Summary Statistics for Pediatric Psychiatric Visits to US

Objectives. To describe characteristics of emergency department (ED) encounters for pediatric patients with an acute mental health diagnosis. Methods. Data are from the National Hospital Ambulatory Medical Care Survey, which includes abstracts from the medical records of a national probability sample of visits to EDs. Analysis was limited to records of patients who were younger than 19 years and had a diagnosis of either confirmed or suspected mental disorder or a suicide attempt. Results. There was an estimated annual average of 434 000 ED pediatric mental health visits from 1993 to 1999, an average annual rate of 326.8 visits per 10 000 people. Visit rates varied by patient’s region, age, race, and gender. Psychosis was the diagnosis in 10.8% of these patients, and suicide attempt was the diagnosis in 13.6%. ED pediatric mental health visits accounted for 1.6% of all ED visits in this age group. Conclusions. The significant increase in emergency department pediatric mental health (EDPMH) visits from 1993–1999 is greatest among patients who are non-white, teenaged, female, and live in the Northeast or Midwest. This variation in EDPMH visits may reflect variability in the shortage of mental health providers. The lack of increase in the 2 categories of diagnoses mandatorily seen in EDs—psychoses and suicide attempts—suggests that the overall rise in EDPMH visits may have been attributable to nonurgent complaints more appropriately managed by a primary mental health provider. Pediatrics 2002;110(4). URL: http://www.pediatrics.org/cgi/content/ full/110/4/e40; emergency services, psychiatric, emergency medicine, mental disorders diagnosed in childhood, National Hospital Ambulatory Medical Care Survey. ABBREVIATIONS. ED, emergency department; EDPMH, emergency department pediatric mental health (visit); NHAMCS, National Hospital Ambulatory Medical Care Survey; PSU, primary sampling unit; ESA, emergency service area; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification. Both lay1–3 and trade4–6 publications have drawn attention to the escalating shortage of mental health inpatient and outpatient resources, and a Surgeon General’s report has called the shortage a “health crisis.”7 The online databases of the US Department of Health and Human Services’ Bureau of Primary Health Care (bphc.hrsa. gov/databases/newhpsa/newhpsa.cfm) show that 771 health service areas nationwide were designated as underserved in the first 6 months of 2001. The Methodology for Epidemiology of Mental Disorders in Children and Adolescents study estimated that almost 21% of US children ages 9 to 17 had a diagnosable mental or addictive disorder associated with at least minimum impairment.8 Between 6 million and 9 million children and adolescents have serious emotional disturbances, accounting for 9% to 13% of all children.9 There is little in the scientific literature describing the characteristics of the cohort of US children who present to emergency departments (EDs) with mental health–related diagnoses. The purpose of this report was to describe the frequency of emergency medical utilization and the patient, drug, and visit characteristics for emergency department pediatric mental health (EDPMH) visits in the United States. We used the National Hospital Ambulatory Medical Care Survey (NHAMCS) to describe the extent and characteristics of emergency medical utilization for mental health disorders in children and adolescents. We examined differences in utilization and treatment patterns during the period 1993 to 1999. The data presented here are important for public health, clinical, and academic purposes related to disease prevalence, emergency medicine research, and therapy guidelines and projections.