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Outcome of pediatric emergency mental health visits: incidence and timing of suicide

  • Joshua Lee (a1), Tyler Black (a2), Garth Meckler (a3) and Quynh Doan

Abstract

Objectives

To determine the incidence, risk, and timing of mortality (unnatural and natural causes) among youth seen in a pediatric emergency department (ED) for mental health concerns, compared with matched non–mental health ED controls.

Methods

This was a retrospective cohort study conducted at a quaternary pediatric ED in British Columbia. All visits for a mental health related condition between July 1st, 2005, and June 30th, 2015, were matched on age, sex, triage acuity, socioeconomic status, and year of visit to a non–mental health control visit. Mortality outcomes were obtained from vital statistics data through December 31st, 2016 (cumulative follow-up 74,390 person-years).

Results

Among all cases in our study, including 6,210 youth seen for mental health concerns and 6,210 matched controls, a total of 13 died of suicide (7.5/100,000 person-years) and 33 died of suicide or indeterminate causes (44/100,000 person-years). All-cause mortality was significantly lower among mental health presentations (121.3/100,000 v. 214.5/100,000 person-years; hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.37–0.78). The median time from initial emergency visit to suicide was 5.2 years (interquartile range, 4.2–7.3). Among mental health related visits, risk of death by suicide or indeterminate cause was three-fold that of matched controls (HR, 3.05 95%CI, 1.37–6.77).

Conclusions

While youth seeking emergency mental health care are at increased risk of death by unnatural causes, their overall mortality risk is lower than non–mental health controls. The protracted duration from initial presentation to suicide highlights the need for long-term surveillance and preventative care for youth seen in the ED for all mental health concerns.

RésuméObjectif

L’étude visait à déterminer trois éléments statistiques liés à la mortalité (par cause naturelle ou non naturelle), soit l'incidence, le risque et le moment, chez des jeunes ayant consulté à un service des urgences pédiatriques (SUP) pour des troubles mentaux par rapport à des témoins appariés exempts de troubles mentaux ayant été examinés au SUP.

Méthode

Il s'agit d'une étude de cohortes rétrospective, menée dans un SUP de soins quaternaires, en Colombie-Britannique. Tous les patients ciblés ayant consulté pour des troubles mentaux entre le 1er juillet 2005 et le 30 juin 2015 ont été appariés selon l’âge, le sexe, le degré de gravité au moment du triage, le statut socioéconomique et l'année de la visite, avec des témoins exempts de troubles mentaux. Les données sur la mortalité ont été obtenues de l'organisme responsable des statistiques de l’état civil, et ce, jusqu'au 31 décembre 2016 (suivi cumulatif : 74 390 personnes-années).

Résultats

Sur l'ensemble des patients sélectionnés, soit 6210 jeunes examinés pour des troubles mentaux et 6210 témoins appariés, 13 jeunes au total se sont suicidés (7,5/100 000 personnes-années) et 33 sont morts par suicide ou de cause indéterminée (44/100 000 personnes-années). La mortalité toute cause confondue était significativement plus basse dans le groupe de personnes ayant consulté pour des troubles mentaux (121,3/100 000 contre 214,5/100 000 personnes-années; rapport de risque [RR] : 0,54; IC à 95% : 0,37–0,78) que dans l'autre. Le temps médian écoulé entre la consultation initiale au SUP et le suicide était de 5,2 ans (intervalle interquartile : 4,2–7,3). Dans le groupe de troubles mentaux, le risque de mort par suicide ou de cause indéterminée était 3 fois plus élevé que celui enregistré dans le groupe des témoins appariés (RR : 3,05; IC à 95% : 1,37–6,77).

Conclusion

Bien que les jeunes qui consultent au SUP pour des troubles mentaux connaissent un risque accru de mort par cause non naturelle, leur risque général de mortalité est inférieur à celui enregistré chez les témoins exempts de troubles mentaux. La longue période qui s’écoule entre la consultation initiale et le suicide met en évidence la nécessité de donner des soins préventifs aux jeunes examinés au SUP pour tous types de troubles mentaux, et d'assurer une surveillance à long terme.

Copyright

Corresponding author

Correspondence to: Dr. Quynh Doan, 4480 Oak Street, Shaughnessy Building, Office B429, VancouverBCV6H 3N1Canada; Email: qdoan@bcchr.ca

References

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Keywords

Outcome of pediatric emergency mental health visits: incidence and timing of suicide

  • Joshua Lee (a1), Tyler Black (a2), Garth Meckler (a3) and Quynh Doan

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