Factors linked to pediatric mental health emergency revisits identified

Pediatric mental health emergency department visits are increasing, and markers of severe disease and health care access are associated with mental health revisits, according to a study published online Dec. 27 in JAMA Pediatrics.

Anna M. Cushing, M.D., from the Children's Hospital Los Angeles, and colleagues describe trends in pediatric mental health emergency department visits and revisits using data obtained from 38 U.S. children's hospital emergency departments between Oct. 1, 2015, and Feb. 29, 2020.

A total of 308,264 mental health emergency department visits from 217,865 unique patients were included; within six months, 13.2 percent of the patients had a mental health revisit. The researchers found an 8.0 percent annual increase in mental health visits, while all other emergency department visits increased by 1.5 percent annually.

Psychiatric comorbidities, chemical restraint use, public insurance, higher area measures of child opportunity, and the presence of an inpatient psychiatric unit at the presenting hospital were associated with mental health emergency department revisits. The likelihood of revisit was increased for patients with psychotic disorders, disruptive or impulse control disorders, and neurodevelopmental disorders (hazard ratios, 1.42, 1.36, and 1.22, respectively). The likelihood of revisit was lower for patients with substance use disorders (hazard ratio, 0.60).

"Improved intervention services for patients with a behavioral health crisis are needed on a hospital and systems level to reduce pediatric mental health emergency department use and ensure access to appropriate follow-up care, with a particular focus on those patients most likely to revisit," the authors write.