Characterization of Young Children Presenting to the Emergency Department for Mental Health Complaints.

OBJECTIVES: From 2011 to 2015, psychiatric emergency department visits among youth in the United States increased 28% and psychiatric visits made up 10% of all pediatric emergency department (ED) visits. Previous research has focused on adolescent mental health, with little characterization of children 10 years of age and younger with mental health complaints. The primary objective of this study was to describe these children who presented to a pediatric ED for mental health complaints in terms of demographics and psychosocial factors. METHODS: One researcher reviewed medical records of children 10 years and younger who presented to the Children's of Alabama ED between January 1, 2016 and May 31, 2016 with a mental health-related chief complaint. Patient data were then categorized based on demographic information, characteristics of the ED visit, and medical and social history. Descriptive analyses were run using SAS version 9.4. RESULTS: In total, 222 patients 10 years and younger were seen between January 1 and May 31, 2016. This age group makes up 20% of all of the children seen in the ED for mental health-related complaints. Patients were 73% male (n = 162) and ages 3 to 10 years, with a mean age of 7.8 years. Patients were 55% white (n = 122), 42% African American (n = 94), 1% Hispanic (n = 2), and 1% other ethnicity (n = 3). Patients' insurance coverage was 76% Medicaid (n = 168), 18% private insurance (n = 39), and 6% uninsured (n = 14). Of the 219 patients treated in the ED (3 left without treatment), 45% of patients were admitted (n = 100). Univariate analyses showed increased odds of admission for children with 3 or more prior psychiatric diagnoses (odds ratio [OR] 2.33, P = 0.03), a family history of psychiatric illness (OR 2.53, P < 0.01), history of any previous psychiatric care (OR 2.61, P = 0.01), a history of trauma (OR 1.84, P = 0.03), and a chief complaint of suicidal ideation (OR 1.54, P < 0.01). Analyses showed a decreased odds of admission for children referred to the ED by their school (OR -1.12, P < 0.01). CONCLUSIONS: The pediatric ED sees a significant number of children ages 10 years and younger for mental health-related complaints. Nearly half of these children were admitted for psychiatric care. Several factors were found to predict admission, which reflect psychosocial influences. These psychosocial factors are important targets for intervention both in the ED and in the community.