Child Opportunity Index and Youth Mental Health Emergency Department Visits

Youth mental health (MH) emergency department (ED) visits are increasing. Neighborhood opportunity may influence the prevalence of youth MH disorders and how frequently they seek MH care in an ED.

To determine differences in rates of youth MH ED visits across zip code levels of neighborhood opportunity.

This was a retrospective population-based cross-sectional study using the Hospital Industry Data Institute dataset, which provided all ED visit encounters that occurred at 254 nonpsychiatric acute care hospitals in Kansas and Missouri during federal fiscal years 2022 and 2023. Participants included youth aged 5 to 19 years in Kansas and Missouri. The American Community Survey provided population data. These data were analyzed from January to February 2024.

The primary exposure was zip code-level neighborhood opportunity, measured by the Child Opportunity Index 3.0 (COI), which is categorized into 5 levels for analysis and presentation. Covariates included state, rural and urban commuting areas, health professional shortage areas, age, sex, and year.

Annual rates of ED visits with a primary MH diagnosis per 1000 youth. A multivariable Poisson regression model calculated adjusted rate ratios (aRR) and 95% CI after adjustment for covariates.

There were 52 362 MH ED visits among 1.79 million youth (57.5% female and 42.5% male) aged 5 to 19 years in Kansas and Missouri. Most of the visits occurred in Missouri (78.5%), in female patients (57.5%), in youth aged 15 to 19 years (57.8%), and in youth living in urban areas (69.5%). Rates of MH ED visits per 1000 youth decreased significantly as COI increased from 17.0 in zip codes with very low COI to 10.1 in zip codes with very high COI (17.0; 95% CI, 15.2-19.0; P < .001). In adjusted modeling, rates of MH ED visits were 1.74 times higher (95% CI, 1.54-1.98) in zip codes with very low COI relative to zip codes with very high COI (10.1; 95% CI, 9.0-11.4; P < .001).

In this study, youth living in lower opportunity zip codes had significantly greater rates of MH ED visits compared with youth in higher opportunity zip codes. Further investigation is necessary to examine causal mechanisms and to determine where additional resources should be directed to optimize youth MH well-being.