Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter May 13, 2016

Two-year prospective study of characteristics and outcome of adolescents referred to an adolescent urgent psychiatric clinic

Nasreen Roberts, Linda Booij, Nicholas Axas and Leanne Repetti

Abstract

Objective:

(a) To describe the clinical characteristics and outcome of adolescents referred for urgent psychiatric consultation, and (b) compare suicidal with non-suicidal referrals.

Methods:

This was a 2-year prospective study. Data was gathered on demographic, historical and clinical variables. Comparison of suicidal and non-suicidal patients was conducted using χ2. A hospital database was used for referral and wait times.

Results:

Of 805 assessments, 55% were referred by emergency physicians and 28% by primary care physicians. Sixty-four percent of referrals were referred for suicidal behavior and depression and 19.6% for aggression. Eighty percent had a positive family psychiatric history and 59% were bullied. The most frequent psychiatrist assigned diagnosis was attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD). Almost a quarter did not require psychiatric follow-up. Referrals to an outpatient clinic and admission were reduced significantly. Greater suicidality was associated with being female, presence of bullying-victimization and substance abuse [χ2(1)=9.33, p=0.002].

Conclusion:

Suicidal behavior is the most common reason for urgent psychiatric consults. ADHD was the most frequent psychiatrist assigned diagnosis. Urgent psychiatric services can reduce admissions, referrals and wait times for hospital based clinics for low lethality, low intent suicidal behaviors and facilitate triage to community services.


Corresponding author: Nasreen Roberts, MBBS, MRCPsych (UK), FRCPC, Director Child and Adolescent Urgent Psychiatric Clinic, Queen’s University, 166 Brock Street Kingston, Ontario, Canada, Phone: +1 613 544-3400 Ext 3510, Fax: +1 613 544-4643

Acknowledgments

Part of the funding for this study was provided by the Southeastern Ontario Academic Medical Organization (SEAMO) Innovation Fund. Partial results of this study were presented at the 33rd Annual Canadian Academy of Child and Adolescent Psychiatry Conference, in Toronto, Ontario, 2014.

  1. Conflict of interest statement: The authors have no conflict of interest to declare.

References

1. World Health Organization. Caring for children and adolescents with mental disorders: setting WHO directions. Geneva: World Health Organization, 2003:27.Search in Google Scholar

2. Kirby MJ, Keon WJ. Out of the shadows at last: transforming mental health, mental illness and addiction services in Canada. Ottawa: Standing Senate Committee on Social Affairs, Science and Technology, 2006.Search in Google Scholar

3. Government of Canada. The human face of mental health and mental illness in Canada. 2006: Catalogue NO. HP5-19/2006E. Ottawa ON.Search in Google Scholar

4. US Department of Health and Human Services. Report of the Surgeon General’s Conference on Children’s Mental Health. Washington, DC: US Department of Health and Human Services; 2001.Search in Google Scholar

5. Newton A, Ali S, Johnson D, Haines C, Rosychuk R, et al. A 4-year review of pediatric mental health emergencies in Alberta. Can J Emerg Med 2009;11:447–54.10.1017/S1481803500011647Search in Google Scholar PubMed

6. Cuypers PJ, Danckaerts M, Sabbe M, Demyttenaere K, Bruffaerts R. The paediatric psychiatric emergency population in a university teaching hospital in Belgium (2003–2008). Eur J Emerg Med 2014;21:384–6.10.1097/MEJ.0000000000000096Search in Google Scholar PubMed

7. Goldstein A, Horwitz S. Child and adolescent psychiatric emergencies in nonsuicide-specific samples: the state of the research literature. Pediatr Emerg Care 2006;22:379–84.10.1097/01.pec.0000216565.26123.34Search in Google Scholar PubMed

8. Sills M, Bland S. Summary statistics for pediatric psychiatric visits to US emergency departments, 1993–1999. Pediatrics 2002;110:e40.10.1542/peds.110.4.e40Search in Google Scholar PubMed

9. Edelsohn G, Braitman L, Rabinovich H, Sheves P, Melendez A. Predictors of urgency in a pediatric psychiatric emergency service. J Am Acad Child Adolesc Psychiatry 2003;42:1197–202.10.1097/00004583-200310000-00010Search in Google Scholar PubMed

10. Chun TH, Katz ER, Duffy SJ. Pediatric mental health emergencies and special health care needs. Pediatr Clin North Am 2013;60:1185–201.10.1016/j.pcl.2013.06.006Search in Google Scholar PubMed PubMed Central

11. Cloutier P, Kennedy A, Maysenhoelder H, Glennie EJ, Cappelli M, et al. Pediatric mental health concerns in the emergency department. Pediatr Emerg Care 2010;26:99–106.10.1097/PEC.0b013e3181cdcae1Search in Google Scholar PubMed

12. Grupp-Phelan J, Mahajan P, Foltin GL. Referral and resource use patterns for psychiatric-related visits to pediatric emergency departments. Pediatr Emerg Care 2009;29:217–20.10.1097/PEC.0b013e31819e3523Search in Google Scholar

13. Kennedy A, Cloutier P, Glennie JE, Gray C. Establishing best practice in pediatric emergency mental health: a prospective study examining clinical characteristics. Pediatr Emerg Care 2009;25:380–6.10.1097/PEC.0b013e3181a79223Search in Google Scholar PubMed

14. Liu S, Ali S, Rosychuk RJ, Newton AS. Characteristics of children and youth who visit the emergency department for a behavioural disorder. J Can Acad Child Adolesc Psychiatry 2014;23:111–7.Search in Google Scholar PubMed

15. Soto EC, Frederickson AM, Trivedi H, Le A, Eugene MC, et al. Frequency and correlates of inappropriate pediatric psychiatric emergency room visits. J Clin Psychiatry 2009;70:1164–77.10.4088/JCP.08m04839Search in Google Scholar PubMed

16. Asarnow JR, Baraff LJ, Berk M, Grob CS, Devich-Navarro M, et al. An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatr Serv 2011;62:1303–9.10.1176/ps.62.11.pss6211_1303Search in Google Scholar PubMed

17. Grudnikoff E, Soto EC, Frederickson A, Bimbaum ML, Saito E, et al. Suicidality and hospitalization as cause and outcome of pediatric psychiatry emergency room visits. Eur Child Adolesc Psychiatry 2015;24:797–814.10.1007/s00787-014-0624-xSearch in Google Scholar PubMed

18. Parker KC, Roberts N, Williams C, Benjamin M, Cripps L, et al. Urgent adolescent psychiatric consultation: from the accident and emergency department to inpatient adolescent psychiatry. J Adolesc 2003;26:283–93.10.1016/S0140-1971(03)00014-9Search in Google Scholar PubMed

19. Lee J, Korczak D. Emergency physician referrals to the pediatric crisis clinic: reasons for referral, diagnosis and disposition. J Can Acad Child Adolesc Psychiatry 2010;19:297–302.Search in Google Scholar PubMed

20. Hamm MP, Osmond M, Curran J, Scott S, Ali S, et al. A systematic review of crisis interventions used in the emergency department: recommendations for pediatric care and research Pediatr Emerg Care 2010;26:952–62.10.1097/PEC.0b013e3181fe9211Search in Google Scholar PubMed PubMed Central

21. Newton AS, Ali S, Johnson DW, Haines C, Rosychuk RJ, et al. Who comes back? Characteristics and predictors of return to emergency department services for pediatric mental health care. Acad Emerg Med 2010;17:177–86.10.1111/j.1553-2712.2009.00633.xSearch in Google Scholar PubMed

22. Fremont WP, Nastasi R, Newman N, Roizen NJ. Comfort level of pediatricians and family physicians diagnosing and treating child and adolescent psychiatric disorders. Int J Psychiatry Med 2008;38:153–68.10.2190/PM.38.2.cSearch in Google Scholar PubMed

23. Breslow R, Erikson B, Cavanaugh K. The psychiatric emergency service: where we’ve been and where we’re going. Psychiatr Q 2000;71:101–21.10.1023/A:1004672202234Search in Google Scholar PubMed

24. Nadkarni A, Parkin A, Dogra N, Stretch D, Evans P. Characteristics of children and adolescents presenting to accident and emergency departments with deliberate self-harm. J Accid Emerg Med 2000;17:98–102.10.1136/emj.17.2.98Search in Google Scholar PubMed PubMed Central

25. Miller AR, Johnston C, Klassen AF, Fine S, Papsdorf M. Family physicians’ involvement and self-reported comfort and skill in care of children with behavioral and emotional problems: a population-based survey. BMC Fam Pract 2005;6:12.10.1186/1471-2296-6-12Search in Google Scholar PubMed PubMed Central

26. Steele M, Zayed R, Davidson B, Stretch N, Nadeau L, et al. Referral patterns and training needs in psychiatry among primary care physicians in Canadian Rural/Remote areas. J Can Acad Child Adolesc Psychiatry 2012;21:111–23.Search in Google Scholar PubMed

27. Goldstein A, Frosch E, Davarya S, Leaf P. Factors associated with a six-month return to emergency services among child and adolescent psychiatric patients. Psychiatr Serv 2007;58:1489–92.10.1176/ps.2007.58.11.1489Search in Google Scholar PubMed

Received: 2016-1-14
Accepted: 2016-3-12
Published Online: 2016-5-13

©2018 Walter de Gruyter GmbH, Berlin/Boston