Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

Abstract

Background: Previous studies of differences in mental health care associated with children's sociodemographic status have focused on access to community care. We examined differences associated with visits to the emergency department.

Methods: We conducted a 6-year population-based cohort analysis using administrative databases of visits (n = 30,656) by children aged less than 18 years (n = 20,956) in Alberta. We measured differences in the number of visits by socioeconomic and First Nations status using directly standardized rates. We examined time to return to the emergency department using a Cox regression model, and we evaluated time to follow-up with a physician by physician type using a competing risks model.

Results: First Nations children aged 15-17 years had the highest rate of visits for girls (7047 per 100,000 children) and boys (5787 per 100,000 children); children in the same age group from families not receiving government subsidy had the lowest rates (girls: 2155 per 100,000 children; boys: 1323 per 100,000 children). First Nations children (hazard ratio [HR] 1.64; 95% confidence interval [CI] 1.30-2.05), and children from families receiving government subsidies (HR 1.60, 95% CI 1.30-1.98) had a higher risk of return to an emergency department for mental health care than other children. The longest median time to follow-up with a physician was among First Nations children (79 d; 95% CI 60-91 d); this status predicted longer time to a psychiatrist (HR 0.47, 95% CI 0.32-0.70). Age, sex, diagnosis and clinical acuity also explained post-crisis use of health care.

Interpretation: More visits to the emergency department for mental health crises were made by First Nations children and children from families receiving a subsidy. Sociodemographics predicted risk of return to the emergency department and follow-up care with a physician.

Figure 1:

Age-and sex-adjusted directly standardized visit rates (with 95% confidence interval) for each fiscal year by First Nations and socioeconomic status.

Figure 2:

Age-and sex-specific emergency department visit rates by First Nations and socioeconomic status, 2007/08.

Figure 3:

Time to return visit to the emergency department (ED) (A) and time to follow-up visit (B) after discharge, by First Nations and socioeconomic status.