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Temporal Trends in Pediatric Mental Health Visits: Using Longitudinal Data to Inform Emergency Department Health Care Planning

Ali, Samina MDCM*; Rosychuk, Rhonda J. PhD*†; Dong, Kathryn A. MD; McGrath, Patrick J. PhD§; Newton, Amanda S. PhD*

Pediatric Emergency Care:
doi: 10.1097/PEC.0b013e31825cf93b
Original Articles
Abstract

Objective: Understanding the temporality of mental health presentations to the emergency department (ED) during the 24-hour cycle, day of the week, and month of the year may facilitate strategic planning of ED-based mental health services.

Methods: Data on 30,656 ED presentations for mental illness, substance use, or intentional self-harm by 20,956 patients (≤17 years) were examined. We studied patient demography, discharge diagnosis, and time and date of presentation.

Results: Most pediatric mental health ED visits (66.0%) occurred after the average work and school day (after 5 PM). Presentations related to substance use and intentional self-harm steadily increased in the evening. Emergency department visits related to substance use peaked on Friday through Sunday (4723/7475; 63.2%), whereas visits for mood disorders (4127/5093; 81.0%), neurotic/stress-related disorders (5960/7989; 74.6%), and behavioral/emotional disorders (237/304; 78%) were highest during the work/school week (Monday to Friday). Visits for intentional self-harm peaked following the weekend (Monday: 771/4676; 16.5%). Summer months had fewer visits (6862/30,656; 22.4%), whereas March to May (range: 2752–2912 visits) and October to November (range: 2701–2751 visits) showed more steady peaks in volume. Most presentations by diagnostic group decreased in volume during the winter months (December to February) to increase again in the spring (March to May).

Conclusions: Peak times for pediatric mental health presentations to the ED are evenings throughout the week, suggesting that mental health services for children, adolescents, and their families should be available after work and school hours, 7 days a week.

Author Information

From the *Department of Pediatrics, University of Alberta; †Women and Children’s Health Research Institute; and ‡Department of Emergency Medicine, University of Alberta, Edmonton, Alberta; and §Departments of Psychology & Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.

Disclosure: The authors declare no conflict of interest.

Reprints: Amanda S. Newton, PhD, Department of Pediatrics, Faculty of Medicine and Dentistry, #8213 Aberhart Centre One, 11402 University Ave, Edmonton, Alberta, Canada T6G 2J3 (e-mail: mandi.newton@ualberta.ca).

The study reported in this article was supported by a research grant from the Canadian Institutes of Health Research (200805KRS). Dr Newton is supported by a Career Development Award from the Canadian Child Health Clinician Scientist Program in partnership with the SickKids Foundation, Child & Family Research Institute (British Columbia), Women & Children’s Health Research Institute (Alberta), and Manitoba Institute of Child Health. Dr Rosychuk is salary supported by the Alberta Heritage Foundation for Medical Research as a Health Scholar.

This study is based in part on data provided by Alberta Health and Wellness. The interpretation and conclusions contained herein are those of the researchers and do not necessarily represent the views of the Government of Alberta. Neither the Government of Alberta nor Alberta Health and Wellness expresses any opinion in relation to this study.

© 2012 Lippincott Williams & Wilkins, Inc.