Journal of the American Academy of Child and Adolescent Psychiatry
Volume 56, Issue 6, 2017, Pages 475-482.e4

Emergency Department as a First Contact for Mental Health Problems in Children and Youth (Conference Paper) (Open Access)

Gill P.J. , Saunders N. , Gandhi S. , Gonzalez A. , Kurdyak P. , Vigod S. , Guttmann A.*
  • a Hospital for Sick Children and University of TorontoON, Canada
  • b Hospital for Sick Children and University of TorontoON, Canada, Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
  • c ICES, United States
  • d ICES, United States
  • e ICES, United States, Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto; and Centre for Addiction and Mental Health, Toronto, Canada
  • f ICES, United States, IHPME, Dalla Lana School of Public Health, University of Toronto, and Women's College Hospital, Toronto, Canada
  • g Hospital for Sick Children and University of TorontoON, Canada, ICES, United States, Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada

Abstract

Objective To characterize youth who use the emergency department (ED) as a “first contact” for mental health (MH) problems. Method This was a population-based cross-sectional cohort study using linked health and demographic administrative datasets of youth 10 to 24 years of age with an incident MH ED visit from April 1, 2010, to March 31, 2014, in Ontario, Canada. We modeled the association of demographic, clinical, and health service use characteristics with having no prior outpatient MH care in the preceding 2-year period (“first contact”) using modified Poisson models. Results Among 118,851 youth with an incident mental health ED visit, 14.0% were admitted. More than half (53.5%) had no prior outpatient MH care, and this was associated with younger age (14−17 versus 22−24 years old: risk ratio [RR] = 1.09, 95% CI = 1.07−1.10), rural residence (RR = 1.16, 95% CI = 1.14−1.18), lowest versus highest income quintile (RR = 1.04, 95% CI = 1.03−1.06), and refugee immigrants (RR = 1.17, 95% CI = 1.13−1.21) and other immigrants (RR = 1.10, 95% CI = 1.08−1.13) versus nonimmigrants. The 5.1% of the cohort without a usual provider of primary care had the highest risk of first contact (RR = 1.78, 95% CI = 1.77−1.80). A history of low-acuity ED use and individuals whose primary care physicians were in the lowest tertile for mental health visit volumes were associated with higher risk. Conclusion More than half of youth requiring ED care had not previously sought outpatient MH care. Associations with multiple markers of primary care access characteristics suggest that timely primary care could prevent some of these visits. © 2017 American Academy of Child and Adolescent Psychiatry

Author Keywords

Primary care mental health services first contact Access emergency department

Index Keywords

immigrant hospitalization refugee mental health service schizophrenia human delusional disorder Cohort Studies psychosis controlled study priority journal general practitioner emergency ward drug dependence Mental Health Services Cross-Sectional Studies mental disease Young Adult social status cross-sectional study Humans Adolescent male female Conference Paper health care utilization Ontario major clinical study adult acute stress disorder utilization outcome assessment cohort analysis hospital emergency service Emergency Service, Hospital Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85017520779&doi=10.1016%2fj.jaac.2017.03.012&partnerID=40&md5=1f37a5a1f1591edaabdcef9419244ca6
DOI: 10.1016/j.jaac.2017.03.012
ISSN: 08908567
Cited by: 26
Original Language: English