Repeat Psychiatric Emergency Services Utilization Among Youths Across Emergency Department and Alternative Settings

This study aimed to identify factors associated with repeat use of psychiatric emergency services (PES) in emergency department (ED) and alternative settings. Specific outcomes were any repeat visit within 180 days, a subsequent visit to an ED, and total repeat visits in any setting within 180 days.

The authors conducted a retrospective chart review of electronic medical records at an urban PES program between 2017 and 2022. The sample included youths who were new patients in the program, ages <18 years, and either publicly insured or uninsured. Binary logistic regression and zero-inflated Poisson models were used to determine the associations between sociodemographic and clinical predictors and repeat utilization outcomes.

The sample comprised 6,522 youths (mean age=12.4 years, >65% persons of color). Over one-quarter of youths had a repeat visit within 180 days of their initial encounter. Adolescents were less likely to have repeat visits than were children ages 7-12 years. School referral was associated with fewer total repeat visits and decreased odds of repeat visits among youths with a non-ED initial encounter. Among youths initially evaluated in EDs, inpatient admission was associated with decreased odds of repeat visits and fewer total repeat visits. Among youths with any repeat visit, inpatient admission significantly predicted a repeat visit to EDs.

The reasons for repeat use of PES are complex and may reflect local characteristics. Proactive case management or care navigation for patients may be helpful to ensure that children and families access necessary mental health care after use of emergency services.