Predictors of Youth Mental Health-Related Visits to a Hospital Emergency Department

Rates of child and adolescent visits to hospital emergency departments (EDs) for mental health and substance-use conditions are on the rise across the United States. Frequent repeat visits suggest a reliance on the ED as a “revolving door” for psychiatric care. Concerns are growing regarding the low quality of mental healthcare provided in the ED and its disproportionate use by Black, Latine, and publicly insured youth. Limited research has explored social determinants of health as predictors of youth mental health-related ED visits. Guided by the Andersen Healthcare Utilization model, the present cross-sectional retrospective cohort study aimed to: 1) examine psychosocial factors (age, gender, race, ethnicity), enabling factors (neighborhood opportunity, primary care utilization, insurance type) and need factors (outpatient mental health service utilization) associated with youth having at least one mental health-related ED visit during the study period and 2) investigate these factors as predictors of repeat mental health-related ED visits. Data was drawn from the electronic medical records of 79,146 Chicago-dwelling pediatric and young adults (ages 5-25) who visited the University of Illinois hospital system between January 2014 and December 2019. Of those, 853 (1.07%) individuals had at least one mental health-related ED visit. The Child Opportunity Index was used to measure neighborhood educational, health and environmental, and socioeconomic opportunity. A Zero-Inflated Poisson multi-level model was constructed to determine the relative effect of each predictor on mental health-related ED visits. Lower educational opportunity, Black racial identity, Latine ethnicity, older age, and preventative primary care utilization were each associated with mental health-related ED visits. Older age, Black racial identity, primary care utilization, and outpatient mental healthcare utilization each emerged as predictors of repeat mental health-related ED visits. Results demonstrate the persistence of racial and ethnic disparities in mental health-related ED utilization even when accounting for socioeconomic status at the individual and neighborhood level. Policies and practices that address educational inequities at the neighborhood level, integrate mental health interventions into primary care, and support referral to outpatient mental health treatment from the ED, may all be effective in preventing youth from using the ED as a revolving door for mental health support.