Article2010

Pediatric Mental Health Concerns in the Emergency Department

Paula Cloutier · Heather Maysenhoelder · Mario Cappelli · Clare Gray

62 citations0/0 files storedPediatric Emergency Care

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Psychiatric care and mental health services Child and Adolescent Psychosocial and Emotional Development Mental Health Treatment and Access

Abstract

OBJECTIVES: The main purpose of this research was to identify the perceived mental health (MH) concerns of caregivers and youths who present to the emergency department (ED) for MH services. The concordance between caregiver and youth perceptions and clinician ratings of MH concerns were evaluated. Expectations for the visit and perceived stressors that triggered the event are described. METHODS: This study consisted of 241 youths accompanied by caregivers presenting to the ED for MH concerns requiring crisis intervention services. The Caregiver Perception Survey and Youth Perception Survey were completed. These surveys were designed to identify the caregivers' and youths' main concerns and perceived stressors, as well as their expectations in coming to the pediatric ED. A chi analysis was conducted to determine the percentage of agreement of reported MH concerns between groups (youth, caregiver, and clinician), and kappa statistics are reported. RESULTS: Caregivers' and youths' top 5 concerns were suicide ideation, depression or mood, suicidal attempt, anxiety, and self-injury. The top 3 stresses identified by both youths and their caregivers were school, issues with parents, and problems with friends/peers. The top 3 expectations that were noted by caregivers were help/guidance for child, assessment/ evaluation/diagnosis, and health care professional resources. Concordance rates between caregivers and youths for the top 5 concerns ranged from 39.4% to 80.6%. Concordance rates between clinician rating of concerns (as requiring some or immediate action) and caregiver concerns ranged from 18.4% to 45.2%. Concordance rates between clinician and youth ranged from 11.1% to 59.4%. CONCLUSIONS: The top 5 caregivers and youths' main concerns for coming to the ED were similar. However, concordance between perceived concern and clinician assessment is low. Caregivers' expectations for coming to the ED highlight their lack of knowledge of referral procedures and MH services.

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References

1987Ontario Child Health Study 2007Sex Differences in Adolescent Depression: Stress Exposure and Reactivity Models 2003The Acceptability of Treatment for Depression Among African-American, Hispanic, and White Primary Care Patients 1999Age and Gender as Determinants of Stress Exposure, Generation, and Reactions in Youngsters: A Transactional Perspective 1999Quebec Child Mental Health Survey: Prevalence of DSM-III-R Mental Health Disorders 2002Parental Problem Recognition and Child Mental Health Service Use 2005Recognition of depression and psychosis by young Australians and their beliefs about treatment 2003Reliability of the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) Scale

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