Psychiatric emergency visits increasing among youth, especially racial minorities

1. An analysis of emergency department (ED) visits across the United States showed a 28% overall increase in psychiatric ED visits per 1000 youth aged 6 to 24 years between 2011 and 2015.

2. Increases were most pronounced among adolescents, African American patients, and Hispanic patients.

Evidence Rating Level: 3 (Average)

Study Rundown: Pediatric emergency department visits have risen over the last several decades, but less is known about more recent trends in psychiatric emergency department visits, especially in relation to different age, sex, and racial or ethnic groups. In this cross-sectional study, researchers used nationwide ED visit data to examine trends in psychiatric ED visits among youth aged 6 to 24 years between 2011 and 2015, stratified by age, sex, and race/ethnicity. During that time period, there was a 28% overall increase in psychiatric ED visits per 1000 youth. Rates of visits rose by more than 50% in adolescents and African American youths, and by more than 90% in Hispanic youths. Although half of psychiatric ED visits lasted at least 3 hours, only 16% of patients were seen by a mental health professional during their visit.

These findings are limited by a lack of diagnostic confirmation and information on visit acuity. Nonetheless, the study is strengthened by its large, nationally representative sample of emergency departments and examination of multiple subgroups. For physicians, these findings highlight the importance of advocating for increased emergency department psychiatric and social work resources.

Click to read the study, published today in Pediatrics

Click to read an accompanying editorial in Pediatrics

Relevant reading: Pediatric Mental Health Emergencies in the Emergency Medical Services System

Study author, Luther Kalb, PhD, speaks to 2 Minute Medicine: Assistant Professor, Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health, Kennedy Krieger Institute, Baltimore, Maryland.

“This study is significant because it points to a need for greater psychiatric expertise in the Emergency Department (ED). The ED has been at a breaking point for a long time, with incredibly long wait times and decreasing access to inpatient psychiatric beds. We really need new, evidenced-based models of crisis care.”

In-Depth [cross-sectional study]: Researchers used data from the 2011-2015 National Hospital Ambulatory Medical Care Survey and US Census Bureau to estimate the probability of a psychiatric ED visit identified by visit diagnoses and recorded reason for visit. Logistic regression models were used to examine trends in the odds of a psychiatric ED visit over time among youth 6 to 24 years of age, reported as visits per 1000 youth, and to identify differences based on demographic and visit-related factors.

Between 2011 and 2015, there was a 28% increase in rates of psychiatric ED visits among youths in the United States from 31.3 to 40.2 per 1000, and a significant increase in odds of visit (odds ratio [OR]: 1.07; 95% confidence interval [CI]: 1.01 to 1.13). Adolescents and young adults were nearly 5 times more likely to have psychiatric ED visits than children (OR: 4.93; 95%CI: 3.99 to 6.10). There was a 53% increase in visit rates and a significant increase in odds of psychiatric ED visit for African American youth (OR: 1.16; 95%CI: 1.03 to 1.30) and a 91% increase in visit rates for Hispanic youth (OR: 1.12; 95%CI: 1.01 to 1.24). There was a significant increase in the proportion and probability of suicide-related visits over time among adolescents (OR: 1.27; 95%CI: 1.10 to 1.48), but not for other groups. About half of psychiatric ED visits lasted at least 3 hours, and 16% of patients were seen by a mental health professional during their visit.

Image: PD

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