Emergency health care use and follow-up among sociodemographic groups of children who visit emergency departments for mental health crises

摘要

Background: Previous studies of differences in mental health care associated with children's sociodemographic status have focused on access to community care. We examined differences associated with visits to the emergency department.Methods: We conducted a 6-year population-based cohort analysis using administrative databases of visits (n = 30 656) by children aged less than 18 years (n = 20 956) in Alberta. We measured differences in the number of visits by socioeconomic and First Nations status using directly standardized rates. We examined time to return to the emergency department using a Cox regression model, and we evaluated time to follow-up with a physician by physician type using a competing risks model.Results: First Nations children aged 15-17 years had the highest rate of visits for girls (7047 per 100 000 children) and boys (5787 per 100 000 children); children in the same age group from families not receiving government subsidy had the lowest rates (girls: 2155 per 100 000 children; boys: 1323 per 100 000 children). First Nations children (hazard ratio [HR] 1.64; 95% confidence interval [Cl] 1.30-2.05), and children from families receiving government subsidies (HR 1.60, 95% Cl 1.30-1.98) had a higher risk of return to an emergency department for mental health care than other children. The longest median time to follow-up with a physician was among First Nations children (79 d; 95% Cl 60-91 d); this status predicted longer time to a psychiatrist (HR 0.47, 95% Cl 0.32-0.70). Age, sex, diagnosis and clinical acuity also explained post-crisis use of health care.Interpretation: More visits to the emergency department for mental health crises were made by First Nations children and children from families receiving a subsidy. Sociodemo-graphics predicted risk of return to the emergency department and follow-up care with a physician.