Pediatric Mental Illness in the Emergency Department: Understanding the Individual, Family and Systemic Factors in Return Visits

Title: Pediatric Mental Illness in the Emergency Department: Understanding the Individual, Family and Systemic Factors in Return Visits
Authors: Leon, Stephanie L.
Date: 2018
Abstract: This dissertation addresses some of the gaps in the research on pediatric mental health (MH) repeat visits to the emergency department (ED). The primary objectives of this thesis are to systematically review the existing literature on youth MH return visits to the ED and to determine the incremental contribution of family factors in predicting these repeat ED visits. The first study systematically reviewed and qualitatively summarized the available literature to better understand predictor of repeat visits. A search was performed using the following databases: PsycINFO, PubMed, and CINAHL. Reporting followed the PRISMA statement checklist and methodological quality was assessed using the following eight criteria: design, generalizability, breadth of predictors, reporting of effect sizes, additional outcomes, interaction terms, confounding variables, and clear definition of outcome. A total of 178 articles were retrieved; 11 articles met inclusion criteria. Findings revealed that repeat visits to the ED for MH concerns is a complex phenomenon that can be attributed to various demographic, clinical, and MH care access and utilization factors. Common predictors associated with repeat ED MH visits included socioeconomic status, involvement with child protective services, as well as previous and current MH service use. For studies using a six-month repeat window, the most common factors were previous psychiatric hospitalization and currently receiving MH services. This systematic review concluded that in order to further elucidate which variables are most significantly associated with repeat ED visits; future research should consider the use of prospective designs and the inclusion of family factors. Investigating recency and frequency outcomes may also be of importance. The second study aimed to determine if family characteristics are significantly associated with repeat ED visits over and above the contribution of demographic, clinical or service utilization factors. A retrospective cohort study of youth aged six to18 years treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Of 266 participants, 70 (26%) had a repeat visit. Receiving MH services within six-months of the index visit, having a parent with a history of treatment for MH concerns, higher severity of symptoms and living closer to the hospital were significantly associated with repeat visits as well as earlier and more frequent repeat visits. Prior psychiatric hospitalization was associated with repeat visits and more frequent repeat visits, while presenting with suicidality was associated with more frequent repeat visits. Family functioning and perceived family burden were not associated with repeat ED visits. This thesis contributes to the growing literature on ED use in pediatric patients with mental illnesses and may be clinically useful to professionals working with repeat visitors. The identification of key factors could provide essential information to ED decision-makers and lead to the development of best practices with this population.
CollectionThèses, 2011 - // Theses, 2011 -