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

Published:March 06, 2015DOI:https://doi.org/10.1016/j.ajem.2015.02.055

      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.

      Abstract

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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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      References

      1. Committee on Pathophysiology and Prevention of Adolescent and Adult Suicide (Bunnry W, Kleinman A, Bell C, et al.). Institute of Medicine report: reducing suicide: a national imperative. Washington DC: National Academic Press; 2002.

        • CDC
        Suicide prevention: youth suicide.
        (Available at) ([(updated 2014). Accessed December 7, 2014])
        • The Committee on Pediatric Emergency Medicine
        Pediatric and adolescent mental health emergencies in the emergency medical services system.
        Pediatrics. 2011; 127: e1356-e1366
        • Murray C.L.J.
        • Lopez A.D.
        The global burden of disease: a comprehensive assessment of mortality and disability diseases, injuries, and risk factors in 1990 and projected to 2020.
        Harvard School of Public Health, on behalf of the World Health Organization and the World Bank, Distributed by Harvard University Press, Cambridge, MA2003
        • Santucci K.
        • Sather J.
        • Douglas M.
        Psychiatry-related visits to the pediatric emergency department: a growing epidemic?.
        Pediatr Res. 2000; 47: 117A
        • Cincinnati Children’s Hospital Medical
        Health news release.
        (Available at) ([(November 26, 2001). Accessed December 7, 2014])
        • ACEP
        Psychiatric patients, including children, routinely boarded in emergency departments.
        (Available at) ([Accessed December 7, 2014])
        • Ganz D.
        • Sher L.
        Adolescent suicide in New York City: plenty of room for new research.
        Int J Adolesc Med Health. 2012; 24: 99-104
      2. Los Angeles unified school district: district school calendars.
        (Available at) ([Accessed December 7, 2014])
      3. Substance Abuse and Mental Health Services Administration (SAMHSA) by the National Association of State Mental Health Program Directors (NASMHPD). Preventing suicide: a toolkit. Available at: http://store.samhsa.gov/shin/content//SMA12-4669/SMA12-4669.pdf (created 2012). Accessed December 7, 2014

        • Robinson J.
        • Pan Yuen H.
        • Martin C.
        • Hughes A.
        • Baksheev G.N.
        • Dodd S.
        • et al.
        Does screening high school students for psychological distress, deliberate self-harm, or suicidal ideation cause distress—and is it acceptable? An Australian-based study.
        Crisis. 2011; 32: 254-263
        • Bernert R.A.
        • Hom M.A.
        • Roberts L.W.
        A review of multidisciplinary clinical practice guidelines in suicide prevention: toward an emerging standard in suicide risk assessment and management, training and practice.
        Acad Psychiatry. 2014; 38: 585-592
        • Dinkes R.
        • Kemp J.
        • Baum K.
        • Snyder T.D.
        Indicators of school crime and safety: 2009 (NCES 2010-012/NCJ 228478). National Center for Education Statistics, Institute of Education Sciences, U.S. Department of Education, and Bureau of Justice Statistics, Office of Justice Programs, U.S. Department of Justice, Washington, DC2009 ([Available at http://nces.ed.gov/pubs2010/2010012.pdf (2009). Accessed December 7, 2014])
        • Kim Y.S.
        • Leventhal B.L.
        • Koh Y.J.
        • Boyce W.T.
        Bullying increased suicide risk: prospective study of Korean adolescents.
        Arch Suicide Res. 2009; 13: 15-30
        • Vossekuil B.
        • Fein R.
        • Reddy M.
        • Borum R.
        • Modzeleski W.
        The final report and findings of the Safe School Initiative: implications for the prevention of school attacks in the United States.
        (Available at) ([(created 2002). Accessed December 7, 2014])
        • Eaton D.K.
        • Kann L.
        • Kinchen S.
        • Shanklin S.
        • Ross J.
        • Hawkins J.
        • et al.
        Youth risk behavior surveillance—United States.
        (Available at) ([(published 2010). Accessed December 7, 2014])
        • Young R.
        • Sweeting H.
        • Ellaway A.
        Do schools differ in suicide risk? The influence of school and neighborhood on attempted suicide, suicidal ideation and self-harm among secondary school pupils.
        BMC Public Health. 2011; 11: 874-889
        • Zakharov S.
        • Navratil T.
        • Pelclova D.
        Non-fatal suicidal self-poisonings in children and adolescents over a 5-year period (2007-2011).
        Basic Clin Pharmacol Toxicol. 2013; 112: 425-430
        • Salmerón D.
        • Cirera L.
        • Ballesta M.
        • Navarro-Mateu F.
        Time trends and geographical variations in mortality due to suicide and causes of undetermined intent in Spain, 1991-2008.
        J Public Health (Oxf). 2013; 35: 237-245
        • Sun J.
        • Guo X.
        • Ma J.
        • Zhang J.
        • Jia C.
        • Xu A.
        Seasonality of suicide in Shandong China, 1991-2009: associations with gender, age, area and methods of suicide.
        J Affect Disord. 2011; 135: 258-266
        • Elder L.
        Where do public school teachers send their own kids.
        (Available at) ([Accessed December 7, 2014])