included descriptive statistics, χ² tests, and correlations. A total of 15 869 mental health–related emergency department visits by individuals aged ≤17 years were recorded between 2000 and 2010. The annual average rate during this period was 49.7 visits per 10 000 youth. Emergency department visits for mental health accounted for 2.1% of all emergency department visits by youth. Analysis of the distribution and annual rates of emergency department visits for mental health by youth

Discussion

We found a high rate of emergency department use for mental health treatment among Hawaiian youth, with significantly higher rates in adolescents. A recent study found that although the overall prevalence of mental disorders in US adolescents with severe impairment or distress exceeds 20%, only approximately 36% of adolescents with a mental disorder receive treatment.¹³ For many adolescents, the emergency room may be the primary, or only, source of health care.¹⁴ Given the low utilization of

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Visits to an emergency department by children and adolescents with substance-related disorders and the perceptions of nursing professionals
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Citation Excerpt :
This study found around 174 visits to the ED by children and adolescents with substance-related disorders, which is 45% of the total 381 visits related to mental health problems by this population. This proportion is high compared to a previous study undertaken in Hawaii (Matsu et al., 2013), which showed that about 28% of visits by youth with mental health problems to an ED were related to substance-related disorders. These results may reflect differences related to the specificities of the health systems of these countries.
The aim of this study was to describe the prevalence of visits to the emergency department (ED) by children and adolescents with substance-related disorders, between 2009 and 2011, to compare them to adults and to analyze how the nursing team perceived the health care for this population. A cross-sectional study was conducted based on qualitative and quantitative data collected in a Brazilian ED. The quantitative data were obtained from records of a hospital's information system, and the qualitative data were collected through semi-structured interviews with nursing professionals from the ED. During the period analyzed, 7.3% of visits to the ED by patients with substance-related disorders corresponded to children or adolescents. Summarily, we found that, from the participants' perspectives, the nursing care provided in the ED to patients with substance-related disorders was strongly framed on the primary role of this setting (i.e., to stabilize acute symptoms and provide security for patients); however the particularities related to the development stages were not emphasized by the participants. Improving clinical knowledge and understanding the emotional dimension of emergency psychiatric care could enhance the capacity of the nursing teams working in this context. Issues related to structure and the politics that framed teaching and assessing mental health are important considerations to further improve the assistance given to patients with substance-related disorders, especially children and adolescents.
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: The authors declare no conflicts of interest.

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Original ArticleDisparities in Psychiatric Emergency Department Visits among Youth in Hawai'i, 2000-2010

Objective

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

Gen Hosp Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

A meta-systems approach to evidence-based practice for children and adolescents

Am Psychol

Trends in mental health and chronic condition visits by children presenting for care at U.S. emergency departments

Public Health Rep

Ethnic minority children's use of psychiatric emergency care in California's public mental health system

Am J Public Health

Kawasaki syndrome in Hawaii

Pediatr Infect Dis J

United States trends in lumbar fusion surgery for degenerative conditions

Spine

International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)

Adolescent depression: views of health care providers in a pediatric emergency department

Pediatr Emerg Care

Hide and seek: the elusive rural psychiatrist

Acad Psychiatry

Original Article
Disparities in Psychiatric Emergency Department Visits among Youth in Hawai'i, 2000-2010