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Geographic Variation in Acute Pediatric Mental Health Utilization

Published:August 05, 2022DOI:https://doi.org/10.1016/j.acap.2022.07.026

      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))
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