Trends and clinical characteristics across the full spectrum of pediatric psychiatric emergency department visits

초록

Purpose: We analyzed annual trends and clinical characteristics across the full spectrum of pediatric psychiatric emergency department (ED) visits. Methods: This retrospective study included patients aged 18 years or younger who underwent psychiatric interview at the ED of Gyeongsang National University Hospital, Jinju, South Korea, from January 2013 through December 2023. The patients were classified as per their clinical presentations: suicide attempt (SA), non-suicidal self-harm (NSSH), suicidal ideation (SI), and other psychiatric problems (OPP). Annual trend was analyzed using the simple linear regression, while group characteristics were compared using the Kruskal-Wallis and chi-square tests. Results: Of 730 patients, 688 and 465 were included for the annual trend and comparative analyses, respectively. Over the 11-year period, their psychiatric ED visits increased (P <0.001), with the most prominent increase in the SA group. A median age was 16.0 years (interquartile range, 14.0–17.0), and 69.2% of the patients were female. Although female patients predominated in all groups, the predominance was more prominent in the SA and NSSH groups. Drug ingestion (60.0%) was the most common mechanism; cutting was more frequent in the NSSH group (SA, 21.7% vs. NSSH, 49.0%; P <0.001), while highly lethal methods were more frequent in the SA group (e.g., falls: 10.1% vs. 0%; P = 0.001). Regarding psychosocial stressors, family-related factors were highest in the SA and NSSH groups (P = 0.002), social/interpersonal (P = 0.026) and academic (P = 0.044) in the NSSH group, psychosocial trauma-related in the SI group (P = 0.005), and individual/psychiatric in the OPP group (P <0.001). A median ED length of stay and hospitalization rate were longest or highest in the SA group (all Ps <0.001). Conclusion: Pediatric psychiatric patients presenting to EDs represent a heterogeneous population, and tailored intervention strategies are needed for each clinical manifestation group.

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