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Depression

Updated 17 December 2018

Sharp rise seen in US kids' ER visits for mental health woes

An increasing number of children with mental health concerns are visiting US paediatric emergency departments.

Mental health issues are sending more and more kids and teens to hospital emergency rooms, and that increase has been most dramatic among minorities, a new report shows.

Between 2012 and 2016, overall admissions shot up 50% in the United States, the researchers said.

Racial and ethnic disparities

"Prior to our study, we knew that an increasing number of children with mental health concerns were coming to the nation's paediatric emergency departments," said study author Dr Anna Abrams. She is a resident physician with the Children's National Health System in Washington, D.C.

"What this new research demonstrates is that not only are these visits increasing at a staggering rate, but that there are significant racial and ethnic disparities in the trends of who visits paediatric emergency departments for mental health issues," Abrams said.

Why this is so remains unclear, she noted.

"Our study really was an effort to characterise the frequency of these emergency department visits," Abrams explained. "It was not designed to investigate the potential reasons that triggered these visits. We do plan to investigate this question in future work."

Abrams and her colleagues plan to present their findings at an American Academy of Pediatrics meeting, in Orlando, Florida. The research should be considered preliminary until published in a peer-reviewed journal.

The study team said that more than 17 million American children struggle with some form of psychiatric illness. In recent years, that has meant that somewhere between 2 to 5% of all paediatric visits to the emergency department have been related to mental illness concerns.

Dramatic rise in visits

To drill down on the trends, the investigators sifted through data that had been collected by the Pediatric Health Information System.

The team focused on the overall number of mental health-related visits to an emergency department among children up to the age of 21.

The mental health issues covered by the analysis included: acute anxiety and delirium states; adjustment disorders and neuroses; alcohol abuse; drug abuse (including opioid abuse); bipolar disorders; childhood behavioural disorders; depression; major depressive disorders; disorders of personality and impulse control; eating disorders; psychosis; and schizophrenia.

During the study period, investigators determined that more than 293 000 children – who were an average age of just over 13 – had been diagnosed for some type of mental illness in a paediatric emergency room setting.

Overall, these visits rose dramatically during the study period, up from about 50 visits for every 100 000 children in 2012 to nearly 79 visits per 100 000 by 2016, according to the report.

But when broken down by race, the investigators found that the observed rise had not unfurled at an equal pace.

For example, nearly 52 out of every 100 000 white children were visiting an ER for a mental health issue by 2016. But among black children, that figure shot up to 78. Among other non-Hispanic minorities, the number rose to more than 79.

A function of social circumstances

The majority of all paediatric mental health visits (55%) were covered by some form of public insurance, the study authors noted.

William Tynan is director of integrated health care with the American Psychological Association. He said he wouldn't be surprised if the study actually underestimates the degree to which mental health is the central concern among paediatric ER visits.

"I would have estimated 10%, so the 2 to 5% looks low to me," Tynan said.

As for the observed racial disparities, Tynan suggested that they are likely "a function of social circumstances".

Poverty aside, "families go to the emergency department because, in general, when there is a problem with a child — either medical or behavioural — all parents feel a sense of urgency and want it addressed immediately," Tynan said.

But, "we do know that children in poverty who have been exposed to social stressors — and sometimes more trauma and violence — have a higher risk of disorders, so the numbers on differences between black and white need to be compared with poverty rates," he added.

On that front, Tynan noted that some estimates put the poverty rate for black children at 27%, compared with just 10% among white children. Pew Research paints an even starker divide, he added: 38% among black kids versus 11% among their white peers.

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