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Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents

Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiat...

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Autores principales: Flury, Raffaela M., Brockhus, Lara, Müller, Martin, Henssler, Jonathan, Exadaktylos, Aristomenis K., Klukowska-Rötzler, Jolanta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9602638/
https://www.ncbi.nlm.nih.gov/pubmed/36293777
http://dx.doi.org/10.3390/ijerph192013196
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author Flury, Raffaela M.
Brockhus, Lara
Müller, Martin
Henssler, Jonathan
Exadaktylos, Aristomenis K.
Klukowska-Rötzler, Jolanta
author_facet Flury, Raffaela M.
Brockhus, Lara
Müller, Martin
Henssler, Jonathan
Exadaktylos, Aristomenis K.
Klukowska-Rötzler, Jolanta
author_sort Flury, Raffaela M.
collection PubMed
description Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. Methods: We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. Results: Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05–0.21, p < 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21–0.37, p < 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65–3.83, p < 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41–0.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p < 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44–0.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04–2.72, p = 0.035). Conclusions: Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group.
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spelling pubmed-96026382022-10-27 Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents Flury, Raffaela M. Brockhus, Lara Müller, Martin Henssler, Jonathan Exadaktylos, Aristomenis K. Klukowska-Rötzler, Jolanta Int J Environ Res Public Health Article Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. Methods: We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. Results: Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05–0.21, p < 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21–0.37, p < 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65–3.83, p < 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41–0.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p < 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44–0.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04–2.72, p = 0.035). Conclusions: Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group. MDPI 2022-10-13 /pmc/articles/PMC9602638/ /pubmed/36293777 http://dx.doi.org/10.3390/ijerph192013196 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Flury, Raffaela M.
Brockhus, Lara
Müller, Martin
Henssler, Jonathan
Exadaktylos, Aristomenis K.
Klukowska-Rötzler, Jolanta
Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents
title Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents
title_full Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents
title_fullStr Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents
title_full_unstemmed Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents
title_short Presentations to the Emergency Department for Problems Related to Mental Health: Sex Differences in Adolescents
title_sort presentations to the emergency department for problems related to mental health: sex differences in adolescents
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9602638/
https://www.ncbi.nlm.nih.gov/pubmed/36293777
http://dx.doi.org/10.3390/ijerph192013196
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