Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Henry Puls, MD
Start Date
14-5-2025 12:30 PM
End Date
14-5-2025 12:45 PM
Presentation Type
Oral Presentation
Description
Background: Youth mental health emergency department visits are increasing and are a burden on the health care system. Prevalence of mental health disorders may be influenced by the neighborhood youths live in.
Objectives/Goal: Determine differences in rates of youth mental health ED visits across zip code levels of neighborhood opportunity.
Methods/Design: We performed a cross-sectional study using the Hospital Industry Data Institute dataset identifying ED visits with a primary mental health diagnosis in Kansas and Missouri for youths aged 5-19 years in 2022-2023. Mental health ED visits were then categorized at the zip code level by neighborhood opportunity using the Child Opportunity Index (COI) 3.0. Mental health diagnoses were identified using ICD-10 codes and categorized using the Child and Adolescent Mental Health Disorders classification system (CAMHD). Population data was acquired from the American Community Survey. Zip code rurality and health care accessibility was categorized by using the Rural-Urban Community Area (RUCA) and Primary Care/Mental Health Professional Shortage Area (HPSA). Our primary outcome was mental health ED visits per 1,000 youths aged 5-19 years and diagnoses across zip code levels of neighborhood opportunity. Poisson regression models determined differences in rates of youth mental health ED visits across COI 3.0 quintiles and calculated adjusted rate ratios in 95% confidence intervals (CI).
Results: Among 1.79 million youths aged 5-19 years there were 52,362 mental health ED visits, a majority of which were in Missouri (78.5%), at children’s hospitals (85.7%), female (57.5%) and aged 15-19 years (57.8%). The most common primary mental health diagnoses were suicide/self-injury (30.5%), depressive disorders (21.7%), anxiety disorders (9.0%), substance use disorders (8.4%), mental health symptoms (6.3%), and other (24.1%). Rates of mental health ED visits decreased in a stepwise fashion as COI increased from very low COI (17.0 [95% CI: 15.2, 19.0]) to very high COI (10.1 [95% CI: 9.0, 11.4]). Rates of mental health ED visits were inversely associated with COI quintiles for state, age, sex, RUCA, and behavioral health shortage areas (mental health and primary care). In adjusted modelling, rates of MH ED visits were 74% greater in zip codes with very low COI compared to zip codes with very high COI (p < 0.001, rate ratio 1.74 [95% CI: 1.54, 1.98]; table).
Conclusions: Rates of youth mental health ED visits in Kansas and Missouri are significantly higher in neighborhoods with low opportunity, demonstrating that identifying these areas is a critical step to combat the current youth mental health crisis.
Association between Neighborhood Opportunity and Youth Mental Health Emergency Department Visits
Background: Youth mental health emergency department visits are increasing and are a burden on the health care system. Prevalence of mental health disorders may be influenced by the neighborhood youths live in.
Objectives/Goal: Determine differences in rates of youth mental health ED visits across zip code levels of neighborhood opportunity.
Methods/Design: We performed a cross-sectional study using the Hospital Industry Data Institute dataset identifying ED visits with a primary mental health diagnosis in Kansas and Missouri for youths aged 5-19 years in 2022-2023. Mental health ED visits were then categorized at the zip code level by neighborhood opportunity using the Child Opportunity Index (COI) 3.0. Mental health diagnoses were identified using ICD-10 codes and categorized using the Child and Adolescent Mental Health Disorders classification system (CAMHD). Population data was acquired from the American Community Survey. Zip code rurality and health care accessibility was categorized by using the Rural-Urban Community Area (RUCA) and Primary Care/Mental Health Professional Shortage Area (HPSA). Our primary outcome was mental health ED visits per 1,000 youths aged 5-19 years and diagnoses across zip code levels of neighborhood opportunity. Poisson regression models determined differences in rates of youth mental health ED visits across COI 3.0 quintiles and calculated adjusted rate ratios in 95% confidence intervals (CI).
Results: Among 1.79 million youths aged 5-19 years there were 52,362 mental health ED visits, a majority of which were in Missouri (78.5%), at children’s hospitals (85.7%), female (57.5%) and aged 15-19 years (57.8%). The most common primary mental health diagnoses were suicide/self-injury (30.5%), depressive disorders (21.7%), anxiety disorders (9.0%), substance use disorders (8.4%), mental health symptoms (6.3%), and other (24.1%). Rates of mental health ED visits decreased in a stepwise fashion as COI increased from very low COI (17.0 [95% CI: 15.2, 19.0]) to very high COI (10.1 [95% CI: 9.0, 11.4]). Rates of mental health ED visits were inversely associated with COI quintiles for state, age, sex, RUCA, and behavioral health shortage areas (mental health and primary care). In adjusted modelling, rates of MH ED visits were 74% greater in zip codes with very low COI compared to zip codes with very high COI (p < 0.001, rate ratio 1.74 [95% CI: 1.54, 1.98]; table).
Conclusions: Rates of youth mental health ED visits in Kansas and Missouri are significantly higher in neighborhoods with low opportunity, demonstrating that identifying these areas is a critical step to combat the current youth mental health crisis.
