Table 1. Patient Demographics and Factors Associated With Mental Health Emergency Department Revisits Within 6 Months of the Index Visit.
| Characteristic | No. (%) | HR (95% CI) | ||
|---|---|---|---|---|
| All patients (N = 217 865) | Patients with revisits (n = 28 716 [13.2%]) | |||
| Predisposing factors | ||||
| Age group, y | ||||
| 3-7 | 16 041 (7.4) | 1940 (6.8) | 1 [Reference] | |
| 8-12 | 64 601 (29.7) | 9655 (33.6) | 1.27 (1.21-1.33) | |
| 13-17 | 137 223 (63.0) | 17 121 (59.6) | 1.04 (0.99-1.09) | |
| Sex | ||||
| Female | 121 922 (56.0) | 15 980 (55.6) | 1 [Reference] | |
| Male | 95 943 (44.0) | 12 736 (44.4) | 0.93 (0.91-0.96) | |
| Race and ethnicity | ||||
| Asian American | 3533 (1.6) | 432 (1.5) | 0.89 (0.81-0.98) | |
| Hispanic | 37 705 (17.3) | 4322 (15.1) | 0.88 (0.85-0.92) | |
| Non-Hispanic Black | 48 595 (22.3) | 6960 (24.2) | 1.02 (0.98-1.05) | |
| Non-Hispanic White | 109 862 (50.4) | 14 562 (50.7) | 1 [Reference] | |
| Othera | 18 170 (8.3) | 2440 (8.5) | 0.93 (0.89-0.98) | |
| Enabling factors | ||||
| Insurance type | ||||
| Public | 109 537 (50.3) | 16 024 (55.8) | 1 [Reference] | |
| Private | 92 741 (42.6) | 11 247 (39.2) | 0.81 (0.78-0.83) | |
| Other | 15 587 (7.2) | 1445 (5.0) | 0.79 (0.74-0.83) | |
| Child Opportunity Index | ||||
| Very low | 52 798 (24.2) | 7196 (25.1) | 1 [Reference] | |
| Low | 37 637 (17.3) | 4473 (15.6) | 1.00 (0.96-1.04) | |
| Moderate | 39 621 (18.2) | 5181 (18.0) | 1.06 (1.02-1.11) | |
| High | 38 512 (17.7) | 4968 (17.3) | 1.06 (1.02-1.11) | |
| Very high | 49 297 (22.6) | 6898 (24.0) | 1.08 (1.03-1.12) | |
| Urbanicity | ||||
| Urban | 183 872 (84.4) | 25 165 (87.6) | 1 [Reference] | |
| Suburban | 18 352 (8.4) | 2136 (7.4) | 1.03 (0.98-1.08) | |
| Rural | 15 641 (7.2) | 1415 (4.9) | 0.85 (0.79-0.90) | |
| Distance quartile | ||||
| First (closest) | 55 323 (25.4) | 8556 (29.8) | 1 [Reference] | |
| Second | 54 309 (24.9) | 7722 (26.9) | 0.91 (0.88-0.94) | |
| Third | 53 798 (24.7) | 6932 (24.1) | 0.78 (0.75-0.81) | |
| Fourth (farthest) | 54 435 (25.0) | 5506 (19.2) | 0.63 (0.60-0.66) | |
| Child psychiatrists per 10 000 children, median (IQR) | 1.51 (0.93-2.41) | 1.59 (1.26-2.93) | 1.00 (0.89-1.13) | |
| Child psychologists per 10 000 children, median (IQR) | 1.58 (1.23-2.93) | 1.76 (1.11-3.15) | 1.09 (0.97-1.22) | |
| Need factors | ||||
| Mental health diagnosis group | ||||
| Suicidal ideation or self-harm | 62 432 (28.7) | 6918 (24.1) | 1 [Reference] | |
| Disorders | ||||
| Mood | 51 170 (23.5) | 8100 (28.2) | 1.16 (1.12-1.20) | |
| Anxiety | 22 585 (10.4) | 2242 (7.8) | 0.95 (0.90-1.00) | |
| Disruptive or impulse control | 21 167 (9.7) | 3640 (12.7) | 1.36 (1.30-1.42) | |
| Trauma | 11 604 (5.3) | 1618 (5.6) | 1.03 (0.98-1.09) | |
| Neurodevelopmental | 8416 (3.9) | 1299 (4.5) | 1.22 (1.14-1.30) | |
| Substance use | 7750 (3.6) | 459 (1.6) | 0.60 (0.55-0.66) | |
| Somatic symptom | 3686 (1.7) | 393 (1.4) | 1.04 (0.94-1.15) | |
| Eating | 3308 (1.5) | 424 (1.5) | 1.18 (1.06-1.30) | |
| Psychotic | 2283 (1.0) | 435 (1.5) | 1.42 (1.29-1.57) | |
| Other | 23 464 (10.8) | 3188 (11.1) | 1.25 (1.19-1.31) | |
| Multiple psychiatric comorbidities | ||||
| No | 143 635 (65.9) | 16 025 (55.8) | 1 [Reference] | |
| Yes | 74 230 (34.1) | 12 691 (44.2) | 1.34 (1.30-1.38) | |
| Complex chronic condition | ||||
| No | 206 071 (94.6) | 27 220 (94.8) | 1 [Reference] | |
| Yes | 11 794 (5.4) | 1496 (5.2) | 0.96 (0.91-1.02) | |
| Disposition | ||||
| Discharged | 126 725 (58.2) | 14 566 (50.7) | 1 [Reference] | |
| Admitted | 61 584 (28.3) | 10 005 (34.8) | 1.29 (1.25-1.34) | |
| Transferred | 29 556 (13.6) | 4145 (14.4) | 1.40 (1.34-1.45) | |
| Intensive care unit stay | ||||
| No | 215 210 (98.8) | 28 508 (99.3) | 1 [Reference] | |
| Yes | 2655 (1.2) | 208 (0.7) | 0.61 (0.53-0.70) | |
| Chemical restraint use | ||||
| No | 210 088 (96.4) | 27 590 (96.1) | 1 [Reference] | |
| Yes | 7777 (3.6) | 1126 (3.9) | 1.22 (1.15-1.30) | |
| Day of presentation | ||||
| Weekday | 179 974 (82.6) | 23 891 (83.2) | 1 [Reference] | |
| Weekend | 37 891 (17.4) | 4825 (16.8) | 1.01 (0.98-1.05) | |
| Hour of presentation | ||||
| 8 am-4 pm | 88 021 (40.4) | 11 412 (39.7) | 1 [Reference] | |
| 4 pm-12 am | 104 579 (48.0) | 14 266 (49.7) | 1.05 (1.02-1.08) | |
| 12 am-8 am | 25 265 (11.6) | 3038 (10.6) | 0.96 (0.92-1.01) | |
| Inpatient psychiatric unit | ||||
| No | 75 767 (34.8) | 7869 (27.4) | 1 [Reference] | |
| Yes | 142 098 (65.2) | 20 847 (72.6) | 1.59 (1.29-1.96) | |
Abbreviation: HR, hazard ratio.
a
Other included non-Hispanic patients who were American Indian, Pacific Islander, multiple, or other races.