Predictors of Hospitalization After an Emergency Department Visit for California Youths With Psychiatric Disorders

Objective:

This study examined patient, hospital, and county characteristics associated with hospitalization after emergency department visits for pediatric mental health problems.

Methods:

Retrospective analysis of emergency department encounters (N=324,997) of youths age five years to 17 years with psychiatric diagnoses was conducted with 2005–2009 California Office of Statewide Health Planning and Development emergency department statewide data.

Results:

For youths with any psychiatric diagnosis, 23.4% of emergency department encounters resulted in hospitalization. In these cases, hospitalization largely was predicted by clinical need. Nonclinical factors that decreased the likelihood of hospitalization included demographic characteristics (such as younger age, lack of insurance, and rural residence) and resource characteristics (private hospital ownership, lack of psychiatric consultation in the emergency department, and lack of pediatric psychiatric beds). For youths with a significant psychiatric diagnosis plus a suicide attempt, 53.8% of emergency department encounters resulted in hospitalization. In these presumably more life-threatening cases, nonclinical factors that decreased the likelihood of hospitalization persisted: demographic characteristics (lack of insurance and rural residence) and resource characteristics (public hospital ownership, lack of psychiatric consultation, and lack of pediatric psychiatric beds).

Conclusions:

Mental health service delivery can improve only by addressing nonclinical demographic and resource obstacles that independently decrease the likelihood of hospitalization after an emergency department visit for a mental health issue; this is true even for the most severely ill youths—those with a suicide attempt as well as a serious psychiatric diagnosis. (Psychiatric Services 63:896–905, 2012; doi: 10.1176/appi.ps.201000482)