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 to 18 years old with an
emergency department (ED) or hospital admission between 2017 and 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 nonrandom geographic clusters
and outliers of high utilization. Census tract utilization rates were stratified into
quartiles, and socioeconomic and demographic characteristics obtained from the US
Census Bureau were compared using analysis of variance, 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 to 428.6 per 1000 children. High utilization clusters localized
to neighborhoods with lower socioeconomic status (p < .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 MH equity.
Keywords
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Article info
Publication history
Published online: August 05, 2022
Accepted:
July 31,
2022
Received:
February 21,
2022
Footnotes
The authors have no conflicts of interest relevant to this article to disclose.
Identification
Copyright
Copyright © 2022 by Academic Pediatric Association
