RT Journal Article
SR Electronic
T1 Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises
JF Canadian Medical Association Journal
JO CMAJ
FD Canadian Medical Association
SP E665
OP E674
DO 10.1503/cmaj.111697
VO 184
IS 12
A1 Amanda S. Newton
A1 Rhonda J. Rosychuk
A1 Kathryn Dong
A1 Janet Curran
A1 Mel Slomp
A1 Patrick J. McGrath
YR 2012
UL http://www.cmaj.ca/content/184/12/E665.abstract
AB 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.