Risk factors for presenting problems in child psychiatric emergencies.
OBJECTIVE
To determine demographic and school-related risk factors for psychiatric emergencies presented by children in a hospital emergency room serving the majority of an urban community.


METHODS
1,436 consecutive psychiatric emergency room visits for children younger than 16 years of age seen over a 10-year period were broadly classified by presenting problem as exhibiting either suicidal ideation, suicide attempt, oppositional-defiance, or aggression. The strength of association of these classes of presentation with demographic risk factors (age, sex, and minority status) and with the school day (weekday or weekend) and school season (school year or vacation) of presentation were modeled using logistic regression. The capacity of these presenting problems and risk factors to predict whether the child was hospitalized was also assessed.


RESULTS
Risk factors additively associated with suicidality included increasing age, being female, and presenting on weekdays and during the school year. Similar risk factors discriminated suicide attempters from suicidal ideators, and racial minority membership contributed additional risk for presenting with a suicide attempt. Risk factors associated with aggressive and oppositional presentation included younger age and male sex. Aggressive children presented relatively more often on weekends, and oppositional children presented more during school vacations. Independent risk factors for hospitalization included a suicidal or aggressive presentation, increasing age, and presentation during the school year. Hospitalization of children at the time of their initial visit protected against suicidality in subsequent presentations of the subset of children who had repeated emergency room visits.


CONCLUSIONS
These findings are consistent with previously reported risk factors for suicidal behaviors and externalizing disorders. The distinctive profiles of risk discerned for the different groups of emergency room psychiatric subjects also suggest some degree of specificity for the risk factors associated with each class of presenting problem. They also suggest the importance of home and school environments as being variably either risk or protective factors for these presenting problems. The findings also suggest a role for hospitalization in the prevention of future suicidality.
Peterson
B S
BS
Yale Child Study Center, New Haven, CT 06520, USA. bradley.peterson@yale.edu
Zhang
H
H
Santa Lucia
R
R
King
R A
RA
Lewis
M
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004637:Emergency Services, Psychiatric; D005260:Female; D006801:Humans; D008297:Male; D008913:Minority Groups / Q000523:psychology; D012307:Risk Factors; D012737:Sex Factors; D013406:Suicide, Attempted / Q000523:psychology*