Risk factors inconsistent in adolescents repeatedly using emergency departments for mental health care

Gender and age were the most frequently assessed risk factors for repeated emergency department visits by adolescents needing mental health care. However, evidence supporting the relationship between gender and high impact use was inconsistent, according to a scoping review published in the American Journal of Emergency Medicine.

The research team reviewed 65 studies looking at the association between risk factors and multiple emergency department visits among 10 to 24-year-olds seeking mental health care. Most of the studies included in the review were from North America and discussed a wide range of risk factors. This made it difficult to assess which factors may be contributing to repeated emergency department attendance, also defined as high impact use.

Studies included in the review also listed previous and current access to mental health care as a factor associated with high impact use. However, researchers couldn’t assess whether this was a reliable indicator of high impact use because of the wide range of mental health care services listed within the reviewed studies.

Those benefitting from private health insurance were also assessed as less likely to be high impact users, compared to those who relied on public insurance or had no insurance. A small number of studies also showed associations between lower socioeconomic status and higher emergency department use.

The study team didn’t find any other factors that could be consistently or uniformly associated with high impact use.

Dr Rebecca Wilson, lead author, said:

“People with serious mental illness are more likely to be high impact users of emergency departments, and adolescents are more likely to repeatedly visit emergency departments to get mental health care. This may reflect unmet needs and suggests patients may not be receiving appropriate or timely mental health care.

“Despite identifying a large number of studies, we couldn’t identify consistent risk factors for high emergency department use among adolescents. This was due to variability in both study design and how studies measured risk factors and outcomes.

“Completing this review has shown that more high-quality research is needed, particularly outside North America.”