Abstract
Objective
To identify locations with higher need for acute pediatric mental health (MH) interventions
or services and describe these communities’ socio-demographic characteristics.
Methods
This single-center retrospective study included patients 5-18 years old with an Emergency
Department (ED) or hospital admission between 2017-2019 for a primary known MH diagnosis
or symptoms. We extracted visit data from the electronic medical record, mapped patients
to their home census tract, calculated normalized visit rates by census tract, and
performed spatial analysis to identify non-random geographic clusters and outliers
of high utilization. Census tract utilization rates were stratified into quartiles,
and socioeconomic and demographic characteristics obtained from the U.S. Census Bureau
were compared using ANOVA, Chi-square tests, and multivariable analysis.
Results
There were 10,866 qualifying visits across 617 census tracts. ED and hospital admission
rates ranged from 2.7 – 428.6 per 1000 children. High utilization clusters localized
to neighborhoods with lower socioeconomic status (p<0.05). Southern regions with high
utilizers were more likely to have fewer children per neighborhood, higher rates of
teen births, and lower socioeconomic status. Multivariate analysis showed regions
with high utilizers had fewer children per neighborhood, lower median household income,
and more families that lacked computer access.
Conclusion
ED and hospital utilization for pediatric MH concerns varied significantly by neighborhood
and demographics. Divergent social factors map onto these locations and are related
to MH utilization. Leveraging geography can be a powerful tool in the development
of targeted, culturally-tailored interventions to decrease acute pediatric MH utilization
and advance child mental health equity.
Keywords
Abbreviations:
MH (mental health), ED (emergency department), ICD-10 (International Classification of Diseases, Tenth Edition), EMR (electronic medical record), IQR (interquartile range), FPL (federal poverty level), SDoH (social determinants of health), RCHSD (Rady Children's Hospital, San Diego (RCHSD))To read this article in full you will need to make a payment
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Article Info
Publication History
Accepted:
July 31,
2022
Received:
February 21,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of Academic Pediatric Association
