Pediatric ED Visits Rising for Mental Health Disorders

Rachel Stanley, MD, MHSA

New study findings shed light onto the rising rate of mental health visits among youth to emergency departments.

Although the number of pediatric visits across the US has remained stable over the last 10 years, visits for mental health disorders have increased by 60% and the rate of visits for deliberate self-harm have risen 329%, Rachel Stanley, MD, MHSA, and a team of investigators found. The findings highlighted the need to improve emergency department preparedness for children.

Stanley, division chief of Emergency Medicine at Nationwide Children’s Hospital, and the team used data from the 2007-2016 Nationwide Emergency Department Sample, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality. The databases tracked information about emergency department visits across the country and contained geographic, hospital, and patient information.

The investigators analyzed patient demographic information including sex, age, and emergency department disposition. Children included were 5-17 years old, as mental health conditions typically do not occur before age 5 years old. There were 3 age groups: 5-9 years old, 10-14 years old, and 15-17 years old. The children were then grouped into 1 of 3 categories: children with any mental health disorders, children with substance use disorders, and children who presented for deliberate self-harm.

Categories of mental health disorders included adjustment disorders, anxiety disorder, and attention-deficit, conduct, and disruptive behavior disorders. The team also included impulse control disorders, mood disorders, schizophrenia and other psychotic disorders, and a miscellaneous mental health disorder group. Substance use disorders were alcohol- or substance-related, while the final group was composed of the category suicide and intentional self-inflicted injury.

Pediatric emergency department volume was classified using the Pediatric Readiness Survey categories. The classifications were low (<4000), medium (4000-9999), high (10,000-24,999), very high (25,000-49,999), and extremely high (>50,000).

Over the study period, pediatric emergency department visits were stable, while visits for mental health disorders rose 60% (P <.001). Among all 3 age categories, mental health emergency department visits rose, most notably a 68% increase among the 15-17-year-old group (P <.001). There was a more pronounced rise in visits among girls, with 74% (P <.001).

The study investigators found that anxiety disorders and impulse control disorders significantly increased by 117% (P <.001) and 111% (P <.001). All substance use disorders increased by 75% (P <.001). Alcohol-related disorder decreased by nearly 40% (P <.001) while substance use disorders increased significantly by >150% (P <.001). Visits for deliberate self-harm increased 329% (P <.001).

There were significant rate increases among all emergency department volumes except for medium-volume settings (P=.23). The trend was most pronounced among facilities with higher pediatric emergency department volumes. There was an absolute rate change among nonchildren’s hospital emergency departments, with an increase from 14.6 per 1000 to 22.7 per 1000—a 55% difference (P <.001).

Stanley and the team noted that it will be important to focus mental health preparedness efforts and resources on all hospital emergency departments, specifically smaller-volume and rural emergency departments, and not just on children’s hospital emergency departments. Toolkits and online trainings can be used to address important components of pediatric readiness, the investigators suggested.

The study, “Children’s Mental Health Emergency Department Visits: 2007-2016,” was published online in the journal Pediatrics.