Leon Stephanie L, Polihronis Christine, Cloutier Paula, Zemek Roger, Newton Amanda S, Gray Clare, Cappelli Mario
Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario.
University of Ottawa, Faculty of Social Sciences, School of Psychology, Ottawa, Ontario.
J Can Acad Child Adolesc Psychiatry. 2019 Apr;28(1):9-20. Epub 2019 Mar 1.
Approximately 45% of youth presenting to the emergency department (ED) for mental health (MH) concerns will have a repeat ED visit. Since youth greatly depend on their caregivers to access MH services, the objective of this study was to determine if family characteristics were associated with repeat ED visits.
A retrospective cohort study of youth aged 6-18 years (62% female) treated at a tertiary pediatric ED for a discharge diagnosis related to MH was conducted. Data were gathered from medical records, telephone interviews, and questionnaires. Family factor contribution was analyzed using a multivariable logistic regression model controlling for demographic, clinical and service utilization factors. Variables associated with earlier and more frequent visits were determined using cox regression and negative binomial regression.
Of 266 participants, 70 (26%) had a repeat visit. While caregiver history of MH treatment decreased the odds of having a repeat ED visit, family functioning and perceived family burden were not associated with repeat visits. Post-visit MH services, prior psychiatric hospitalization, higher severity of symptoms, and living closer to the hospital increased the odds of repeat visits.
This study examined the contribution of multiple family factors in predicting repeat MH visits to the ED. Results suggest caregiver characteristics may impact the decision to return. Healthcare providers should therefore consider caregiver and youth service utilization factors to inform patient management and discharge planning.
因心理健康问题前往急诊科就诊的青少年中,约45%会再次前往急诊科。由于青少年在很大程度上依赖其照顾者来获得心理健康服务,本研究的目的是确定家庭特征是否与再次前往急诊科就诊有关。
对在一家三级儿科急诊科接受治疗且出院诊断与心理健康相关的6至18岁青少年(62%为女性)进行了一项回顾性队列研究。数据通过病历、电话访谈和问卷调查收集。使用多变量逻辑回归模型分析家庭因素的影响,该模型控制了人口统计学、临床和服务利用因素。使用Cox回归和负二项回归确定与更早和更频繁就诊相关的变量。
在266名参与者中,70人(26%)再次就诊。虽然照顾者的心理健康治疗史降低了再次前往急诊科就诊的几率,但家庭功能和感知到的家庭负担与再次就诊无关。就诊后的心理健康服务、既往精神科住院治疗、症状严重程度较高以及住得离医院较近增加了再次就诊的几率。
本研究探讨了多种家庭因素在预测再次前往急诊科进行心理健康就诊方面的作用。结果表明照顾者特征可能会影响复诊决定。因此,医疗服务提供者应考虑照顾者和青少年的服务利用因素,为患者管理和出院计划提供参考。