A Randomized Controlled Trial to Engage in Care of Adolescent Emergency Department Patients With Mental Health Problems That Increase Suicide Risk

Grupp‐Phelan, Jacqueline; McGuire, Leslie; Husky, Mathilde M.; Olfson, Mark

doi:10.1097/pec.0b013e3182767ac8

Cited by 44 publications

(80 citation statements)

References 30 publications

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“…In 5 of the 6 trials that demonstrated effective interventions, results were statistically conclusive 24,27,30,36,45 ; in the sixth, the significant effects observed within the first 2 weeks (OR, 2.38 [95% CI, 1.60-3.54]) were not sustained during the 6-month reporting period (OR, 0.86 [95% CI, 0.56-1.32]). 37 Strategies found to improve the rate of outpatient follow-up included structured telephone contact, postdischarge reminders, 24,30 assistance with scheduling an outpatient follow-up appointment during the ED visit, 27,45 and verbal/written instructions or education about the importance of outpatient follow-up. 27 One study involving patients with asthma also found that providing parents with documentation of their child's allergic status improved adherence to scheduled continuity appointments.…”

Section: Tablementioning

confidence: 96%

“…In most studies, the control group received routine care (n = 13). 26 -29, 31, 33, 34, 36 -38, 40, 43, 45 Three studies included an enhanced usual care: Teach et al 42 (usual care with an asthma educational packet), Asarnow et al 24 (usual care with ED staff trained on linking patients with outpatient care), and Grupp-Phelan et al 30 (usual care with standard referral).…”

Section: Controlmentioning

confidence: 99%

“…Age varied between 0 and 18 years (one study 34 did not mention the age range but specified the average age as 2.2 [SD, 2.8]). One-half of the selected studies (n = 8) included patients with asthma (or acute asthma) 28, 31, 36-38, 42, 43, 45 ; 2 studies focused on suicide attempts or suicide ideation 24,30 ; and 1 study focused on mental health problems. 29 The remaining studies lacked specificity in the clinical conditions: 3 described minor health concerns 26,27,40 ; 1 studied acute infections 33 ; and 1 did not specify the clinical condition that was considered.…”

Section: Populationmentioning

confidence: 99%

“…24,27,30,36,37,45 Three studies included patients with asthma, 2 included patients with mental health issues, and 1 involved patients with minor illnesses. Effect sizes varied between trials ranging from an OR of 1.20 to 9.63.…”

Section: Tablementioning

confidence: 99%

“…24, 27 -30, 37, 38, 42, 43, 45 Only 6 interventions supported all 3 functions of care continuity. 29,30,37,38,43,45 We also investigated the time of administration of the interventions (ie, during the visit, after the visit [eg, within 24-48 hours]). Interventions were administered during the ED visit in 3 studies 27,28,36 and after the ED visit in 3 others.…”

Section: Interventionmentioning

confidence: 99%

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Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review

Abraham¹,

Kannampallil²,

Caskey

et al. 2016

Pediatrics

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CONTEXT: Successful care transitions between emergency departments (EDs) and outpatient settings have implications for quality, safety, and cost of care. OBJECTIVE:To investigate the effectiveness of ED-based care transition interventions in achieving outpatient follow-up among pediatric patients.DATA SOURCES: Medline, Embase, CINAHL, Cochrane Library, trial registers, and reference lists of relevant articles. STUDY SELECTION AND DATA EXTRACTION:Eligible studies included randomized controlled trials of ED-based care transition interventions involving pediatric patients (aged ≤18 years). Study selection, data extraction, and risk of bias assessment were performed in duplicate and independent manner. Study results were pooled for meta-analysis by using a random effects model. RESULTS:Sixteen randomized controlled trials, comprising 3760 patients, were included in the study. Most interventions were single-site (n = 14), multicomponent (n = 12), and focused on patients with asthma (n = 8). Pooling data from 10 studies (n = 1965 patients) found moderate-quality evidence for a relative increase of 29% in outpatient follow-up with interventions compared with routine care (odds ratio, 1.58 [95% confidence interval, 1.08-2.31]). Successful interventions included structured telephone reminders, educational counseling on follow-up, and appointment scheduling assistance. There was low-quality evidence when pooling data from 5 studies (n = 1609 participants) that exhibited little or no beneficial effect of interventions on ED readmissions (risk ratio, 1.02 [95% confidence interval, 0.91-1.15]).LIMITATIONS: All studies were conducted in urban US hospitals which makes generalization of the results to rural settings and other countries difficult.CONCLUSIONS: ED-based care transition interventions are effective in increasing follow-up but do not seem to reduce ED readmissions. Further research is required to investigate the mechanisms that affect the success of these interventions.

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Section: Tablementioning

confidence: 96%

Section: Controlmentioning

confidence: 99%

Section: Populationmentioning

confidence: 99%

Section: Tablementioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

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Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review

Abraham¹,

Kannampallil²,

Caskey

et al. 2016

Pediatrics

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National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

Bommersbach

McKean

Olfson

et al. 2023

JAMA

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ImportanceThere has been increasing concern about the burden of mental health problems among youth, especially since the COVID-19 pandemic. Trends in mental health–related emergency department (ED) visits are an important indicator of unmet outpatient mental health needs.ObjectiveTo estimate annual trends in mental health–related ED visits among US children, adolescents, and young adults between 2011 and 2020.Design, Setting, and ParticipantsData from 2011 to 2020 in the National Hospital Ambulatory Medical Care Survey, an annual cross-sectional national probability sample survey of EDs, was used to examine mental health–related visits for youths aged 6 to 24 years (unweighted = 49 515).Main Outcomes and MeasuresMental health–related ED visits included visits associated with psychiatric or substance use disorders and were identified by International Classification of Diseases-Ninth Revision, Clinical Modification (ICD-9-CM; 2011-2015) and ICD-10-CM (2016-2020) discharge diagnosis codes or by reason-for-visit (RFV) codes. We estimated the annual proportion of mental health–related pediatric ED visits from 2011 to 2020. Subgroup analyses were performed by demographics and broad psychiatric diagnoses. Multivariable-adjusted logistic regression analyses estimated factors independently associated with mental health–related ED visits controlling for period effects.ResultsFrom 2011 to 2020, the weighted number of pediatric mental health–related visits increased from 4.8 million (7.7% of all pediatric ED visits) to 7.5 million (13.1% of all ED visits) with an average annual percent change of 8.0% (95% CI, 6.1%-10.1%; P &lt; .001). Significant linearly increasing trends were seen among children, adolescents, and young adults, with the greatest increase among adolescents and across sex and race and ethnicity. While all types of mental health–related visits significantly increased, suicide-related visits demonstrated the greatest increase from 0.9% to 4.2% of all pediatric ED visits (average annual percent change, 23.1% [95% CI, 19.0%-27.5%]; P &lt; .001).Conclusions and RelevanceOver the last 10 years, the proportion of pediatric ED visits for mental health reasons has approximately doubled, including a 5-fold increase in suicide-related visits. These findings underscore an urgent need to improve crisis and emergency mental health service capacity for young people, especially for children experiencing suicidal symptoms.

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Effect of a Motivational Interviewing–Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents

et al. 2019

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IMPORTANCE Emergency department (ED) visits present opportunities to identify and refer suicidal youth for outpatient mental health care, although this practice is not routine.OBJECTIVE To examine whether a motivational interviewing-based intervention increases linkage of adolescents to outpatient mental health services and reduces depression symptoms and suicidal ideation in adolescents seeking emergency care for non-mental health-related concerns who screen positive for suicide risk. DESIGN, SETTING, AND PARTICIPANTSIn this randomized clinical trial, adolescents aged 12 to 17 years who screened positive on the Ask Suicide Screening Questions (ASQ) during a nonpsychiatric ED visit at 2 academic pediatric EDs in Ohio were recruited from INTERVENTIONS The Suicidal Teens Accessing Treatment After an Emergency Department Visit (STAT-ED) intervention included motivational interviewing to target family engagement, problem solving, referral assistance, and limited case management. The enhanced usual care (EUC) intervention consisted of brief mental health care consultation and referral. MAIN OUTCOMES AND MEASURES Primary outcomes were mental health treatment initiation and attendance within 2 months of ED discharge and suicidal ideation (assessed by the Suicidal Ideation Questionnaire JR) and depression symptoms (assessed by the Center for Epidemiologic Studies-Depression scale) at 2 and 6 months. Exploratory outcomes included treatment initiation and attendance and suicide attempts at 6 months. RESULTS A total of 168 participants were randomized and 159 included in the intention-to-treatanalyses (mean [SD] age, 15.0 [1.5] years; 126 [79.2%] female; and 80 [50.3%] white). Seventy-nine participants were randomized to receive the STAT-ED intervention and 80 to receive EUC. At 2 months, youth in the STAT-ED group had similar rates of mental health treatment initiation compared with youth in the EUC group as assessed by parent report (29 [50.9%] vs 22 [34.9%]; adjusted odds ratio [OR], 2.08; 95% CI, 0.97-4.45) and administrative data from mental health care agencies (19 [29.7%] vs 11 [19.3%]; adjusted OR, 1.77; 95% CI, 0.76-4.15). At 2 months, youth in the STAT-ED group and the EUC group had similar rates of treatment attendance (1 appointment: 6 [9.7%] vs 2 [3.6%]; adjusted OR, 2.97; 95% CI, 0.56-15.73; Ն2 appointments: 10 [16.1%] vs 7 [12.7%]; adjusted OR, 1.43;95% CI, 0.50-4.11). There were no significant group × time differences in suicidal ideation (F = 0.28; P = .72) and depression symptoms (F = 0.49; P = .60) during the 6-month follow-up period. In (continued)

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A Randomized Controlled Trial to Engage in Care of Adolescent Emergency Department Patients With Mental Health Problems That Increase Suicide Risk

Abstract: When adolescents are identified in the ED with previously unrecognized mental health problems that increase suicide risk, a brief motivational and barrier-reducing intervention improves linkage to outpatient mental health services.

Cited by 44 publications

References 30 publications

Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review

Emergency Department-Based Care Transitions for Pediatric Patients: A Systematic Review

National Trends in Mental Health–Related Emergency Department Visits Among Youth, 2011-2020

Effect of a Motivational Interviewing–Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents

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