Do emergency pediatric psychiatric visits for danger to self or others correspond to times of school attendance?

Published:March 06, 2015DOI:

      Key practitioner message

      • Adolescents experience school-related threats to mental health, including bullying, academic stress, and a sense of community disengagement.
      • In our population, there was a significant increase in patients presenting to the emergency department as a danger to self or others.
      • This may have implications, on a hospital level, for staffing and, on a community level, for school-based interventions.



      Pediatric and adolescent mental health complaints are growing problems for emergency departments and inpatient facilities. We sought to investigate the relationship between weeks when school is in session (vs vacation) and presentation with concern for danger to self or others.


      We retrospectively studied the risk of presenting with these complaints while school is in attendance compared to the risk while on vacation over a 4-year period (2009-2012) at an academic pediatric emergency department. The week of presentation was recorded for all children making psychiatric visits related to suicidality or homicidality, and these were correlated with the public school calendar for the local school district. The incidence rate ratio (IRR) was calculated for psychiatric visits while in school status vs vacation. Similar data were collected for a diagnosis of urinary tract infection to serve as a control.


      Of 3223 eligible patients (mean age, 13.8 years), 82.7% presented while in school, although the students only spent 68.6% of their time in school, yielding an IRR of 2.18. By comparison, the IRR for the diagnosis of urinary tract infection was 1.25.


      Children and adolescents are more likely to present with concerns for danger to self or others while attending school compared with while on vacations. Causation and opportunities for intervention require further study.
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