Trends in Pediatric Emergency Department Visits for Mental Health Conditions and Disposition by Presence of a Psychiatric Unit

Gretchen J. Cutler*, Jonathan Rodean, Bonnie T. Zima, Stephanie K. Doupnik, Alicia L. Zagel, Kelly R. Bergmann, Jennifer A Hoffmann, Mark I. Neuman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


Objective: To examine trends in mental health (MH) visits to pediatric emergency departments (EDs) and identify whether ED disposition varies by presence of a hospital inpatient psychiatric unit (IPU). Study Design: Cross-sectional study of 8,479,311 ED visits to 35 children's hospitals from 2012 to 2016 for patients aged 3 to 21 years with a primary MH or non-MH diagnosis. Multivariable generalized estimating equations and bivariate Rao-Scott chi-square tests were used to examine trends in ED visits and ED disposition by IPU status, adjusted for clustering by hospital. Results: From 2012 to 2016, hospitals experienced a greater increase in ED visits with a primary MH versus non-MH diagnosis (50.7% vs 12.7% cumulative increase, P < .001). MH visits were associated with patients who were older, female, white non-Hispanic, and privately insured compared with patients of non-MH visits (all P < .001). Forty-four percent of MH visits in 2016 had a primary diagnosis of depressive disorders or suicide or self-injury, and the increase in visits was highest for these diagnosis groups (depression: 109.8%; suicide or self-injury: 110.2%). Among MH visits, presence of a hospital IPU was associated with increased hospitalizations (34.6% vs 22.5%, P < .001) and less transfers (9.2% vs 16.2%, P < .001). Conclusion: The increase in ED MH visits from 2012 to 2016 was 4 times greater than non-MH visits at US children's hospitals and was primarily driven by patients diagnosed with depressive disorders and suicide or self-injury. Our findings have implications for strategic planning in tertiary children's hospitals dealing with a rising demand for acute MH care.

Original languageEnglish (US)
Pages (from-to)948-955
Number of pages8
JournalAcademic Pediatrics
Issue number8
StatePublished - Nov 1 2019


  • depression
  • discharge disposition
  • emergency department
  • pediatric mental health
  • suicide or self-injury

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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