Mental health-related emergency department presentations and hospital admissions in a cohort of urban Aboriginal children and adolescents in New South Wales, Australia: findings from SEARCH

Abstract

ObjectivesThe aim of the current study is to quantify mental health-related emergency department (ED) presentations and hospitalisations, and associated child and family characteristics, in children recruited through four Aboriginal Community Controlled Health Organisations.SettingFour Aboriginal Community Controlled Health Services that deliver primary care. All services were located in urban or large regional centres in New South Wales, Australia.Participants1476 Aboriginal children aged 0–17 years at recruitment to the Study of Environment on Aboriginal Resilience and Child Health.Primary outcome measuresED presentations and hospital admissions with a primary mental health diagnosis obtained via linkage to population health datasets.ResultsOver a median of 6-year follow-up, there were 96 ED presentations affecting 62 children (10.7/1000 person-years) and 49 hospitalisations affecting 34 children (5.5/1000 person-years) for mental health conditions. Presentations/admissions increased with age. ED presentation was increased with: living in foster versus parental care (adjusted rate ratio (RR)=3.97, 95% CrI 1.26 to 11.80); high versus low baseline child emotional/behavioural problems (adjusted RR=2.93, 95% CrI 1.50 to 6.10); and caregiver chronic health conditions versus none (adjusted RR=2.81, 95% CrI 1.31 to 6.63). Hospitalisations were significantly increased with caregiver unemployment versus home duties (adjusted RR=4.48, 95% CrI 1.26 to 17.94) and caregiver chronic health problems versus none (adjusted RR=3.83, 95% CrI 1.33 to 12.12).ConclusionsTertiary care for mental health issues was relatively common among participating Aboriginal children, with risk elevated for those living in foster care, with prior mental health and behavioural problems and with carers with chronic illness and/or unemployment. While this study suggests high rates of serious mental health events among children from participating communities, the optimum means for reducing these rates, and the need for tertiary care, has not yet been determined. Such information is urgently required to inform policy and programmes to support Aboriginal child and adolescent mental health.

Exploring pathways to mental healthcare for urban Aboriginal young people: a qualitative interview study

“…The centrepiece of the programme is the SEARCH cohort study, which is the largest cohort study of urban Aboriginal children in Australia 45. The current qualitative study on mental healthcare pathways was initiated in response to findings from the SEARCH cohort study which showed high rates of Aboriginal young people at risk for emotional and behaviour problems,4 data linkage work which illustrated high rates of mental health-related hospitalisation for Aboriginal young people for mental health problems30 and qualitative data highlighting community concerns around mental health 27. As most research published thus far has examined general Aboriginal child and adolescent mental health, for this paper, mental health problems will be defined broadly as behavioural or emotional problems or associated impairment.…”

“…The last 5 years has seen an increase in funding for mental health services and programmes for Aboriginal people 29. However, recent data show Aboriginal young people being hospitalised for mental health events at a significantly higher rate than the general population,30 and rates of suicide among young Aboriginal people remain high 31. While there are systematic reviews of Indigenous mental health programmes available internationally,32 in the Australian context, the small amount of published work that exists has largely been descriptive 33.…”

Psychopathology in the Offspring of Indigenous Parents with Mental Health Challenges: A Systematic Review: Psychopathologie des descendants de parents autochtones ayant des problèmes de santé mentale: Une revue systématique

“…[40][41][42] In 2 studies, participants were recruited from health services that specifically provided care to Indigenous groups. 43,44 In the remaining 2 studies, parental Indigeneity was determined through offspring self-identification. 33,45 Tables 1, 2, and 3 contain descriptions of included studies, categorized by parental mental health challenge (i.e., poor parental mental health [broadly defined], parental substance misuse, and maternal internalizing issues and arranged in ascending order of offspring age [youngest to oldest] with studies containing non-Indigenous comparison groups being listed first).…”

“…Seven studies were conducted in the United States, 32,[34][35][36][37][38]42 and 2 each in Taiwan, 33,45 New Zealand, 40,41 and Australia. 43,44 One included Indigenous groups from Canada and the United States. 39 Five studies included measurements of both maternal and paternal mental health, 32,33,[36][37][38] 6 of maternal mental health only, 34,35,[39][40][41][42] and 3 studies did not specify whether parental mental health was that of mothers, fathers, or both.…”

“…39 Five studies included measurements of both maternal and paternal mental health, 32,33,[36][37][38] 6 of maternal mental health only, 34,35,[39][40][41][42] and 3 studies did not specify whether parental mental health was that of mothers, fathers, or both. [43][44][45] The most common parental mental health problem examined was substance misuse (n ¼ 8) including alcohol use by !1 parent(s), 33,[36][37][38]45 maternal drug use, 34,35,39 and La Revue Canadienne de Psychiatrie 66 (6) maternal alcohol use. 34,35 Five studies included assessments of maternal internalizing issues, with maternal depression being measured in 4, 35,[40][41][42] and maternal depressive episodes, dysthymic disorder, or generalized anxiety disorder in the other.…”