Returning to the emergency department: a retrospective analysis of mental health re-presentations among young people in New South Wales, Australia

Patricia Cullen; Robert Neil Leong; Bette Liu; Natasha Walker; Katharine Steinbeck; Rebecca Ivers; Michael Dinh

doi:10.1136/bmjopen-2021-057388

Returning to the emergency department: a retrospective analysis of mental health re-presentations among young people in New South Wales, Australia

BMJ Open. 2022 May 31;12(6):e057388. doi: 10.1136/bmjopen-2021-057388.

Authors

Patricia Cullen^{1

2

3}, Robert Neil Leong⁴, Bette Liu⁴, Natasha Walker⁴, Katharine Steinbeck^{5

6}, Rebecca Ivers^{4

3}, Michael Dinh^{7

8}

Affiliations

¹ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia patricia.cullen@unsw.edu.au.
² Ngarruwan Ngadju, First Peoples Health and Wellbeing Research Centre, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia.
³ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Discipline of Child and Adolescent Health, Faculty of Medicine and Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
⁶ Academic Department of Adolescent Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
⁷ NSW Institute of Trauma and Injury Management, NSW Agency for Clinical Innovation, Sydney, New South Wales, Australia.
⁸ Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.

Abstract

Objectives: This study aimed to describe mental health emergency department (ED) presentations among young people aged 8-26 years in New South Wales, Australia, and to identify key characteristics associated with higher risk of ED mental health re-presentation.

Design, setting and participants: Retrospective analysis of linked ED data records for mental health presentations between 1 January 2015 and 30 June 2018.

Main outcome measures: The main outcome was the total number of mental health ED re-presentations within 1 year, following initial presentation. Count regression models were fitted to estimate factors associated with higher likelihood of re-presentations.

Results: Forty thousand two hundred and ninety patients were included in the analyses, and 9713 (~25%) re-presented during the following year; 1831 (20%) presented at least three times. On average, patients re-presented 0.61 times per 365 person-days, with average time until first re-presentation of ~92 days but greatest risk of re-presentation within first 30-60 days. Young people with self-harm or suicidal diagnoses at initial presentation were more likely to re-present. Re-presentations were highest among young people <15 years (IRR 1.18 vs ≥20 years old), female (IRR=1.13 vs male), young people residing outside of major cities (IRR 1.08 vs major cities) and Aboriginal and Torres Strait Islander young people (IRR 1.27 vs non-Indigenous).

Conclusions: ED mental health re-presentation is high among young people. We demonstrate factors associated with re-presentation that EDs could target for timely, high-quality care that is youth friendly and culturally safe, with appropriate referral pathways into community-based primary and mental healthcare services.

Keywords: ACCIDENT & EMERGENCY MEDICINE; Child & adolescent psychiatry; MENTAL HEALTH; PAEDIATRICS; Paediatric A&E and ambulatory care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Australia
Emergency Service, Hospital*
Female
Humans
Male
Mental Health*
New South Wales / epidemiology
Retrospective Studies
Young Adult